Sore, Itchy Nipples - Do I Have Thrush?

Sudden nipple and breast pain can be alarming for any woman, but for a breastfeeding woman, it can cause a lot more than just pain. Babies that are having trouble nursing can become cranky and have difficulty sleeping, which only compounds mom's discomfort. If you are having sudden pain when nursing, it might be due to a thrush infection. The best way to determine is to see your doctor for an evaluation of your pain. You can also consult with a lactation counselor before seeing your doctor to determine if your breastfeeding pain might be from another source.

What is Thrush?

Thrush is a fungal infection caused by a yeast-like organism called candida. They can occur around the mouth, gut, or vagina. If you have ever had a common yeast infection, then you likely have experience with this type of fungal growth. This fungal infection is easily transmissible from mom to baby and back again. Hence, it is crucial to seek immediate treatment and follow recommendations strictly.

Thrush can be caused by an infection of candida in any other location on the body. It can also be caused by contraceptives or antibiotics and corticosteroids being taken by mom or baby. If other family members have a candida type infection such as athlete's foot, diaper rash, or tinea cruris (also known as jock itch) the infection can be transmitted through shared towels, washcloths or other items. Thrush is most common in infants under six months.

How Can I Know If I Have Thrush?

The first symptom you'll likely notice is nipple and breast pain. This can range from soreness in just the nipple to the entire breast and stabbing pains behind the nipple. You may also notice burning nipple pain and the skin of the areola and nipple being flaky and shiny. Your baby may have white patches inside their mouth on their cheeks, tongue, or gums. When wiped, these patches may become red, raw, and sore. You can have difficulty breastfeeding during this time, but it is vital that you continue to do so. Your breastmilk supply may even reduce a little bit. Don't be alarmed by this; it will come back after the infection is resolved. Your baby may also experience pain and soreness of the mouth and be fussy while breastfeeding.

What Can I Do For Treatment?

Since a thrush infection can be easily transmissible and hard to get rid of, it's essential to treat it immediately. Make an appointment with your doctor as soon as you can. Your doctor will decide how severe is the infection and the treatment option. If you are prescribed an antifungal medication apply it exactly as directed and make sure you are given something to treat the baby. Thrush is easily passed back and forth, thus both you and the baby need treatment. If your doctor isn't comfortable prescribing for both of you, make an appointment with your baby's pediatrician.

The most common antifungal given to moms with a thrush infection is a nystatin suspension. Your doctor may prescribe this same antifungal in an oral gel to your baby. This antifungal is entirely safe for the breastfeeding mama and the baby and it is very effective. Your doctor may also give you an antifungal azole ointment to apply to your nipples to prevent the spread and growth of the bacteria. Nystatin is the number one recommended treatment by the Academy of Breastfeeding Medicine. Still, it doesn't mean that it is the right one for your bacteria. Some thrush infections can be antifungal-resistant, so don't be discouraged if it takes a couple different antifungals to get rid of the infection. If you feel like your condition is not improving, definitely make a followup appointment with your doctor to discuss other treatment options.

Make sure you are handwashing often and keeping anything that touches your breasts or breastmilk thoroughly clean. Avoid using breast pads and change your bra often (at least once a day). Do not store pumped milk during this time as you do not want to bring the infection back to your baby once you've cleared it up. Taking probiotics can also help keep thrush infections from occurring or returning once you've resolved them.

Sterilize anything that touches your breast or your baby's mouth, including pacifiers, bottles, and breast pump equipment. Breastmilk and anything touching your breast should be assumed to be infected by candida bacteria. Keep your nipples as dry as possible. If you are experiencing itchy nipples, as long as your nipples aren't cracked or bleeding you can rinse them with a solution of 1 tablespoon vinegar to 1 cup of water (La Leche League). You can do this rinse up to four times a day. If you are having trouble breastfeeding due to soreness you can try pumping and feeding baby through a bottle, if your little one will take a bottle.

It may take up to two weeks to clear up the candida infection. Stick with your recommended treatment regimen, continue breastfeeding (even if you must exclusively pump due to pain), and be patient with yourself and your baby. If you need help with breastfeeding during this time, reach out to a lactation consultant in your area or, if one is not available, your La Leche League or Breastfeeding USA chapter. These counselors can offer valuable advice and help during breastfeeding obstacles. Also, join our Facebook group to get information from a lactation consultant or other moms who have been through the same situation.

La Leche League. (n.d.). Thrush and Breastfeeding. Retrieved from laleche.org.uk/thrush/

Healthline. (n.d.) What You Should Know About Thrush and Breastfeeding. Retrieved from healthline.com/health/parenting/thrush-breastfeeding/