The Signs and Symptoms of Thrush (and How to Treat It)

Definition, Signs and Symptoms, and Treatment of a Yeast Infection

Mother looking up information on the computer with baby. Breastfeeding and Thrush, The Yeast Infection from Candida.
What is thrush and is it safe to breastfeed if you or your baby has it?. Courtney Keating / Getty Images

Thrush and Breastfeeding

Thrush is a common breastfeeding problem. While you can take care of some breastfeeding issues on your own, this isn't one of them. Thrush is an infection, and it needs to be treated. If you notice any of the signs or symptoms of thrush listed below, and you think that you or your baby have thrush, call your doctor and your baby's doctor right away. With treatment, you and your baby will be feeling better and back to your normal breastfeeding routine in no time.

But, if you let it go, thrush can lead to very painful, cracked and damaged nipplesa nursing strike, or early weaning. It can also spread to others members of your family. 

What Is Thrush?

Thrush is a yeast (fungal) infection that grows and spreads in warm, moist, dark environments. It's caused by the overgrowth of a type of fungus called Candida albicans (also referred to as Monilia, candidiasis, or candidosis). Candida is normally found on and in your body. It usually doesn't cause any harm because there's also good bacteria on and in your body that keeps the yeast in check. However, when there's a change in the healthy balance of bacteria and yeast, Candida can grow and cause problems.

The natural balance of bacteria and yeast in your body can be affected by the use of antibiotics. If you or your baby take antibiotics to fight off an infection, the antibiotics can also kill off some of the body's good bacteria.

When there are less healthy bacteria, it leaves an opening for the yeast to grow. 

You are also more likely to develop thrush on your breasts and nipples if you tend to get vaginal yeast infections. You may be prone to yeast infections if you have diabetes or you use birth control pills. Additionally, if your breasts leak breast milk and you use breast pads, the warm, wet pads against your skin can provide another opportunity for the yeast to grow.

 

What Are the Signs and Symptoms of Thrush?

Thrush can show up on your breasts or in your baby's mouth. If all of a sudden breastfeeding becomes very painful for you, or your baby becomes fussy and refuses to breastfeed, check for these signs and symptoms of thrush.

  • Breast and Nipple Pain: Thrush can cause severe nipple pain. If you feel burning, itching, pins-and-needles, or a sharp, stabbing breast pain, you might have thrush. 
  • Inflammation (Swelling): If your nipples and areola are swollen and very red, it could indicate a yeast infection.​
  • Irritation of the Nipples: Thrush may make your nipples look shiny or flaky, or you may see small blisters or white patches on the skin around your nipples. ​
  • Diaper Rash: A yeast infection on your baby's bottom looks like a red, bumpy rash. A fungal diaper rash is one of the symptoms of thrush. ​
  • Irritation in Your Baby's Mouth: If your baby has thrush in his mouth, you may not see anything. But, sometimes thrush appears as white patches in your baby's mouth or a white coating on your baby's tongue.

    Can You Breastfeed if You Have Thrush?

    If you think you have thrush, or you've just been diagnosed, you might be nervous about breastfeeding. It's normal to be worried and a little scared about spreading an infection to your baby. But by the time you realize you have it your child's already been exposed and probably has it, too. Or, it may be that your baby had it first and gave it to you. What does this mean for breastfeeding?

    You can continue to breastfeed if you have thrush. It's safe. However, there may be a few issues that you'll have to face. Thrush in your baby's mouth may make it painful for her. Your baby may be fussy and refuse to breastfeed. For you, your nipples and your breasts may hurt very badly. If you can take the pain, continue to breastfeed. If you need to give your breasts a break while you're undergoing treatment, you can pump to keep up your breast milk supply until you feel well enough to breastfeed again.

    Thrush and Your Expressed Breast Milk

    Even though it's OK to breastfeed your baby when you have thrush, you should not collect your breast milk to store.  Candida can live in your breast milk and freezing the milk does not kill it. Wait until you finish taking the entire course of medication and you no longer have any symptoms of thrush before you begin collecting and freezing your breast milk for storage again.

    How to Treat Thrush

    Candida grows and spreads quickly so it can be hard to get rid of it. Yeast can easily spread to other family members, too. If you think you and your baby have thrush, you need to get treated together. Call your doctor and your baby's doctor so that you can get diagnosed and treated quickly.

