Breastfeeding And Nipple Thrush

Nipple thrush is a fungal infection of the nipple that can cause pain in the breast of breastfeeding mothers. This infection can even pass back and forth between the mother and the baby.¹ This is a treatable condition and it is safe for breastfeeding to be continued during infection and treatment.

Certain physical and environmental conditions can make the body more susceptible to thrush. The warm, moist environment of the nipple during breastfeeding, as well as nipple cracks, make it easy for fungi to grow and cause infection. Thrush is treatable with anti-fungal cream and both the mother and baby should be treated at the same time if they both have it. The treatment is safe for both the mother and the baby.²

What causes nipple thrush?

A fungus called Candida is the cause of nipple thrush.¹ This is a fungus that normally stays on the skin and is kept under control by good bacteria. However, certain conditions can affect this balance, causing it to grow and cause infection.

Who is at risk of getting nipple thrush?

If a feeding mother or her baby was previously treated with antibiotics or a medicine called steroids, this can cause an imbalance between good and bad organisms in the body, like bacteria. This can lead to growth and infection by the fungi Candida. If the nipple skin is cracked or damaged, which can happen in breastfeeding, that also predisposes the individual to this infection. 

Those who have had previous vaginal Candida infections, those living in warm, humid climates or have excessive sweating are also more at risk. Wearing feeding bras for long periods, not changing breast pads frequently, or not washing hands frequently can all contribute to increasing the risk of infection.³

Any person whose immunity is low due to some other medical condition is also at a higher risk of a Candida infection. Generally, fungi thrive in warm and moist environments, hence making the nipples more susceptible during breastfeeding.

How do I know if I have nipple thrush?

Pain in the breast is one of the commonest symptoms of thrush. However, thrush is not the only cause of pain in the breast in a nursing mother. One of the more common reasons is that the baby is not latching onto the breast properly. 

The pain that occurs in thrush usually occurs in both breasts and usually occurs after feeding, even when you are free from pain during feeding. 

The pain can range from mild soreness to deep pain in the breast that can persist for up to an hour after feeding. 

If you have pain in one breast or always had pain during breastfeeding, thrush may not be the reason. In nipple thrush, your nipples may be itchy, tender or red with flaky skin or, more rarely, have tiny, white pin-head-like patches.

How do I know if my baby has thrush?

Babies usually develop small white patches on the inside of their mouths or upper palate. These spots do not go away even if you gently wipe them. The tongue may appear coated with a ‘cottage cheese-like appearance. Additionally, the babies may be fussy to feed as their mouth is sore.⁵ They may also be a little more irritable. Some babies also can have a nappy rash at the same time, since the same organisms cause both these infections.

How do doctors diagnose nipple thrush?

Your doctor may ask you about symptoms, such as pain in the nipples of both breasts after feeding. They may also examine you and note the change in colour of your nipples, such as shiny redness or pink colour.

In babies, there may be white patches inside of their cheeks or upper palate that will not disappear with gentle wiping. There may even be a thick white coating on the tongue.

Are laboratory tests needed to diagnose it?

Usually the characteristic symptoms and signs are enough to diagnose this condition. Sometimes, the doctor may have to collect a sample from your nipple discharge to diagnose the type of fungi that is causing the infection.

How is nipple thrush treated in mothers?

Most often, nipple thrush can be treated by a topical application of an anti-fungal cream. Miconazole is one such anti-fungal that is available in different trade names. 

This should be applied sparingly over the nipple area after feeding. Usually, with this treatment, the symptoms tend to go away in two to three days. 

However, it is essential to take treatment for at least 10 days or a week after the symptoms subside. If the body is not responding to this or if deep breast pain persists, which is quite rare, some patients may need oral treatment like antifungal tablets.

How is thrush treated in babies?

Thrush in babies can also be treated with topical applications like antifungal gels. There is one called Miconazole and some of them are available in oral suspensions. These are usually used in babies over 4 months of age. If your baby is under 4 months, it is best to see a doctor to have the suitable treatment prescribed.

It is very important to treat both the mother and the baby at the same time if they both have the condition, or else they will keep passing the infection back and forth to each other. In some cases, either the mother or the baby or both may be given oral probiotics as capsules. These contain good bacteria and help restore the body’s normal balance between good bacteria and other organisms.

How do I prevent a recurrence of nipple thrush?

Good hygiene practices during breastfeeding are always important as otherwise, nipple thrush can reoccur. Washing your hands before and after nursing your baby is always considered good practice.

Since the fungal spores can survive in cold water, it is important to 

• wash your feeding bras and towels in hot water 
• ironing also helps kill the fungal spores.⁶ 
• ensure that you do not share towels with anyone
• you can ensure that you wash your hands with soap and water after changing the babies’ diapers
• if you are using pacifiers or dummies for the baby, make sure they are sterilized properly in boiling temperatures. While you are being treated, it would be advisable to change your breast pads frequently or else use ones with disposable lining
• ensure that you wash your hands thoroughly before and after applying the anti-fungal cream on your nipples

Can I still breastfeed my baby while having nipple thrush?

Thrush is not a reason to stop breastfeeding. You can take treatment and continue to breastfeed your baby. If you stop nursing your baby until thrush is better, your milk supply may become low.

If the breasts are very painful, you can take pain killers that are safe to be used during breastfeeding.⁵

If there was breast milk that was expressed and stored at the time of infection, these should be discarded and not used later as the organisms can persist in the feeds and pass to the baby.

Summary

Nipple thrush is a fungal infection that can occur on the nipple during breastfeeding. It can cause pain and soreness in the nipple as well as redness. The infection can also pass from the mother to the baby and can be seen as white patches inside the cheeks or palate of the baby.

This is a treatable condition most often cured by topical antifungal cream. Rarely, oral antifungals may also be required. Less commonly, your doctor may take a sample from the nipple discharge or a swab from the skin area to confirm the presence of the fungi.

Certain conditions like taking previous antibiotics can predispose to thrush. Good hygiene practices during nursing can contribute to keeping thrush away. These include changing breast pads frequently, washing your hands and keeping your breasts clean and dry after breastfeeding. 

Breastfeeding need not stop because of thrush. It is quite important to continue it because otherwise, reduced feeding will lead to a low milk supply in the mother.

Poor techniques causing cracks or soreness in the nipple can predispose to thrush.

When treating thrush, it is important to treat both mother and baby at the same time. Thrush is not the only cause of pain in the breast. It is important to explore all causes of breast pain that occur related to feeding as these can have multiple implications for mother and baby.