To a woman who has endured the experience, the mere mention of the word might be enough to make her cringe.  “Thrush” is a yeast infection commonly found in the mouths of both bottle and breastfed infants.  In infants who are breastfed, chances are it will eventually bestow itself upon the breasts and/or nipples of the nursing mother.  Once this stubborn fungus has settled into its new environment, a long and frustrating process of eradicating it often follows, sometimes taking weeks to destroy.  Thrush can be present without any symptoms at all, and, to complicate matters more, symptoms can be present in an infant’s mouth and not the mother’s breasts, and vice versa.

What Causes Thrush?

Many people carry yeast, or “Candida,” in the skin and intestines of the body, which most often exist harmoniously without presenting a problem.  Thrush occurs when the normal balance of this flora is interrupted, resulting in an overgrowth of the organisms, turning yeast from a benign condition into a pathogenic, or disease-causing condition.  This can follow a course of antibiotics, which often destroy both the good and bad bacteria in the body, upsetting the usual harmony of these organisms and resulting in a yeast infection.  Another common cause of yeast infections is the unusually high levels of estrogen and progesterone present during pregnancy, which can result in a sudden change in the pH of the vagina.  A woman can have a mild yeast infection at the time of delivery without knowing it, and, in a vaginal birth, a baby can be exposed to the infection and begin to show symptoms of oral thrush within several days. 

What are the Symptoms?

With oral thrush, the baby may exhibit some or all of the following symptoms:

• The sudden appearance of tiny white curd-like patches on the mouth, gums, and/or tongue – they may resemble tiny droplets of pooled milk, and upon attempting to wipe off, may bleed.
• Nurses and continuously pulls off of the breast and/or refuses to nurse or suck from a bottle.
• A yeast infection around the diaper area characterized by a bright red rash that does not respond to traditional diaper rash ointments or creams.
• Irritability
• Gassiness
• A distinct “clicking” sound when nursing.
• Saliva that is “pearl” colored

Symptoms of nipple thrush may include:

• Unbearable nipple and/or breast pain or burning during nursing and between feedings.  For some women, the pain is so intense, they may not be able tolerate clothing against the skin. 
• Sudden onset of intense pain in a seasoned nursing mother.
• Chronic nursing pain that doesn’t resolve from traditional attempts to correct positioning and/or latch.
• Intense itching of the breasts and/or nipples.
• Deep, stabbing or shooting pains throughout one or both breasts, which often occurs if yeast gets into the milk ducts.
• Dry skin around the nipple area that may result in peeling.
• Nipples that appear swollen, bright red or pink, and may crack and/or bleed.
• A “shiny” and/or taut appearance of the breasts and/or nipples.
• A rash with tiny, fluid-filled blisters and/or white dots covering the areola.
• Recurrent vaginal yeast infections.

If any of these symptoms are experienced, it is important to see a medical care provider or certified lactation consultant as soon as possible, as immediate attention is crucial to in order to quickly treat the condition, and in severe cases, preserve a breastfeeding relationship that may be on the rocks as a result of pain.  In any case, if either the baby or the mother is infected in a breastfeeding situation, it is essential that both be treated simultaneously to avoid re-infection.

How is Thrush Treated?

Treatment for thrush varies, depending on the severity of the condition for either patient.  The most common treatment for oral thrush in infants is Nystatin.  Oral Nystatin is a thick, sticky medication that, when used correctly, will kill the yeast organisms in an infant’s mouth.  Mothers with thrush will often respond to the same medication in a topical form applied directly to the nipples.  Other treatments for nipple thrush include Gentian Violet, an over-the-counter, antiseptic liquid found in some pharmacies that is applied directly to the nipple area as directed.  Gentian Violet, a bright purple solution that, although extremely messy and staining, has been found to be useful in curing thrush for some women. 

In some cases, a thrush infection can become severe and spread through the breasts and/or milk ducts internally, or “systemically,” in which case a more powerful drug, such as fluconazole, may be prescribed.  Although fluconazole will cure a vaginal yeast infection with one dose, many healthcare professionals agree that many more doses are necessary to resolve systemic yeast.  Depending on the severity, fluconazole treatment may be required for 10 or more days in some cases of systemic thrush.

How Can I Avoid Thrush?

Although thrush is a common ailment afflicting many new mothers and newborns, there are some ways to lessen the chances of the infection. 

• Avoid rubbing or washing the nipple area with soap if breastfeeding.  The areola naturally produces oils that lubricate and protect the skin and, interfering with these natural oils can damage skin layers, leaving an open invitation for yeast.   

• Yeast thrives on sugar.  Avoid foods high in sugar or aspartame, including honey, sweeteners, and excessive amounts of fruits or juices.

• Make plain, unsweetened yogurt part of your every-day diet, or consider a daily over-the-counter Acidophilus tablet.  The most effective forms of Acidophilus require refrigeration, so read labels carefully.

• Oral garlic tablets.

• If nipple thrush has been a problem, after breastfeeding, rinse nipples with a solution of 1 tablespoon of vinegar to one cup of water after nursing and let air-dry.

• Avoid antibacterial soaps.

• Wash hands frequently, particularly before and after nursing.

• Avoid a high carbohydrate diet and foods containing molds or yeasts, including cheese, beer, wine, bread, and brewer's yeast.

• Avoid synthetic undergarments, tight jeans or pants.

• When treating thrush, boil bottles, breast pump parts, nipples, toys, nursing bras or anything that comes in contact with mother or baby, for at least 20 minutes after use.  Boiling water kills yeast.

• If expressing breastmilk during treatment, use it as soon as possible.  Feeding an infant yeast-contaminated breastmilk after treatment has been completed can re-infect.  Freezing does not kill yeast.

Although it is a common condition that often creates a great deal of pain and frustration, with prompt medical treatment and care to prevent re-infection, thrush can be resolved and, with a little ingenuity and caution, can, in some cases, be prevented.