Thrush
By Nancy Mohrbacher
Mt. Prospect, Illinois, USA
From: NEW BEGINNINGS, Vol. 10 No. 3, May-June 1993, pp. 83-4
We provide articles
from our publications from previous years for reference for our Leaders and
members. Readers are cautioned to remember that research and medical information
change over time
In the proper balance, yeast
can be beneficial to our bodies. But when it becomes too abundant, problems,
such as thrush, can develop, making breastfeeding painful. Massachusetts
mother Carol Anne Uphold tried the usual recommendations for easing
sore nipples, but found that none of them worked. "By the end of my
third week at home it was almost unbearable! I could not even put Gregory
against me to burp him. At Gregory's six-week checkup the doctor discovered
that he had thrush and explained to me that this had been transferred
to my nipples and was causing most of my soreness. He treated us both,
the problem cleared up, and it has been smooth sailing ever since."
Candida albicans, the organism
that causes thrush, is a fungus that thrives on milk on the nipples,
in the milk ducts, and in the baby's mouth.
In the baby, possible symptoms of thrush include:
- diaper rash,
- white patches on the inside of the mouth, cheeks, or tongue,
- refusing the breast or
a reluctance to nurse (because baby's mouth is sore). The baby may
also be without symptoms. In other words, a mother may have thrush
on her nipples even if her baby has no sign of it.
In the mother, possible symptoms of thrush include:
- prolonged or sudden onset of sore nipples during or after the
newborn period (the nipples may be pink, flaky, crusty, and itchy, or red and burning)
- cracked nipples,
- a vaginal yeast (monilial) infection.
An intense stabbing or burning
pain in one or both breasts during or shortly after feedings may mean
that a secondary yeast infection has developed within the milk ducts.
This seems to be more common if mother or baby has been on antibiotics
(because antibiotics kill the beneficial bacteria in the body that keep
yeast under control) or if the mother has had cracked nipples (the fungus
can enter the breast through the cracks).
Thrush is more likely to
develop if either mother or baby has been treated with antibiotics,
the mother's diet is high in sugars, the mother has diabetes, or the
mother's resistance is low, due to fatigue or other health problems.
Although thrush is usually
not serious, it can definitely be a nuisance. In a few reported cases,
mothers have chosen to wean their babies because of the severity and
persistence of thrush. Before reaching that point, however, a number
of steps can be taken to solve the problem. Fortunately, the treatment
for thrush need not interfere with nursing.
Treating Thrush
The first step in treating
thrush is to contact a health-care provider. Mother and baby need to
be treated simultaneously for at least two weeks, and breastfeeding
need not be affected. In Breastfeeding: A Guide for the Medical Profession,
Ruth Lawrence, MD, recommends doctors prescribe liquid nystatin for
the baby's mouth and a nystatin cream for the mother to apply to her
nipples and areolae (the dark areas around the nipples). Nystatin pills
or liquid for the mother may be necessary if deep breast pain develops
or if the thrush recurs after a full course of treatment. Some strains
of thrush have become resistant to nystatin, so if the nystatin does
not bring relief, other drugs may be necessary. Over-the-counter preparations
and other prescription drugs are available and may be used on the recommendation
of a health-care professional.
In mild cases of thrush,
once treatment has begun, relief may be felt in twenty-four to forty-eight
hours. In severe cases, the symptoms may take three to five days to
disappear. It is important that the medication be continued for the
entire time recommended, since the thrush may recur if the medication
is stopped when the symptoms disappear.
Comfort Measures during Treatment
When treatment for thrush
is started, the symptoms may seem worse for a day or two before they
improve. To help speed relief, try rinsing the nipples with clear water
and air drying them after each nursing, as thrush thrives on milk and
moisture.
Before the pain is gone,
the following suggestions may help make nursing more comfortable:
- offer short, frequent feedings,
- nurse first on the less sore side (if there is one), and
- break the baby's suction
before taking him off the breast by gently pulling on the baby's chin
or by inserting your finger into the corner of his mouth.
Preventing Recurrence
Thrush can be harbored in
many places, including milk. Once thrush has been confirmed, the following
precautions may help prevent recurrence:
- Wash your hands often,
especially after diaper changes and after using the toilet.
- Expressed milk can be
fed to the baby, but milk expressed during a thrush outbreak should
not be saved and frozen. Freezing deactivates yeast but does not kill
it (Rosa 1990). So if the frozen milk is given to the baby after treatment
is completed, it could cause the thrush to recur.
- If the baby uses pacifiers,
bottle nipples, or teethers, boil them once a day for twenty minutes
to kill the thrush. After one week of treatment, discard them and
buy new ones.
- If a breast pump is used,
boil daily all parts that touch the milk (except rubber gaskets).
- Disposable nursing pads
should be discarded after each feeding. Cloth nursing pads should
be changed after each feeding and not used again until they've been
washed in hot, soapy water.
- If the baby is old enough
to play with toys, anything the baby puts into his mouth should be
washed frequently with hot, soapy water so that he does not reinfect
himself or spread thrush to other children.
- Add Lactobacillus acidophilus
to your diet to re-colonize your digestive tract with the good bacteria
that can keep yeast in check.
- Consider eliminating sugar,
yeast-containing foods and supplements, and other highly processed
foods from your diet. The yeast won't have anything to feed on and
you may find yourself healthier and more disease resistant in general.
Also, men can have thrush
without symptoms. Thrush can be passed back and forth between husband
and wife during sexual relations. If thrush continues to recur after
mother and baby have had two full courses of treatment, all members
of the family may need to be treated simultaneously.
Don't Give Up
If sore nipples persist,
don't suffer unnecessarily. Rhode Island mother Diane Malczewski called
her La Leche League Leader about sore nipples when her baby was three
weeks old and dismissed thrush as a possibility, because "the pediatrician
had seen Matthew two days before and told us that he was in perfect
health, so I felt that thrush must be out of the question." Three weeks
later she was still miserable. "One evening, the pain was so intense
that I decided to wean my baby. After two hours of both mother and baby
crying, my husband suggested that I call my Leader just one more time.
My Leader informed me that a baby can have thrush without patches on
the gums. I had tried everything else at this point, so I thought why
not. After a phone call to the pediatrician, I received a prescription
over the phone. After a day on the medication, I could nurse without
tears. In three days, the pain was gone, and I began to enjoy nursing
as I should have from the start."
REFERENCES
Danforth, D. 1990. Could it be thrush? LEAVEN 26:56.
La Leche League International.
THE WOMANLY ART OF BREASTFEEDING, 35th Anniversary ed. Franklin Park,
Illinois, 1991, p. 126.
Lawrence, R. Breastfeeding:
A Guide for the Medical Profession, 3rd Ed. St. Louis, Mosby, 1989,
pp. 392-93.
Mohrbacher, N. and J. Stock.
THE BREASTFEEDING ANSWER Book, Franklin Park, IL, La Leche League International,
1991, pp. 148-49, 172-74, 262, 429.
Rosa, C, et al. 1990. Yeasts
from human milk collected in Rio de Janeiro, Brazil. Rev Microbiol
21(4):361-63.
Last updated 11/12/06 by jlm.
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