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!
References- American Family Physician. “Fluconazole Is More Effective for Treating Thrush in Infants.” https://www.aafp.org/afp/2003/0415/p1818.html
- Frances-Morell, Jimi. “Diagnostic Value of Signs and Symptoms of Mammary Candidosis among Lactating Women.” https://journals.sagepub.com/doi/abs/10.1177/0890334404267226
- Newman, Jack, M.D. “All Purpose Nipple Ointment (APNO).” https://ibconline.ca/information-sheets/all-purpose-nipple-ointment-apno/
- KidsHealth. “Oral Thrush.” https://kidshealth.org/en/parents/thrush.html
I have been dealing with pain for the last 3-4 months. It was in the left with a milk bleb and had awful pain for a while. I contacted a lactation consultant and she suggested just pumping on the pain side for a few days and apply coconut oil. I feel that that helped on that side, it took a while. But then it happened on the right. A milk bleb and pain. When I do get it “normal” for a hot second, I then get alot of pain in the side and lower part of my breast and it feels clogged. The nipple area turns white sometimes and is very sensitive. She does not show any signs of thrush but I am wondering if this is what i am fighting.
This is my third breastfed baby and this time has by far been my least enjoyable journey. I am not sure what to do or where to go with it next.
Hi Ashley! So sorry you’re dealing with this. Maybe it would make sense to try OTC APNO and see if it helps? Just an idea.
Hi I feel like I have the symptoms of thrush and my doctor spoke to me over the phone and advised me to use Daktarin gel. My LO has a white tongue and white spots on her lips which is what led me to research what it could be and I discovered it could be thrush!
She also said any breastmilk I’ve pumped I can still give to my LO. I have pumped milk in the fridge ready for the next two days. Can I still give this to her?
I’m Not sure if that sounds right?
As long as you and LO are being treated, yes you can. 🙂
I had an awful yeast infection while exclusively pumping with my first baby. I noticed flakey, crusty nipples while pregnant and was told it was normal by my dr. Obviously it wasn’t. I think the belly balm I was using on my breasts mixed with having a bra on all day Created the perfect storm for yeast. It’s been two years since I stopped pumping and I’m pregnant again. I don’t think I every truly got rid of the yeast, my nipples have been flakey ever since I quit pumping. Now that I’m pregnant it’s even worse, white flakey patches on the nips and spreading onto the areola. While I was EP my first daughter I did rounds on diflucan, triple nipple cream and every thing I could Possibly find to relieve the infection but nothing worked. I eventually gave up pumping after 9 months. I want to start off on the right foot this time yeast free. Has anyone found a sure fire cure for this? Please help!
Hi Brianna – is the triple nipple cream APNO? I wasn’t sure.
Wafieka did you resolve the problem? I am having the exact same thing you described. I was diagnosed with thrush a few months ago and tried all kinds of things. A few weeks ago I was prescribed diflucan. My left nipple is back to normal and my right is significantly better but if LO eats frequently or a long time my right nipple burns. Please tell me you figured this out because I’m at my wits end and I’ve already put up with thrush for 4 months I can’t imagine another 6 months or more.
It’s terrible. I don’t feel any lumps and no sensitivity to cold. I wonder what this could be. Should I continue with the Gentian Violet to see if it helps? Or maybe try changing feeding positions? The nipple seems very fine now, if is only when he drinks for a long period of time. I have to admit that this nipple does look a bit different to my other, it’s more flat. Not sure if that matters. I remember with thrush I had terrible shooting pain but it’s not that type of pain, it’s more burning and stops after a while.
I’m so sorry you’re dealing with this! I honestly don’t know, but I wish I could help! Are you able to go back to the doctor?
My baby and i have been diagnosed with thrush just over two weeks ago. The doctor prescribed diflucan for two weeks, daktarin gel and a probiotic. Symptoms has improved a lot. My left nipples seems 100%, no pain whatsoever. My right nipple on the other still feels very sensitive when feeding, it burns a bit but no shooting pain. Lactation consultant had a look at them yesterday and ruled out thrush. Said it couldn’t be poor latch. Latch seems fine, first two feedings are fine, anything more causes the burning pain. It gets a lot more pink after feeds. Could my one nipple still possibly be infected? I started using Gentian Violet on that nipple lastnight as im a little desperate. What do you recommend I do? Your thoughts on the above would be highly appreciated. Thank you!
You poor thing! I’m so sorry you’re dealing this. My two thoughts are maybe you have a small bleb on the affected side? (Do you notice any lumps at all?) OR maybe you’re having nipple vasospasms? The changing color is what made me think of that. Are you having any sensitivity to cold at all?
My baby was diagnosed with thrush first at one of his check-ups (we didn’t notice the white mouth patches, and thought his red bum was just diaper rash); he was a few weeks old and developed it after a long course of antibiotics. He was put on liquid meds and I felt fine but as we were combo pumping/nursing back then, the very next day I got a shooting pain that went deep into my breasts; nursing was incredibly painful and pumping wasn’t much better.
Luckily, based on my baby’s diagnosis and my symptoms, my OB didn’t need to see me; she just called the Nystatin prescription in. (FWIW, even if you share the infection with your baby, the pediatrician can’t prescribe for you, it has to come from your doctor.) Within a week we were both all better. So glad that thrush hasn’t come back since!
I’m so glad to hear that it hasn’t come back!