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.