As a lactation consultant one of the more tricky questions to answer is “do I have thrush?” “Why?” you may well ask. Normally thrush presents as a white, furry coating that bleeds when rubbed. You’d think it would be easy to see - in fact it sounds hard to miss! However position it with nipples and the story changes. Breastmilk contains many properties that fight bacterial, fungal and other pathogens. “Lactoferrin present in human milk can inhibit growth of Candida albicans, thereby limiting the ability to detect yeast infections.” This can mean that the thick white coating isn’t visible and the other symptoms could also be because of something else.
Thrush is a fungal infection. Our bodies house thrush, or candida albicans, to give it it’s proper name, on our skin, in our mouths, digestive systems and vaginas. Like most things, the problems arise when we get too much of a good thing. When certain conditions present these fungi can multiply and cause us problems. An overgrowth of thrush can occur when there is already damage to the skin of the nipple itself, if the mother or baby have had a recent course of antibiotics or the mother is on oral contraception or steroids. Babies that use dummies and bottles also show an increased likelihood of thrush.
Both mother and baby can have thrush and even if only one is presenting with symptoms it is recommended that both are treated.
In the mother thrush may present with
Your baby may have one or more of the following symptoms:
Seeing your IBCLC can help rule out some of the other things that could be the cause of pain and poor feeding . Such things could be latching and positioning issues, vasospasm, or tongue mobility issues for the baby. It is always best to work through a feed in its entirety with your lactation consultant.
Seeing your GP to rule out eczema, psoriasis, or other skin issues and the possibility of a subacute mastitis is also advisable. Diabetes or anaemia could be contributing to the problem and your doctor will advise if this is so.
If thrush is the culprit what next??
Both mum and bub need to have treatment. Thrush loves a wet and moist environment, so consider areas such as under the arms, under the breast or any of the creases in your babies neck, arms, between fingers and toes, and the groin etc as potential sites for an overgrowth of yeast.
Medical treatment is always best discussed with your doctor. They may use a combination of oral medication for your baby such as daktarin gel or nilstat drops. It may be advised that mother use a topical anti-fungal ointment or cream on her nipple and areola. Preparations such as miconazole and clotrimazole also inhibit some bacterial growth as well. Sometimes an oral tablet may be prescribed. Continuing the medical treatment for 10-14 days past the last signs of thrush is recommended. However the indiscriminate use of treatments is contributing to a build up of resistance to effective and current medical treatment, hence the need for an informed diagnosis.
Other helpful things to try include:
Pain can impact on the mother's enjoyment of the feed. Ideally make sure that the baby has optimal positioning at the breast and a deep latch. Taking over the counter pain medication as directed may help with pain. Using ice pre-feeds to help numb the sore nipples may also help.
Decreasing the likelihood of getting thrush is possible. Aiming for a nutritious diet, adequate rest, avoiding if possible, dummies and bottles, working towards a comfortable and deep latch when baby is feeding can all help,
Get help early.
How to handle the summer heat
Today in my neck of the woods, records might be broken. The heatwave prediction is for the temperature to rise above 4o degrees! It is important to stay hydrated and whilst for us that might mean frequent drinks of cold water, many mums wonder about how to ensure their babies are well hydrated. Thankfully our breastmilk is still the perfect balance of water and nutrients for our children. For babies under 6 months, exclusive breastfeeding is still the recommended way to ensure babies receive what they need. If your baby is older, then in addition to more breastfeeds water can be offered from a cup.
You may notice that your baby asks to feed more frequently but for a shorter duration when the weather is hot. Breastmilk is always changing to suit the baby's needs. When your baby begins their feed the milk available is less fat rich and is more watery which quenches your baby's thirst. As the feed progresses the fat content naturally increases. If your baby is having quick frequent feeds, they are more likely to be getting the lower fat milk, thus quenching their thirst.
A reassuring indication of a well hydrated baby can be summed up by saying, "what goes in, must come out."
When the mercury soars the idea of snuggling up on the sofa with our little ones may feel less than appealing.
Here are some tips to help beat the heat:
"Deep summer is when laziness finds respectability" - Sam Keen
Touch comes before sight, before speech. It is the
first language and the last, and it always tells the
truth Margaret Attwood
Our babies crave touch. It’s not a want. It is a need. Without touch, babies don’t thrive. Babies that don’t receive enough loving touch are at a higher risk for behavioural, emotional and social problems as they grow up. Yet how often do we hear, “Put the baby down”, “You’ll spoil the baby”, “You’re making a rod for your own back”. All too often we are bombarded with baby paraphernalia that encourages us to put our babies elsewhere: car-seat, pram, swing, bassinet, or the cot, and yet from a baby’s perspective being separated from its mother is life-threatening.
Babies need to be touched.
Despite knowing this throughout time, the Victorian era saw families move away from this. The invention of the pram, the idea that children should be seen and not heard and the outsourcing of baby feeding through the growth of the formula industry have had a lasting impact that continues even today. It took some rather distressing studies by Harlow in the 1930s for the tide to slowly begin to change.
