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Moving along in a discussion of common problems women may encounter during nursing is a problem that can be very painful...but is easy to treat.

Topic #3: Thrush

(From Breastfeeding.com)

CAUSE:

Candida is a yeast-like fungus that grows in dark, damp places and is found in the birth canal of most women.  As a result, babies can become infected during vaginal birth.  While the infection is not serious, it can be very painful.  Sometimes a baby will refuse to breastfeed. 

SIGNS:

Baby: The baby can become infected during vaginal birth or while breastfeeding.  Signs of infection often appear 2-4 weeks after birth and include small, white patches in the mouth (thrush) and a bright, red rash in the diaper area.

Mother: The mother can become infected while breastfeeding.  Signs of infection include small red or white patches on the breast, red or purple nipples, and sharp, shooting pain in the breast. Frequently severe pain is the only symptom.  Some women also have a thick, white, vaginal discharge with redness, itching and burning in the vagina.

Father or sexual partner: Your partner can become infected during sex.  Signs of infection include a red rash on or around the penis and small white patches in the mouth.

RECOMMENDED TREATMENT:

Treat both mother and baby, even if only one has symptoms.  You may need to call your doctor as well as your baby's doctor.  Treat your sexual partner or any family member (siblings) with signs of infection.

Mother:

* Rinse the breasts with clear water after each breastfeeding.

* Your doctor will recommend one of the following medications: Nystatin (mycostatin), Monistat (miconazole),or Lotrimin (clotrimazole).  Put the cream on the nipple areola of both breasts after each breastfeeding for 14 days.

* If the pain is severe, use one of the above medications with cortisone (Mycolog, Lotrisone) for the first 1-3 days.  Gently massage the cream into the nipples.  It is not necessary to remove the cream before breastfeeding.

* Wash bras in hot, soapy water each day and rinse well. Boil all pump parts for 20 minutes each day.

* Wash your hands carefully before each breastfeeding and after each diaper change.

* Use condoms during sex.  Do not let your partner's mouth come into contact with your breasts.

Baby:

* Your baby's doctor will prescribe medication in liquid form, Nystatin (mycostatin) for the baby's mouth, and in cream form, Monistat (miconazole) or Lotrimin (clotrimazole) for the baby's diaper area.  The cream used on the mother's nipples also can be used on the baby's bottom.

* Paint the liquid on the inside of the baby's mouth (cheeks, gums, tongue, and roof) after each breastfeeding, using a clean cotton swab for each part of the mouth.  Do not put a used cotton ball back into the medicine bottle.

* Put the cream on the red rash in the diaper area during each diaper change.

* Boil all rubber nipples and pacifiers daily for 20 minutes. Replace with new ones after the first and second week of treatment.

Mother and baby:

* Expose your breasts and your baby's bottom to air and sunlight.  Avoid sunburn.

* Change breast pads and diapers frequently.  Do not use pads with plastic liners.

If the infection continues:

* If signs of infection remain after 14 days of treatment, the fungus may be resistant to the medicine in the cream.  You can choose a different cream and treat for 4-6 weeks or apply a 1 % solution of gentian violet once a day for 3 days. Using a cotton swab, paint the solution on the nipple and areola of both breasts and on the inside of the baby's mouth (cheeks, gums, tongue, and roof).  The purple solution will stain the skin and clothing, so wear an old bra and T-shirt. 

* Resistant infections that do not respond to creams or solutions can be treated with pills or tablets taken by mouth.  Your doctor may prescribe fluconazole (Diflucan), 100-200mg a day for 14 days.  You may want to avoid foods that support the growth of fungus, such as alcohol, sugar, dairy products, wheat, nuts, peanut butter, dried fruits, and fruit juices.  

PREVENTION:

* Wash your hands carefully before each breastfeeding and after each diaper change.

* Expose your breasts and your baby's bottom to air and sunlight whenever possible. Avoid sunburn.

* Change breast pads and diapers frequently. Do not use pads with plastic liners.

* Avoid the use of nipple creams and lotions that may encourage the growth of yeast-like fungus or bacteria.

* Air dry nipples after each breastfeeding whenever possible. 
 

Some resources in Colorado:

St. Francis Medical Center Lactation Support

Yampa Valley Medical Center Lactation Consultation

Mountain Midwifery Center

Breastfeeding class at Lutheran Adventist Center

See Part I and Part II of this article series!