Thrush is a common and harmless yeast infection in a baby’s mouth that can affect your nipples during breastfeeding. Yeast is a normal part of everyone’s digestive system, but when there’s an overgrowth, an infection sets in.
Please see our popular Audioboom about Thrush above and there are more details on the symtoms, causes and treatment below.
| Symptoms | Cause |
| Creamy white patches in Baby’s mouth, on tongue, gums, Inside of lips, which do not rub off. | Oral Thrush |
| Red, fiery, shiny sore nipples, Creamy white patches on nipple skin. Sore nipples that do not heal when Attachment is correct. | Topical Thrush |
| Intense pain during and between feeds, lasting up to an hour after feeds. Pain may shoot through breast. Nipple may be itchy or super sensitive to touch. | Systemic thrush in the breast |
What to do
Firstly, it is important to keep feeding and if you are using breast pads – try to ensure you are frequently changing them and using disposable pads while the thrush is present. Nursing bras should be changed frequently, hot washed and line or tumble-dried.
Thrush is often over-diagnosed, but most commonly develops if the mother is already prone to frequent bouts of vaginal thrush, and if mother and/or baby have been treated with antibiotics since the birth. Many women develop thrush after bouts of mastitis, especially if the mastitis is recurrent and has been treated with several lots of antibiotics. Check the positioning and attachment really carefully as the thrush may not be the only problem.
Treatment
Mum and baby must both be treated, even if symptoms are only apparent in one, and the treatment needs to continue for at least a week after all the symptoms have subsided.
The baby needs Miconazole (Daktarin) gel in his mouth 4x per day initially, reducing to 2x per day once thrush has visually disappeared. At present, this is only licensed for babies 4 months or older, younger babies are usually treated with Nystatin drops 4x per day. It is essential that all of the mouth is treated, not just the tongue. If the baby has thrush in the nappy area, this can be treated with Miconazole (Daktarin) cream, and bear in mind that he will have thrush in this area after it has tracked through his intestine from his mouth.
The mum’s nipples need to be treated with Miconazole (brand name – Daktarin) 2% cream, not the gel,(or clotrimazole 1% cream (brand name – Canesten), although anecdotally there is some evidence that more women experience allergic reaction to clotrimazole than to miconazole), and a small amount needs to be massaged into the nipple and areola (everywhere the baby’s mouth would touch) after every feed/expressing. It does not need to be washed off before feeds. If thrush deeper in the breast tissue is suspected, this may be treated with oral antifungal agents such as Fluconazole, which the GP must prescribe. Guidance about dosage etc is available from the Breastfeeding Network and it may be helpful for the mum to have a copy of the leaflet ‘Thrush and Breastfeeding’ which can be downloaded from their website, www.breastfeedingnetwork.org.uk
If thrush deeper in the breast tissue is suspected, this may be treated with oral antifungal agents such as Fluconazole, which the GP must prescribe. Guidance about dosage etc is available from the Breastfeeding Network and it may be helpful for the mum to have a copy of the leaflet ‘Thrush and Breastfeeding’ which can be downloaded from their website, www.breastfeedingnetwork.org.uk