Could We Have Thrush?
Thrush to indicate that within the baby's mouth and yeast to indicate
that on the mother's nipples or within her breast is a fungus that
thrives on milk on the nipples, in the milk ducts, and in the baby's
mouth. Thrush and yeast can both be present in non-lactating women and
men, too. The medical term for this condition is candidiasis.
Predisposing Risk Factors for Yeast
All of the following have been known to increase mother's and baby's risks for yeast:
- Vaginal yeast infection in the mother either during pregnancy or
shortly before or during time that other yeast symptoms occur. Mothers
who have a history of frequent vaginal yeast infections are also more
- Antibiotics administered to the mother during pregnancy, during
labor and delivery, or shortly before or during the time that yeast
symptoms occur. Please note that antiobiotics are always administered
when a cesearean section is performed or when GB Strep is diagnosed or
is being treated preventatively prior to delivery. A history of
long-term or frequent antibiotic use in the mother is also a
predisposing factor for yeast.
- Antibiotics administered to the baby
- Long term or frequent use of steroids in either mother or baby
- Nipple trauma such as cracks. The breakdown of the skin allows
for the entrance of yeast as well as bacteria. Cracking is not normal.
This type of nipple trauma should be addressed quickly by a lactation
- Maternal use of oral contraceptives containing estrogen
- Allowing damp nursing pads or bras to stay up against nipple tissue for long periods of time
- Using plastic lined nursing pads which prevent good air flow to the nipple area
- Pacifier use in the baby
- Excessive consumption of dairy products, artificial sweeteners, or sweets in the mother
- Diabetes in the mother
- Anemia in the mother
Signs and Symptoms
- intense nipple or breast pain that occurs from birth, lasts
throughout the feeding, or is not improved with better latch-on and
- sudden onset of nipple pain after a period of pain-free nursing
- cracked nipples
- nipples that are itchy and/or burning and that may appear pink or red, shiny, or flaky and/or have a rash and tiny blisters; nipples may also appear normal
- shooting pains in the breast during or after a feeding if the yeast has invaded the milk ducts
- nipple or breast pain with correct use of an automatic electric breastpump
- a vaginal yeast infection
- diaper rash that does not respond to typical rash ointments (see this picture for one representation of a yeast diaper rash)
- creamy white patches that cannot be wiped off on the inside of
the mouth, along the inside of the gums, inside of the cheeks, roof of
mouth, throat, or tongue
- a shiny or "mother of pearl" look on the inside of the mouth
- breast refusal, pulling off breast, or a reluctance to nurse due to mouth soreness
- repeated clicking during nursing
- excessive gassiness due to the yeast's invasion of the gut
The baby may also be without visible symptoms.
How Diagnosis Is Made
There really isn't a definitive way to diagnose yeast in the mother.
Often it is visible in the baby's mouth but may not always be so
obvious, as in a persistent click, repeated pulling off the breast, or
excessive gassiness. Diagnosis is best made after taking a thorough
history of both mother and baby. If there are things in the history
that predisposed the nursing couple to yeast and there are symptoms
consistent with yeast it is appropriate to begin treatment. If the
mother and/or baby begin to respond to yeast treatment then the
diagnosis is confirmed. Treating with yeast medications, especially
those that are topical, usually cannot hurt and can only help if yeast
is suspected. If symptoms do not respond to treatment within 4 days,
the treatment should be reevaluated. Failure to improve with aggressive
treatment requires a look at possible other causes. Sometimes a
bacterial infection can be present either alone or with yeast.
Courses of Treatment
Please be advised that some doctors will not treat mother and baby
simultaneously if one is free of symptoms. However, the breastfeeding
literature states that this is crucial to complete healing. Not doing
so increases the risk of reinfection.
Treatment in both mother and baby should continue for at least 1-2
weeks after all symptoms are gone. All of the following remedies are
considered compatible with breastfeeding and do not necessitate any
cessation of the nursing relationship.
