Thrush is a fungal infection of the breast that can cause severe pain for a nursing mother. It can be difficult to diagnose (mainly due to lack of experience by doctors and pediatricians), and incredibly difficult to eradicate. It can be accompanied by a simultaneous fungal infection in the mouth of the nursing baby, but can also occur in mothers with no evidence of infection in the baby.
Thrush can occur in any nursing mother or baby, but may be more common in those who have a history of susceptibility to yeast infections and those who have taken antibiotics for illness and/or during labor for GBS infection. Thrush can also be misdiagnosed when the cause of breast pain or nipple soreness may be caused by another issue. Painful letdown can be confused with thrush of the milk ducts, or nipple soreness due to incorrect latch, dermatitis from pumping or nipple shields or other nipple trauma or other nursing issues. There's a great handout that shows photos of the effects of different types of nipple trauma that may help you determine if you have thrush (see related links below). A lactation consultant once told me that the classic presentation of thrush would be when the nipples have the texture of tissue paper and are red and painful.
Common treatments for thrush might include nystatin, miconazole or gentian violet applications to the mother's nipples and/or baby's mouth (not all nipple treatments would be appropriate for the baby's mouth, so consult a pediatrician), or oral medications like diflucan. Changing the diet to make the body less susceptible to yeast colonization through diet might also be appropriate in combination with other treatments (see the series of articles on the BellaOnline Stomach Issues site on Systemic Candida and Candida Diet).
If you believe that you (or your baby) have thrush, try and get confirmation from your ob/gyn, primary care doctor, a lactation consultant and/or pediatrician. It can sometimes be tricky to find someone who can reliably diagnose thrush and has any idea how to treat it. I struggled with a thrush diagnosis for several months with my first daughter, and in my opinion, the absolute authority on this subject is Dr. Jack Newman in Canada. His Candida Protocol is available on the web (see related links below). Not only is he quite knowledgeable about thrush and what works, but his protocol also addresses the reality that thrush may be either mistaken for or related to another problem. His all-purpose nipple ointment addresses not only thrush but damaged nipples and dermatitis that may accompany thrush or be confused with it. He also recommends gentian violet, which is sometimes controversial, but widely believed to work. I was even once told by a lactation consultant that if gentian violet doesn't cure it, it is isn't thrush (and in my case, that turned out to be true!).
If you have thrush, or have breast pain believe you may have thrush, seek help immediately. Do remember to stay open to the possibility that it is not, in fact, thrush. In my case, what was thought to be thrush was an original misdiagnosis of a painful letdown (some women do have painful milk ejection reflex, especially in the early stages of nursing when milk lets down forcefully), in combination with dermatitis due to using a nipple shield (see my article on Nipple Shields – My Experience in the archives of this breastfeeding site).
Finding a health care provider knowledgeable about thrush who can help you with Dr. Newman's Candida Protocol, or other appropriate care as they advise can help move you past a sometimes hard-to-beat thrush infection and onto sustained breastfeeding. Do hang in there! When you finally prevail, you'll have cause to celebrate even more than most the satisfaction and connection an established and pain-free breastfeeding relationship brings to you and your nursling.
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