Nipple Thrush - Not such a "fungi" after all!

Nipple Thrush

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

• Shiny, flaky skin
• Burning nipple pain
• Painful breasts
• Itchy nipples
• Stabbing pain in nipple or breast  that doesn’t improve with an improved latch
• History of antibiotics, steroids, nipple damage

Your baby may have one or more of the following symptoms:

• White patches inside his cheeks or on his tongue or gums. These can look like leftover milk. A good trick is to try to wipe them off with a moistened washer. Thrush will leave red sores which may bleed. 
• Your baby’s mouth may be uncomfortable or painful, making him fussy during and between feeds. He may slip on and off the breast and may make a clicking sound. 
• Nappy rash

Things get trickier when we talk about how best to treat thrush. Research presents us with conflicting views on the best way to do this. A study from 2017 showed low incidence of thrush when milk samples were tested. Instead they found the cause of the pain to be due primarily to a bacterial infections. This study suggests that for a more accurate diagnosis milk samples should be taken and assessed. 

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:

• Washing all clothing and fabric that comes in contact with you or your baby in HOT water with anti-fungal detergent including any cloth nappies and dry in the sun.
• Rinse nipples with a vinegar solution (1 tablespoon of apple cider vinegar to 1 cup water) or baking soda (1 tablespoon per cup) after each feed. Mix a new solution each day.
• Use of dummies and bottles does increase the likelihood of thrush so be mindful of good hygiene if using these.
• Boil pacifiers or artificial teats/nipples daily and replaced frequently.
• Anything else that goes into your baby’s mouth, (other than your breast or a finger) washed in hot soapy water daily.
• If using a breast pump be meticulous with washing and disinfecting of parts.
• Ensuring good hand hygiene by using a non-antibacterial hand soap as antibacterial soaps kill good and bad bacteria and you are trying to reestablish a healthy balance.
• Wash hands before and after feeding your baby and whenever they have contacted possible infected areas eg after nappy change
• Coconut oil is known for its antifungal and antibacterial properties. Used in conjunction with miconazole cream for the mother, gel for the baby four times a day interspersed with applications of organic coconut oil on the nipples works well. 
• Trim the baby's fingernails to prevent Candida being harbored under the nail and transferred to the mouth.
• Keep and use separate towels for each person in your family
• Ensure nipple area is kept clean and dry. Discard moist breast pads regularly and consider leaving breasts exposed after feeds to allow nipples to dry. 
• It may be worth considering a probiotic, research is mixed, but it won’t hurt.
• If the mum is rundown or stressed, she will be more susceptible to an overwhelmed immune system. Ensuring a healthy diet with an abundance of nutrients and vitamins helps keep her body working at it’s best

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.