When yeast is ductal, causing shooting or stabbing pains within the
breast, often topical treatments (those applied to the nipple area) do
not penetrate well enough to affect the overgrowth of yeast in the
ducts. Almost always, systemic (the entire body) treatment with an oral
medication/supplement is necessary. Occasionally, treatment with
Gentian Violet (see below) will reach the milk ducts.
Many physicians will prescribe oral Nystatin drops as the first course of treatment for the baby's mouth. This should be done even if the baby is asymptomatic
and the mother is showing symptoms to prevent cross contamination. Half
the dosage should be dropped into each side of the baby'mouth after a
feeding so that the medication is not washed away with nursing. A
cotton swab may be used to apply the medication to the other areas of
the mouth using care not to insert a swab back into the bottle that has
touched the baby's mouth. A clean swab should be used each time it's
necessary to dip into the bottle or a small amount may first be poured
out into a cup and any amount left over discarded after that
application. The medication should be applied after all daytime
feedings. The directions that come with the prescription may say to
only use the Nystatin four times a day, but because yeast grows back in
about 90 minutes, it is important to apply the Nystatin much more often
For mother Nystatin cream may be recommended first. The doctor can
prescribe this as well. It should be rubbed into the nipples and
areolae after every feeding once the area has been rinsed with cool
water and pat dried. It does not need to be washed off before nursing.
Nystatin pills are sometimes recommended if symptoms still persist
after a full course of treatment lasting two weeks or if a secondary
yeast infection of the milk ducts causing shooting pains in the breast
during or after a feeding is present.
Because yeast seems to be becoming highly resistant to
Nystatin, it is helpful to know of other routes of treatment. Some
practitioners recommend foregoing the use of Nystatin completely and
going on to other methods because more times than not it is not
Over the Counter Antifungal Creams:
Several over the counter antifungal creams can be used in place
of Nystatin for nipple application. These include Lotrimin AF, Micatin,
or Monistat 7. These are all available at the local drugstore. As with
Nystatin, the creams should be applied to the nipple area after a
feeding and once the area has been rinsed with water and pat dry. The
excess only needs to be wiped off with a dry cloth prior to nursing.
These creams can also be applied to the baby's bottom when a yeast
diaper rash is present. Often the best clue that a diaper rash is due
to yeast is that it does not respond to regular rash ointments over a
period of a few days but responds rapidly to an antifungal cream.
All Purpose Nipple Ointment:
This nipple ointment formula was developed by Dr. Jack Newman.
It consists of two antifungals, an antibiotic, and a steroid. The three
ingredients are mixed (compounded) together by a pharmacist to make a
cream. This cream is then applied to the nipples after each feeding
once the nipples have been rinsed with cool water and pat dry. A doctor
will need to call this in as a prescription. The ingredients are as
- 100, 000 units/ml Nystatin (15 grams)
- 0.1 % Betamethasone (15 grams)
- 2% Mupirocin ointment (15 grams)
- 10% Clotrimazole (vaginal ointment) (15 grams)
Some pharmacies do not stock the Clotrimazole and if this is the
case, it is the one ingredient that can be left out if necessary.
APNO (All Purpose Nipple Ointment) works especially well with
Gentian Violet (see below). It can be applied after all feedings except
the one when the Gentian Violet is used.
Acidophilus is the good bacteria that normally lives in the body
keeping the overgrowth of yeast in check. Adding more of this to the
diet when yeast is present or preventatively when antibiotics must be
taken is an effective way to regrow the good bacteria. Because it does
not kill yeast it is not an overnight treatment but a very important
part of total treatment.
Acidophilus can be purchased at most drugstores. Some
pharmacists refrigerate it so it may be necessary to ask for it. While
taking antibiotics or while treating yeast, the dosage is two capsules
three separate times a day. Acidophilus may also be given to the baby
at one capsule three times a day. The capsule can be broken open and
the baby allowed to suck it off a clean finger or it can be put into
the baby's food. It should be taken while on antibiotic therapy and for
1-2 weeks thereafter. If using during an active yeast infection, it
should be taken for 1-2 weeks after all symptoms are gone.
