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Thrush in the baby is becoming increasingly common, especially if mum and/or baby have had antibiotics.
It is essential to treat mum and baby simultaneously, even if mum has no symptoms, or the baby will not be treated effectively and thrush will keep recurring, and mum’s nipples/breasts may become infected too.
Miconazole gel is much more effective than Nystatin suspension to treat the baby.  It should be applied 4x per day until the thrush is no longer visible, then 2x per day for a further week.  It is best applied to every part of the baby’s oral mucosa (using a pea-sized blob) by mum using her finger tip, with clean hands and short nails.  It should NOT be applied via the tip of the mum’s nipple before a feed – this is more likely to cause choking or gagging, and this inappropriate use is the reason why the licensing guidance for Miconazole gel was changed in June 2008 (see page 20 of the GP handbook)
Miconazole 2% cream (not the gel used for the baby’s mouth) should be applied sparingly to the nipples and areolae after every feed, again for at least 1 week after visible thrush has gone.  This does not need to be washed off the nipples before feeding.
Other self-help tips can be read in the ‘Breastfeeding and Thrush’ leaflet, downloadable free from www.breastfeedingnetwork.org.uk

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