Breastfeeding A to Z

Care Plan For Thrush

Thrush or a yeast infection is caused by candida albicans. 

Candida albicans is a one-celled organism that causes both thrush and vaginal yeast infections.  It is a fungus that thrives in moist, dark places, which include: the nipple area, the mouth, tonsils, milk ducts, vaginal and diaper areas. (1)

SYMPTOMS

Mother

  • Sudden onset of intense nipple or breast pain (sometimes described as being “on fire”)
  • Nipples that are itchy or burning and can appear pink, red, shiny, flaky and/or have a rash with tiny blisters
  • Cracked nipples, especially if they happen after breastfeeding is established and things were going fine
  • Shooting pains in the breast during or after feedings
  • Vaginal yeast infection
  • May occur after a course of antibiotics
  • May have NO visible symptoms

Baby

  • NO visible symptoms
  • Diaper rash
  • Creamy white patches or cottage-cheese looking covering of baby’s mouth, cheeks, tongue or tonsils.  Note: a milk film will wipe off with a washcloth, thrush will not easily come off, or may have a red or bleeding base to it.
  • Having trouble nursing–mouth can be sore
  • May occur after a course of antibiotics

WHAT TO DO?

  1. See your healthcare provider for medication.  Mother and baby should be treated at the same time for the same length of time, even if one of them doesn’t exhibit symptoms. (1)(2)(3)
  2. Don’t be discouraged once you start the medication, sometimes the pain may become worse before it gets better.  (3)  Thrush or yeast infections are treated with different medicines in different parts of the world, as a strain in a particular area can be resistant to some treatments, so if after 3 days you’ve seen no improvement, check with your healthcare provider again. (3)  Once you’ve found medicine that works, you will want to use the full course of the medicine.
  3. If your thrush medication is the type with an applicator you may find a cotton swab or gauze pad can sometimes be helpful in applying medication also.  Be sure to try to get some between cheek and gum line of baby’s mouth.
  4. Wash your hands with soap and water, use paper towels to dry.  You want to be able to throw away the towels, so yeast is not spread on damp moist towels.
  5. Offer short, frequent feedings, to help if your breast is tender or if baby’s mouth is sore.
  6. Breastfeed first on the least sore side (if there is one).
  7. Rinse nipples with water after each feeding and pat dry.  This helps remove any thrush that remains on your nipple from your baby’s saliva.  Thrush thrives on milk and in warm moist areas. (3)
  8. Expressed breast milk during a thrush outbreak should not be saved or frozen beyond when mom and baby are being treated for thrush.  Freezing deactivates yeast but does not kill it.  If expressed milk is given after treatment of yeast is over, thrush can reappear. (2)
  9. If baby uses pacifier, bottle nipple or teething toy, they need to be boiled for 20 minutes once daily to kill thrush.  After one week, discard and replace them.
  10. Any toys your baby uses need to be boiled once per day or washed in hot soapy water. (3)  Toys that can’t be boiled can be washed daily in hot soapy water.  Rinsing toys in vinegar and then plain water can also help.  Doing these things decrease the chances of spreading the infection or having it reappear.
  11. If you are using a breast pump, boil all parts that touch the breastmilk once per day for 20 minutes. (3)
  12. Disposable nursing pads should be changed and discarded as soon as they are wet.  If you use reusable nursing pads see laundering instructions below.
  13. Hot, dry and acid environments kill yeast.  Launder any towels or clothing that comes in contact with the yeast infection in hot water (above 122 degrees F. or 50 degrees C. preferably), before using again. (3)  As an added precaution, items, especially, bras and reusable nursing pads can be rinsed in mild vinegar and water solution before or after washing.
  14. Try to reduce your consumption of sugar and increase your intake of yogurt with active acidophilus (acidophilus is also available in pill form) when on any antibiotic therapy. (3)  Check with your healthcare provider regarding amounts.  Antibiotics kill the good bacteria as well as the bad–it is often after a course of antibiotics that mom/baby will develop thrush/yeast infection.  This is not a reason to not take your full prescription of antibiotics, this is a way to keep the balance of bacteria happy in your system.

References:

  1. Mannel, R, Marten, PJ, Walker, M, Core Curriculum for Lactation Consultant Practice, 3rd edition, Burlington, MA, Jones & Bartlett Learning, 2013, pp 764-66.
  2. Lawrence, RA, Lawrence, RM, Breastfeeding: A Guide for the Medical Professional, 7th edition, Maryland Heights, MO, Elsevier Mosby, 2011, pp 558-59.
  3. Mohrbacher, N, Stock, J, La Leche League International The Breastfeeding Answer Book, 3rd revised edition, Schaumburg, IL, La Leche League International, Jan 2003, pp 127-28, 480-84.