Garlic is known to be a powerful yeast fighter. Consider adding
4-6 capules/tablets of odorless garlic to your diet during a yeast
outbreak and for 1-2 weeks after all symptoms are gone (see "Pat Gima's
Yeast Treatment Plan" below for brand suggestions).
Echinacea is an immune system boosting herb. When there is a
yeast overgrowth the immune system is somewhat compromised. Consider
adding this herb to your diet during a yeast infection and for 1-2
weeks after all symptoms are gone (see "Pat Gima's Yeast Treatment
Plan" below for more specific directions).
Yeast cannot survive in an acidic environment. Vinegar rinses of
both the nipples and/or the baby's bottom often bring relief and help
slow the yeast growth. For either, mix a half vinegar, half water
solution. Apply the solution to the nipples with a cotton swab after
rinsing the nipples after a feeding and before applying any creams. The
solution can be applied to the baby's bottom with a squirt bottle
before closing up the diaper. It can be applied to the vaginal area in
the same way after a trip to the bathroom.
Because traditional medications to treat thrush/yeast, such as
Nystatin, often do not work, Gentian Violet is regaining popularity
again among practitioners. It has been around for many years and is
known to be an extremely effective yeast fighter. It can be purchased
at the local pharmacy but calling ahead is advised as some pharmacies
do not carry it. Gentian Violet can be used on the nipple area by
painting the nipples and areolae once a day at night. As with the
Nystatin care should be taken not to dip the same cotton swab back in
the bottle after painting the nipple area. A clean swab should be used
each time or a few drops poured out of the bottle into a cup and any
leftovers discarded after that application. Very little is needed as it
Gentian Violet may also be used to paint the baby's mouth. The
entire mouth - inside of lips, roof of mouth, sides of cheeks, tongue,
etc. - should be painted with a clean swab once a day. The baby should
then be turned over onto his stomach to lessen the amount that is
Some mothers have been told that Gentian Violet is dangerous
due to its alcohol content and should not be used by nursing mothers.
Please understand that the amount of alcohol in the Gentian Violet is
insignificant and thus the amount the baby ingests will also be
insignificant. The contents of the bottle may be diluted with 50% water
if there is still concern.
Gentian Violet should be used for 4 days. If symptoms have
improved but not completely, application can continue for another 3
days. It should not be used longer than one week. If there is a need to
continue with it after one week of treatment, a break of a few days
should be taken before resuming its use. If symptoms are no better or
in fact worse after 4 days of treatment with Gentian Violet follow-up
should be made with a lactation consultant.
Old clothing should be worn when treating with Gentian Violet
as it temporarily stains everything it comes in contact with purple.
Many mothers need to be prepared for the site of the baby's mouth. It
will be bright purple. It helps to know that this does fade and rather
quickly. For tips on preventing or lessening and cleaning Gentian
Violet stains see our information page.
Grapefruit Seed Extract:
This treatment consists of the mother taking a 250 mg capsule orally
three times a day. This can be taken in place of Diflucan (see below)
or along with it if the yeast is especially resistant. This remedy can
be found at most health food stores and nutrition centers.
Diflucan (fluconazole) is usually very effective against yeast
when taken orally. Dosage is 200-400 mg on the first day (loading or
stat) dose followed by 100-200 mg for 10-14 days after or longer if
yeast is especially resistant. Some practitioners want to prescribe one
150 mg pill for treating nipple or breast yeast. This is the vaginal
dosage and is seldom effective when the yeast is present on the nipples
or within the breast ducts (intraductal yeast). Diflucan be used safely
with any of the topical treatments discussed above. Very little of this
drug passes into breastmilk so the amount the baby will be exposed to
is clinically insignificant. Diflucan is available by prescription
only. Please note that it may be necessary to share professional
literature with your doctor which supports the use of the medication as
well as that which outlines the effetive dosage and length of
treatment. Dr. Jack Newman's article "Fluconazole (Diflucan)" is a good
choice and can be obtained online by following the link at the end of
Comfort Measures While Waiting for Treatment to Work
Breastfeeding can and should continue throughout treatment. In mild cases relief may be felt within 48 hours. In severe cases, it may take 3-5 days to notice any
improvement. Symptoms may appear worse for a day or two before they
begin to improve. In cases where yeast has not been treated properly or
not diagnosed quickly enough, or where it is especially resistant,
relief may not come for several days and a combination of different
treatments may be necessary before there is total clearance. Treatments
may have to be aggressive with changes in diet and a boosting of the
overall immune system even after all symptoms are gone.
