When a mother has been nursing comfortably for several weeks or months, then suddenly begins to have sore nipples, she may have a yeast infection (candida albicans), also known as "thrush." The pain from thrush does not diminish after latch-on; in fact, sometimes it continues even after the baby has stopped nursing. The nipples may have a red or dark pink irritated appearance, or look very dry, and the mother may report that they are itchy or have a burning sensation. However, thrush might be present without any external symptoms at all. Another common symptom of thrush is shooting pain deep within the breast after or between feedings. Some mothers report it as pain in the area under their arms (the axilla); others describe a pain shooting through the chest wall toward the back. If you are having these symptoms, then you and your baby both need to be treated.
Babies can have thrush in their mouths, as well. It looks like little white patches inside their cheeks and lips or on the roof of the mouth. Some babies don't have any symptoms in their mouths, but have a red, angry looking diaper rash that is caused by candida. Whether the baby has any symptoms or not, however, both mother and infant must be treated to prevent the recurrence of thrush.
One of the oldest and quickest (and messiest) treatments is gentian violet. Dip a q-tip in the gentian violet and swab the inside of your baby's mouth right before you nurse. After you nurse, you will have gentian violet on your breasts as well. If the nipple and areola are not covered, use a q-tip to make sure they have sufficient gentian violet. Doing this once a day should resolve the problem within a week. Conversely, you can apply the gentian violet to your nipple and areola just prior to nursing, and baby will get the benefit as well. However, may mothers don't want the mess of gentian violet. Thankfully, there is another great option.
Dr. Jack Newman recommends an All Purpose Nipple Ointment which must be compounded by a pharmacist. If your physician is unfamiliar with this compound, you can send the link from Dr. Newman into his office. The ingredients include the following:
- Micanazole (flucanazole may be substituted)
Occasionally the yeast infection will be intraductal which requires a systemic treatment. Flucanazol (Diflucan) is widely recognized as an effective treatment for systemic yeast. An initial dose of 200-400 grams followed by at least 2 – 3 weeks of 100 grams a day has been shown to provide long-term relief from candidiasis. The treatment must continue until you have been symptom free for 7 days.
No doubt about it, yeast is very frustrating. You will need to boil all your baby's pacifiers and nipples to make sure you kill all the yeast. Moms who take immediate action and stay on top of their yeasty beasties can beat this annoying problem!