Thrush

Thrush infections can affect both mother and baby whilst breastfeeding and can often occur following nipple damage or antibiotic treatment.

Other contributing factors may be use of poorly cleaned and sterilized dummies and nipple shields or the practice of adults and older children putting the dummy in their mouth.

Either mother or baby or both can be affected. Other causes of breast and nipple pain should be excluded before treatment - it is particularly important to check positioning and attachment and address any problems at the same time.

Signs of thrush in the mother:

Sudden start of breast and/or nipple pain after pain free breastfeeding - the nipple may be itchy or very sensitive to any touch.

  • Intense pain in the nipple or breast which is NOT resolved by improving attachment.
  • Shooting pains in the breast during or after feeding (maybe deep in the breast) which can last for up to an hour after. Pain which worsens during the feed
  • Cracked nipples which do not heal.
  • Loss of colour in the nipple or areola - or pink, shiny areola.

Signs of thrush in a baby:

  • Baby may pull away from the breast whilst feeding; he will appear unhappy or uncomfortable as his mouth may be sore.
  • There may be creamy white patches, which will not rub off, visible inside the baby's mouth or on the tongue, possibly far back in the mouth.
  • Baby may have a nappy rash which is difficult to heal
  • Baby may be fretful, windy, and difficult to settle.

Treatment:

  • Check positioning and attachment - thrush may be secondary to poor positioning and attachment
  • Topical antifungal / oral
  • Strict hygiene measures
  • Treat vaginal thrush if present
  • It is important the both mother and baby are treated with antifungal medication in order to get rid of the infection. Once treatment begins, the pain and other symptoms should begin to improve in 2-3 days. A full recovery may take longer and treatment should be continued for 10-14 days. www.BreastfeedingNetwork.org.uk

Mother:

  • Miconazole 2% cream / nystatin to the nipples after each feed Baby - Miconazole oral gel may be effective more quickly than Nystatin suspension
  • Due to change in the manufacturer's license, use of Miconazole oral gel is no longer considered suitable for use in babies under 4 months because of a potential choking risk. Practitioners should note that responsibility for use in a baby under 4 months remains the responsibility of the person who prescribes or recommends its use.
  • Deep breast pain or symptoms which do not respond to topical treatment indicate that thrush may have entered the milk ducts, in which case systemic antifungal treatment may be required, for example oral Fluconazole.
  • A loading dose of 150-400 mg, followed by 100-200 mgs daily for at least 2 weeks may be necessary(26,27).
  • Fluconazole is not currently licensed for use by lactating mothers (or infants under 4 weeks of age - who would be receiving it via the milk). Nystatin is a well established treatment, which appears to be sufficient to treat thrush in the breast, but oral absorption is poor. There is no contraindication to use, but pain does not generally resolve for 10 days. Thrush can be passed between mother, baby and father.

Suggest the following:

  • Wash hands thoroughly, especially after nappy changing
  • Use a separate towel for each family member
  • Dummies, teats and nipple shields should be cleaned and sterilised after each use.
  • Wash any plastic toys which have been in the baby's mouth
  • Wear a clean bra every day and use disposable breast pads
  • Any breast milk expressed while mother or baby has thrush can be used within 24 hours but should not be frozen for use later.

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