    • Use Medications: Both you and your baby should be treated with medication if either one of you shows symptoms of thrush. For a list of medications see below.
    • Wash Your Hands: Good handwashing prevents the spread of many infections including thrush. Wash your hands before and after you touch your breasts, after you use the bathroom, and after you change your baby's diaper.​
    • Wash Your Breasts: Keep your breasts and nipples clean and dry. After you breastfeed, rinse your nipples with water or a solution of vinegar (1 part) and water (4 parts) then let them air dry. If you can expose your bare nipples to the sun for a few minutes every day, that would also be helpful.
    • Wash Your Baby's Items: To kill the yeast, clean all the things that come in contact with breasts and your baby's mouth. You should boil or use hot, soapy water to thoroughly wash pacifiers, bottles, bottle nipples, teethers, toys, and the washable parts of your breast pump each day.
    • Change Your Breast Pads Often: If you leave wet breast pads on your breasts, they keep your breasts warm and moist. It's the perfect breeding ground for yeast, so change breast pads whenever they get wet.
    • Keep Your Nursing Bra Clean and Dry: Wear a clean nursing bra every day and change it if it gets wet. Wash your bra, nursing clothes, pajamas, and bed sheets in hot water or bleach to kill the yeast.
    • Try Probiotics: Probiotics are good bacteria. You can try a probiotic supplement such as Lactobacillus acidophilus, or you can eat yogurt with active cultures.
    • Limit Sugar in Your Diet: Yeast loves sugar. If you avoid sugary foods and drinks while you're being treated for thrush, it may help you get rid of infection more quickly.

    The Medications Used to Treat Thrush

    Antifungal medications are used to treat yeast or fungal infections. Both you and your child will need to take medication but the medication that you'll give your child will be different than yours. If necessary, your partner and your other children may also need medication. 

    It's very important to use the medication the way your doctors prescribe it and to take it for as long as you're supposed to. If you feel better before the course of medication is complete and stop using it, the yeast can come back. 

    • Nystatin Cream: Nystatin cream is an antifungal medication that you apply directly to the affected area on your breasts and nipples.
    • Diflucan: Diflucan (fluconazole) is a pill that you take by mouth. Your doctor may prescribe Diflucan if you've already tried nystatin and other antifungal creams that didn't work, or if the yeast infection is inside of your breasts where an antifungal cream is not effective.
    • Monistat or Gyne-Lotrimin: If you have a vaginal yeast infection along with other signs and symptoms of thrush, you need to treat that infection while you're treating your breasts and your baby. Your doctor can prescribe an antifungal vaginal cream or suppository, or you can use one of the over-the-counter products found at your local pharmacy.
    • Nystatin Oral Suspension: Your baby's doctor will probably give you a prescription for a liquid form of nystatin to use inside of your baby's mouth.
    • Antifungal Diaper Rash Creams or Ointments: You can use an antifungal cream or ointment such as Mycostatin (nystatin) or Lotrimin (clotrimazole) to treat a fungal diaper rash on your baby's bottom
    • Gentian Violet: Gentian violet is a liquid that you swab on your nipples and in your baby's mouth. It's a natural, over-the-counter treatment for thrush that you can find in natural food stores.
    • APNO: Dr. Jack Newman's All-Purpose Nipple Ointment (APNO) contains three types of medication: an antifungal, an antibiotic, and a steroid. You can rub it onto to your nipples to treat nipple pain and infections from yeast or bacteria.

    Getting Rid of Thrush

    Thrush is difficult to conquer. It can take a few weeks for the medications to work and completely get rid of the yeast. Plus, yeast may be lurking in areas of your body other than your breasts and your baby's mouth. When these areas are left untreated, the yeast can show up again even after you think you've successfully treated the infection.

    Yeast can also live on pacifiers and toys so it can quickly spread to your other children. When you're dealing with thrush, it may take a little work to wipe it out. Follow the medication instructions that your doctor and your child's doctor gives you, try to keep up with cleaning all the things that your breasts and your baby's mouth touch, and most of all, be patient.

    If thrush doesn't seem to be getting better or it keeps coming back, talk to your doctor or a lactation consultant. Other skin conditions of the breast such as psoriasis or eczema can look like thrush. Your health care provider will examine you, investigate your situation further, and reevaluate your treatment plan. 

    Sources:

    Academy of Breastfeeding Medicine. (2014). Clinical Protocol #4: Mastitis.

    American Academy of Pediatrics. (2011). New Mother’s Guide To Breastfeeding. Bantam Books. New York.

    Brent, N. B. (2001). Thrush in the breastfeeding dyad: results of a survey on diagnosis and treatment. Clinical Pediatrics, 40(9), 503-506.

    Lawrence, Ruth A., MD, Lawrence, Robert M., MD. (2011). Breastfeeding A Guide For The Medical Profession Seventh Edition.  Mosby.

    Riordan, J., and Wambach, K. (2014). Breastfeeding and Human Lactation Fourth Edition. Jones and Bartlett Learning.

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