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September 10, 2019
One of the most common reasons why people stop breastfeeding is pain. There are many things that can contribute to breastfeeding pain, including a shallow latch, blocked ducts, mastitis, and thrush. Thrush is a very common diagnosis, affecting an estimated 10-20% of new mothers. It can be extremely painful, frustrating, and hard to get rid of.
Breast or nipple thrush, also called mammary candidiasis or a yeast infection of the breast, is a fungal infection that is caused by an organism called candida albicans. Candida naturally lives on your body, specifically in moist areas like your mouth and vagina (it’s the same organism that causes vaginal yeast infections). If there is severe nipple pain without obvious trauma or fever, often the cause is attributed to an overgrowth of candida.
Sometimes, breastfed babies will develop thrush in their mouths (oral thrush or oral candidiasis). It can then be passed back and forth between the mother and the child, which makes it particularly difficult to treat.
If your nipples are cracked or damaged, you may be more likely to develop a thrush infection because it allows the candida to get into your breast or nipple.
Also, like vaginal yeast infections, antibiotics make you more susceptible to thrush. This is because antibiotics kill the good bacteria that keep the candida at bay.
Breast or nipple thrush is characterized by red, painful nipples and a shooting or burning pain while breastfeeding. Unfortunately, these are similar symptoms to other types of breast infections, so it’s estimated that many thrush occurrences are actually other types of infections. One way to tell for sure is a culture test, but they are rarely done. They are more likely to be done if the baby shows signs of infection.
The most common sign of oral thrush in breastfeeding babies is white patches in the mouth. If there are patches on the tongue, gums, inside of the cheeks, or roof of the mouth, that don’t come off when wiped with a cloth, talk to your child’s doctor or pediatrician.
If your baby does not have oral thrush, then the typical treatment for nipple thrush is an antibiotic cream called mupirocin, or an antifungal such as clotrimazole or ketoconazole. You’ll typically need a prescription for these, so call your doctor if you have symptoms. Your doctor may also mention a cream called APNO (all-purpose nipple ointment), which contains mupirocin, a corticosteroid called betamethasone to reduce swelling, and an antifungal. However, this is not always widely available (you have to get it from a compounding pharmacy), it’s not usually covered by insurance, and it’s pricey.
If your baby also has oral thrush, following the treatment instructions from the pediatrician, which is typically an antifungal gel. In addition, it’s recommended to wash or sterilize anything that comes in contact with your nipples or your baby’s mouth. Wash your hands frequently, wash your bras, and sterilize pacifiers, pump parts, and bottles. If you’re pumping, use the pumped milk right away, instead of freezing it for later and risking the thrush returning.
Once you start treatment, it should clear up in 2-3 days. If it’s been longer than a week, follow up with your doctor.
Morrill JF, Heinig MJ, Pappagianis D, Dewey KG. Risk factors for mammary Candidosis among lactating women. Journal of Obstetric, Gynecologic & Neonatal Nursing. 2005;34:37–45. Retrieved on September 6, 2019 from https://www.jognn.org/article/S0884-2175(15)34243-X/fulltext
Heinig, M. J., Francis, J., & Pappagianis, D. (1999). Mammary Candidosis in Lactating Women. Journal of Human Lactation, 15(4), 281-288. Retrieved on September 6, 2019 from https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0181071
Amir LH; Academy of Breastfeeding Medicine Protocol Committee. ABM Clinical Protocol #4: mastitis, revised March 2014. Breastfeed Med. 2014;9:239-243. Retrieved on September 6, 2019 from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4048576/
Dinsmoor MJ, Viloria R, Lief L, et al. Use of intrapartum antibiotics and the incidence of postnatal maternal and neonatal yeast infections. Obstet Gynecol 2005;106:19–22. Retrieved on September 6, 2019 from https://www.ncbi.nlm.nih.gov/pubmed/15994612
The Royal Women’s Hospital. Breast & nipple thrush. Retrieved on September 6, 2019 from
NHS. Breastfeeding and thrush. Retrieved on September 6, 2019 from https://www.nhs.uk/conditions/pregnancy-and-baby/breastfeeding-and-thrush/
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