In the meantime, following the measures listed in "Treatment Measures for Sore, Cracked, or Bleeding Nipples"
may bring some degree of relief. Rubbing breastmilk into the nipples
while yeast symptoms are present is not advised however, because yeast
thrives in milk.
If nursing becomes too painful, pumping for a few days may be a
good option. Optimally this will done with a hospital or professional
grade pump such as the Medela Lactina or the Medela Pump In Style,
especially if baby's time away from the breast is longer than a few
days. Pumping should be as frequent as baby was nursing so that the
milk supply is maintained well. If the baby is younger than 4-6 weeks
of age, expressed milk should be offered by way of an alternative
feeding device to lessen the risk of nipple confusion.
Hygiene Guidelines to Prevent Reinfection
The following precautions should be followed during treatment to lessen the chances of reinfection:
- Hands should be washed often but not with antibacterial soap. This
kills the "good" bacteria which helps keep yeast in check. Paper towels
that are discarded after each use should be used for drying rather than
- Expressed milk should not be frozen during treatment. Yeast
is deactivated during freezing but not killed. If frozen milk is given
to the baby after the treatment, thrush may recur. The baby may be fed
fresh or refrigerated expressed breastmilk, however.
- All bottle nipples, pacifiers, toys that the baby may
mouthe, and pump parts that come in contact with breast or milk should
be boiled 20 minutes each day during treatment. All bottle nipples and
pacifiers should be replaced after one week.
- Disposable nursing pads should be thrown away as soon as they
become damp. Cloth pads and bras should be changed as soon as they
become damp and not worn again until they have been washed. If weather
permits, bras and washable pads can be dried in the sun. The
ultra-violet rays are additionally effective at killing the yeast.
Adding a cup of bleach to the wash load if clothes are chlorox bleach
safe or a cup of vinegar to other wash loads will also ensure that any
lingering yeast on clothing is killed.
- Nipples should be rinsed with cool, clear water after each
feeding and airdried 10-15 minutes before applying any topical
ointments or creams.
- If baby has a yeast diaper rash, diaper wipes should be
avoided (use a washcloth and plain water instead) and a vinegar rinse
applied after each diaper change (see above). Baby should be allowed to
go without a diaper as much as possible. Switching to cloth diapers if
possible is preferable to disposable diaper use during a yeast
- If vaginal yeast is present cotton panties should be worn and
the area rinsed with a vinegar/water solution after each trip to the
bathroom (see above). Sleeping without panties at night is advised as
Dietary Changes That May Be Necessary
Because yeast thrive on sugars (including artificial ones) and dairy
products in the diet, it may be helpful to greatly limit or eliminate
dairy foods and sweets from your diet during yeast treatment and for
1-2 weeks after all symptoms are gone.
Written by Becky Flora, BSed, IBCLC
Last revision: December 4, 2001
La Leche League's, "The Breastfeeding Answer Book" (1997) by Nancy Mohrbacher, IBCLC and Julie Stock, BA, IBCLC
"The Nursing Mother's Guide to Weaning" (1994) by Kathleen Huggins, R.N., M.S. and Linda Ziedrich
"Medications and Mothers' Milk" (1999) by Thomas Hale , R.Ph., Ph.D.
"Dr. Jack Newman's Guide to Breastfeeding" (2000) by Dr. Jack Newman and Teresa Pitman
La Leche League's Lactation Consultant Series, "Candidiasis and Breastfeeding" (1995) by Lisa Amir, M.B.B.S., I.B.C.L.C., Kay Hoover, M.Ed., I.B.C.L.C., and Chris Mulford, R.N., B.S.N., I.B.C.L.C.
More info at other sites:
"Pat Gima's Yeast Treatment Plan"