By all means follow the link to read about the studies, but I shall summarise the results here by saying that Harlow found there was far more to the mother-infant bond than an exchange of milk. He found that it was the physical contact that was needed for the optimal psychological development of baby monkeys. Harlow concluded that “nursing strengthened the mother–child bond because of the intimate body contact that it provided” and the hormonal cascade it initiated. “Touch was more important than food to motherless monkeys!”
Researchers Drs Mason and Berkson in their monkey studies, demonstrated that touch and movement were both required for normal brain and social development. They demonstrated that only the monkeys who were raised with both touch and motion had normal brain development, demonstrating the importance of maternal holding and carrying throughout infancy for ongoing brain development.
A 2017 study also looked at the effects of a ‘nurturing touch’ on a baby’s development. The type of touch that this encompasses may include massage, stroking, holding, carrying and skin-to-skin contact. Breastfeeding fulfils many of these roles. Dr Maitre showed that an ‘intentional supportive touch’ is “absolutely crucial to babies’ developing brains.”
Ideally, positive, nurturing touch begins after birth when a baby is placed skin against skin with the mother. This becomes the catalyst for a hormonal dance that mammals have perfected over millennia.
Hormones known to influence attachment behaviours are increased by skin-to-skin contact. Babies in contact with their mothers are assisted in regulating their heart and with the mother’s body warming in response to a baby that is cool and falling as the baby’s temperature rises. This in turn helps a baby maintain its blood sugar level as the mother’s body continues to assist the baby with these functions meaning that calories can be used for growth instead. The American Academy of Pediatrics recommends skin-to-skin contact should continue for at least the first three months and even beyond. They suggest snuggling for around 60 mins at a time.
So cuddle, love and hold your babies. Maybe at times it will feel that they will never be happy anywhere else. Don’t despair, as Dr Maitre says, “Gentle touch, especially skin on skin, is just one of the most important things parents can do for their babies.”
“A touch communicates what can't be said.”
The birth of a baby is a joyous event. Everyone wants to hold the baby. Family and friends arrive with gifts, love and that double-edged sword known as "advice". Babies are allowed to be babies. We acknowledge that they are learning new skills and that to meet their potential, an environment infused with love and acceptance is key. We don't judge them for not knowing how to breastfeed perfectly in the days after birth. We don't gossip about their need for nappies and inability to dress themselves. We gently step in, aiming to anticipate their needs based on our growing understanding of their every squirm and squeak.
Well every baby's birthday is also the birth of a new mother. As our babies are born, we too a born into our new role, our new purpose our very new raison d'etre. The psychiatrist and author, Daniel Stern explains it by saying "Giving birth to a new identity can be as demanding as giving birth to a baby."
However all too often women feel underprepared. The structure of our society means that for most women the peccadillos of a new baby are unknown. This can leave women feeling unsure of themselves, lost amongst the clamour of cooing baby-focused relatives. All too often once the novelty of the birth has worn off, and partners are back at work and family and friends have resumed their own busy lives, who is left to mother the mother? Where is her environment of love and acceptance, her cocoon of safety and support while she practises her skills and builds her confidence?
What can we do to help mother the mother? Two researchers, Luthar and Ciciolla say unconditional acceptance by friends, feeling comforted when needed, friendship satisfaction and authenticity in relationships play essential roles in keeping mum happy, and thus grounded in her tasks with child rearing and development. Not surprisingly women need to feel seen and loved for themselves not for the tasks they do or the job title they hold, even if that title for now is predominantly, MOTHER.
It isn't surprising to read that according to their research, Luthar and Ciciolla found that, "just as unconditional acceptance is critical for children, so it is critical for mothers who must provide it. Mothers, like children, benefit greatly when they know they have reliable sources of comfort when in distress." In other words, New-born mothers need exactly what their newborn babies need, love, acceptance and a safe and non-judgemental space to be imperfect.
So in addition to meals, company, help with chores and older children, excitement and a dozen new baby outfits, mothers need warm and loving arms to hold them whilst they grow into their new role as mothers.
We often hear that breastfeeding is "natural". And perhaps in days gone by women did find adjusting to feeding a new baby easier. So why does it seem so hard for us? "Why is it so hard for me? "
Well the world we live in has changed. No longer are we living in close communities where we are participating in the raising of children from a young age. We don't see other women feeding their babies. These days there is a whole movement intent on having mothers stay hidden in case a breast or nipple is seen out in public with a hungry baby trying to feed. But that is a discussion for another day. The learning that once took place throughout our lives is suddenly thrown at us once the baby is placed on our chests after birth. The pressure to have breastfeeding sorted before discharge anywhere from 4 hours to maybe 4 days post delivery is daunting to say the least.
Learning about breastfeeding before your baby is born, without the stress of a crying infant and a sleep deprived brain can set you up for a better and more enjoyable breastfeeding experience.
Create a positive mindset