A Pain in the Boob: Breastfeeding and Thrush

Thrush is often the go-to suspect when a lactating mother has breast pain that’s not in a specific spot (which is likely a clogged milk duct) and is not accompanied by a fever (which likely mastitis). Here is what breastfeeding thrush is, plus the symptoms, how to treat it, and how to prevent it in the future.

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What is breastfeeding thrush?

Thrush is a fungal infection – also known as candida – that can cause discomfort for breastfeeding mothers and their babies. The bacteria that causes thrush exists naturally in our digestive system, but under certain circumstances, candida can overpopulate in your body and cause an infection known as a yeast infection.

This can happen in different parts of the body – for example, vaginal yeast infections, yeast diaper rash, and jock itch. And, in instances of breastfeeding thrush, it can appear in your nipples and your baby’s mouth.

What causes thrush while breastfeeding?

There are a few things that can make you more likely to get thrush. The most common issue is a weakened immune system, due to either illness – particularly diabetes – or stress. The lower amounts of “good bacteria” in the intestinal tract can result in an imbalance in bacteria, resulting in candida overgrowth.

People taking antibiotics are also more likely to get thrush, since antibiotics can kill both good and bad bacteria, creating this imbalance.

What are the signs of thrush? How do I know that I have it?

Your doctor will need to diagnose it to be certain. According to one study, the most common symptoms of thrush are:

• A burning pain in your nipples or breast in general
• Breast soreness
• Shiny skin on nipple/areola
• Flaking skin on your nipple/areola
• Stabbing breast pain
• Non-stabbing breast pain

If you have both skin changes (shiny or flaky nipple/areola) and breast pain, or both types of skin changes (shiny AND flaky nipple/areola), thrush is likely.

Often, both breasts are affected, and in many cases, when a breastfeeding mother has thrush, so does her baby. The most common symptoms are a white patches in the baby’s month. Some babies also get a yeast diaper rash.

Can I get thrush if I’m exclusively pumping?

Yes. As discussed above, thrush is a result of a bacterial imbalance, and contact with your baby is not necessary for it to occur.

(As an analogy, it’s also possible to get a vaginal yeast infection without being sexually active.)

I have thrush. What should I do? How is thrush treated?

First, you will need to go to your doctor or your baby’s pediatrician to confirm the thrush diagnosis in order to get treatment prescribed.

Thrush Treatment for You

Thrush is most often treated with with an anti-fungal cream or ointment. Nystatin is very commonly prescribed, though it isn’t always effective.

Another option, recommended by breastfeeding expert Jack Newman, is what he calls APNO (all-purpose nipple ointment). It combines an anti-fungal, an antibiotic, and a steroid. To use it, you will need a prescription from your doctor and a compounding pharmacy to mix it for you.

You can also make a version of OTC APNO by mixing ingredients you can get over the counter in a pharmacy.

If creams are not effective, and thrush has been definitively diagnosed, your doctor may prescribe an oral anti-fungal medication (often Diflucan).

Normally, symptoms should improve within a few days, but it will take longer for the infection to completely clear. Make sure that you finish the entire course of medication prescribed, versus stopping when you start feeling better.

Thrush Treatment for Baby

If your baby has thrush, he or she will also need be treated. Often, a pediatrician will prescribe a gel or a liquid antibiotic. Again, your baby should take the entire course of the medication.

Can thrush affect your milk supply?

It’s possible. The pain caused by thrush can be stressful; stress can inhibit letdown.

Your best bet for maintaining your milk supply is to manage your pain as best you can with pain relievers that are considered safe for breastfeeding, and to continue your normal breastfeeding and/or pumping schedule.

Is it okay to feed my baby milk I pumped when I had thrush?

While you and your baby are being treated for thrush, it’s totally fine to give your baby your milk. It’s also fine to give your baby any milk that was pumped before you had thrush.

The tricky question is what to do with any extra milk that is pumped while you had thrush, after the thrush has cleared. It’s thought that feeding your baby milk you pumped when you were infected could lead to your baby (and then you, if you nurse or comfort nurse) getting reinfected. This is true even if the milk is frozen, because freezing only deactivates yeast; it doesn’t kill it.

If you can’t bear the idea of dumping your frozen “thrush milk” (which is totally understandable!), one option is to heat the breast milk to boiling to kill the yeast. (Yeast is killed at about 140 degrees.) Here is a step-by-step process for how to pasteurize breast milk at home.

I never want this to happen to me again. How can thrush be prevented while breastfeeding?

It’s possible to reduce your chances of getting thrush again. Here are four things that you can try.

• Add a probiotic (like yogurt) to your diet. This can help keep your gut bacteria in better balance and prevent candida from overpopulating.
• Change your breast pads frequently! If you (like me), leak a lot and don’t change your breast pads, your bra becomes an inviting wet, sugary environment for yeast.
• For the same reason, it’s a good idea to change your nursing bra often, too.
• Hand washing may also help you avoid getting thrush again, as it can keep you from getting sick and your immune system from being weakened.

If you suspect you and your baby may have thrush, you’ll want to see a doctor as soon as possible to get relief. And if you’ve had thrush, tell us about your experience!

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