dealing with thrush

Mother
 Wash hands frequently especially after using the bathroom, diaper
changes, and before and after nursing. Dry with paper towels.
 Discard disposable nursing pads after each feeding or when wet and
change cloth nursing pads. Avoid using nursing pads if possible.
 Wear a clean bra every day.
 For sore nipples refer to your “Breastfeeding Matters” Booklet. Consider
wearing breast shells during the day for very painful nipples.
 Nipples can be rinsed with water and allowed to air dry after
breastfeeding. Avoid use of soap/creams on breasts.
 Breastfeed more frequently, but for a shorter period of time.
 If one breast is less sore, start all feedings on that side until the let-down
occurs.
 Take mild pain medication 30-60 minutes before a feed.
 If pumping, fresh milk may be used but it should not be frozen. Freezing
will not kill the yeast infection and then the yeast may return when fed to
your baby later.
 Eat a well-balanced diet that follows Eating Well With Canada’s Food
Guide.
 Reduce intake of foods high in sugar, yeast, and white flour.
 Eat two cups of plain yogurt each day (yogurt with a live culture) or take
acidophilus supplements.
Household
 Boil items which come in contact with nipples or milk for twenty minutes
each day. This includes breast shells, pump parts, toys, bottles, pacifiers
and teething rings (Breastfeeding Answers Made Simple, 2010).
 Wash undergarments and cloth diapers in hot water.
 Avoid sharing personal items with family members, such as tooth brushes.
 Use only plain soap for handwashing.
REFERENCES
La Leche League International (2003). The Breastfeeding Answer Book, 3nd Ed.,
Toronto Public Health (2007). Breastfeeding Protocols for Health Care Providers.
Newman, Dr. J. (2011). Candida Protocol. Retrieved December 18, 2012 from
http://www.breastfeedinginc.ca/content.php?pagename=doc-CP.
Mohrbacher, N. (2010). Breastfeeding Answers Made Simple: A Guide for Helping Mothers
For more information:
Contact your health care provider
Talk with a public health nurse at 1-800-563-2808
Revised September 2013
DEALING WITH THRUSH
(Candida / Yeast Infection)
WHAT IS THRUSH?
When a yeast infection is present in a baby’s mouth, it is called thrush. A yeast
infection can invade any tissue of the body but often causes infection in warm,
moist, dark places such as the mouth of infants, the diaper area, the nipples of
breastfeeding mothers and the vagina.
WHAT FACTORS ENCOURAGE THE GROWTH OF YEAST?
 Presence of vaginal yeast at birth so that when baby passes through the birth
canal, he/she contracts thrush and then transfers the infection back to your
nipple when breastfeeding
 Recent use of antibiotics, and/or corticosteroids (i.e. long term use of
Steroids such as for asthma)
 Use of nursing pads
 Use of estrogen-containing birth control methods
 Pregnancy
 Nipple damage
 Diabetes
 Anemia, poor nutrition, diet high in sugar or yeast products
 Fatigue
WHAT ARE THE SIGNS OF INFECTION?
In Baby
 White patches on the inside of the mouth, gums or tongue (that are not
easily wiped off using a clean damp cloth)
 a whitish sheen to the saliva or the inside of baby’s mouth
 refusal to nurse or pulling off the breast frequently
 gassy, fussy baby
 in rare cases, inadequate weight gain
 diaper rash (red/scalded appearance or raised dots)
 frequent breastfeeding
 thrush may be present with no symptoms
In Mother
 Sharp, shooting, or burning breast pain which may radiate to the back that
lasts throughout the nursing, and possibly after the feed (the pain does not
improve with proper positioning and latching)
 Nipples that are cracked, itchy or painful (burning/stinging) and appear
swollen, flaky or shiny
 A sudden development of painful nipples, when breastfeeding was previously
going well
 Mastitis (a breast infection) that keeps coming back
 Vaginal yeast infection (symptoms include redness, itchiness or cheesy, white
vaginal discharge)
* If any of the above signs are present consult your health care provider.
THRUSH TREATMENT
 Both mother and baby need to be seen by their health care provider for
diagnosis. Treatment needs to be completed for both of you at the same
time (to prevent thrush from being passed back & forth).
Note: During a yeast infection, breastfeeding should be continued.
MEDICAL TREATMENT OPTIONS
 Nystatin cream is available for your nipples along with nystatin suspension
for your baby’s mouth. Studies in recent years are showing that nystatin has
become less effective than other treatment options.
 All purpose nipple ointment (APNO) can help with painful nipples. This
ointment contains antifungal properties and is available by prescription from
your health care provider.
 Apply the APNO sparingly after every feed. Do not wash or wipe off
ointment. Use until symptoms disappear.
 Gentian violet can be used at the same time as the APNO and is available
without a prescription. Paint your baby’s mouth and/or your nipples with a
Q-tip dipped into the gentian violet and then put your baby to breast. This
can be done once a day for 3-4 days. Do not repeat treatment and check that
the label reads 0.5 – 1.0% diluted solution in water (stronger concentrations
should not be used as they can cause sores in your baby’s mouth). Gentian
violet stains so wear old clothing.
 You may also choose to take probiotics orally 2-3 times daily, and/or
grapefruit seed extract either as a liquid or in tablet form.
 In cases that are not resolving or are frequently recurring, an oral antifungal
medication may be prescribed for you (e.g. fluconazole).
 If your baby has a diaper rash, it will also need to be treated with an
antifungal cream.
 Treat any vaginal yeast infection.
In addition to the medical treatment, there are other steps you can take…
Baby
 Keep the diaper area clean and dry. Try to air-dry the baby’s bottom often.