Thrush is a term used to describe the overgrowth of yeast in a baby's mouth (although anyone can get it). It's characterized by white patches on the tongue or inside the cheeks. While thrush is unlikely to bother your baby, and it is not harmful, it can be passed to a nursing mother and may become painful, itchy or uncomfortable, especially during breastfeeding.
How to Tell If You Have Thrush
In a baby, it's generally easy to see if he has thrush. Look for milky white spots along the tongue or sides of the cheek. If they are persistent and do not wipe off, your baby might have thrush. However, in mom, it's a little harder to tell. According to a Breastfeeding Essentials guide, you may have an overgrowth of yeast on your nipples or even in the milk ducts if you experience the following symptoms:
- Intense and shooting pain in the breast after breastfeeding
- Nipples that are itchy
- Cracked nipples that may appear flaky
- A burning pain
- Pain that doesn't go away if you position the baby differently or fix his latch
- Pain that is deep inside your breast rather than on the surface
- Onset of pain after you've been breastfeeding for a while with no pain
Related Symptoms
Sometimes, particularly if you and baby have had a rocky start to the breastfeeding relationship, it's not readily apparent that thrush may be causing your issues. While the following symptoms and risk factors do not mean that you definitely have thrush, they may go along with a thrush infection. If you experience any of these symptoms in conjunction with burning breast pain or itching while you're nursing, you may want to see your doctor to rule out thrush as the culprit:
- A vaginal yeast infection in the mother
- If baby has a diaper rash that does not respond to over-the-counter creams
- If baby makes a clicking noise while breastfeeding
- If baby refuses or pulls off the breast
- Excessive gassiness (caused by a buildup of yeast in the gut)
According to Cigna Health, most cases of thrush are diagnosed by just looking at the white splotches in a baby's mouth. Your doctor may also ask you a few questions about you and your baby's health history to see if you have any other of the issues that make you more susceptible to getting thrush.
Other Possible Causes
While the most common symptom of thrush in breastfeeding mothers is the burning pain in the breasts and nipples, it is important to note that not every breast pain is caused by this pesky overgrowth. While you should always go to your doctor if you suspect an issue, you may first want to examine your baby's latch and positioning while at the breast. According to Best for Babes, a breastfeeding advocacy and information website, poor latch and improper positioning will also cause breast pain and cracked nipples.
Treating and Controlling Thrush
There are a variety of options for treating thrush. However, it's important to note that many breastfeeding experts, including The Breastfeeding Network (page 4), recommend treating the baby and the mother simultaneously even if one does not have symptoms. You can treat the yeast infection in a variety of ways.
Prescription Medication
According to HealthyChildren.org there are a few prescription medications that your doctor might prescribe to treat you and baby depending on your (or baby's) symptoms. La Leche League International (LLLI) notes that one effective treatment protocol is to give the mother Nystatin cream for the nipples and the baby oral nystatin for oral thrush.
If you do apply Nystatin cream to your nipples, pediatricians typically recommend that you not nurse for at least 10 minutes after applying the medication. Many moms just wait to apply the medication until after they have finished breastfeeding.
Gentian Violet
Many practitioners, including Dr. Sears and Dr. Newman (of the International Breastfeeding Center) note Gentian Violet as an option to treat a stubborn case of thrush. Studies have shown that the remedy has anti-fungal properties. However, it is very messy to use as it will stain your clothing, the baby's mouth and your nipple.
According to Dr. Newman, it should be used in a 1% concentration (so if you have 2% concentration, add an equal amount of water to get 1%). One common sense approach to using it and minimizing the mess is to apply the tincture to your nipple before bed and right before you feed baby. This way, both your nipple and the baby's mouth are treated, and it doesn't matter if you both are stained purple for a while.
Good Hygiene
While good hygiene alone will not prevent or treat thrush, it's an important part of a holistic approach to dealing with it. You can help keep it at bay by:
- Changing your nipple pads regularly. Yeast thrive in warm, moist places - like a nipple pad.
- Wash and change your bras daily. Use a separate bra for daytime and nighttime wear.
- Sterilize baby's pacifiers or other things he might put in his mouth regularly (i.e. toys, bottle nipples, etc.)
- Wash and sterilize breast pump equipment properly
- After you baby finishes feeding, let your nipples air dry so that you're not putting any moisture in your bra.
Managing Breastfeeding During an Episode of Thrush
Having a case of thrush is a figurative pain and sometimes a literal one too, but it doesn't have to disrupt the breastfeeding relationship. You can continue to breastfeed while you or the baby is being treated, but managing the pain can be difficult. However, there are a few things you can do to help get over this common hump.
Ibuprofen
Your physician may suggest Ibuprofen to help relieve the pain so you can cope with feeding your baby, but this should only be taken under the direction of a medical professional. Ideally, take it about 30 to 60 minutes before you are set to feed your baby so that it has time to take effect.
Therapeutic Breast Pads
You may see these under a variety of brand names including Boob-ease or Soothies or simply "breast gel packs" or "breast therapy pads." The pad is shaped like a regular breast pad, but it has gel or something on the inside that you can cool down. Applying a cold gel pad to the breast can significantly help the pain subside if you are experiencing burning after nursing.
A Treatable Nuisance
It's important to remember that while thrush is a nuisance to deal with, it's not harmful to your baby or you. You don't have to stop breastfeeding to cure it, and most cases will clear up relatively quickly with proper treatment.
If you suspect thrush, consult your child's pediatrician so that you can treat the problem immediately. Remember too that if pain persists, you should contact a lactation consultant for an evaluation.
