Thrush is a common yeast infection that can impact both baby and mom.

Thrush can occur in the baby’s mouth and/or diaper area. It can also happen on the mother’s nipples or in her vagina.

You are more likely to get a yeast infection if you have had antibiotics, damaged nipples or a present/past vaginal yeast infection. It is also more common in people with diabetes and those who are anemic.

Signs and symptoms

Baby

  • Creamy white patches (like curd or cottage cheese) in your baby’s mouth that do not wipe off with a soft, moist cloth
  • A white tongue on its own does not always mean thrush
  • Fussiness at the breast
  • Diaper rash which is red and rough and with well marked edges, that does not improve with a zinc oxide cream

Mom

  • Itchy, flaky, shiny or red nipples with small white spots or blisters
  • Sore nipples
  • Deep or shooting breast pain or a burning feeling while nursing
  • Pain may worsen during and after a feeding and may extend to the back, armpit or shoulder

Treatment

It is important that both you and your baby are treated as the infection can be passed on to one another. There are many options for treatment. Discuss with your public health nurse to know what is best for you.

If yeast infections are caught early, non-prescription treatments may be effective. These include gentian violet and over-the-counter creams. If you are unsure, it is always best to consult your health care provider.

Non-prescription treatment options

Gentian violet – aqueous 0.5% - 1% solution

An old remedy, gentian violet is inexpensive and quite effective. However, it is messy – staining skin and clothing purple.

Pour a very small amount of gentian violet into a small cup. Using a Q-tip, paint your nipples and areolae (dark brown area around your nipple). Paint your baby’s mouth including cheeks, top and bottom of tongue, gums and the roof of the mouth.

Do this twice a day for three to seven days. Stop after four days if symptoms are gone. If symptoms are still present after seven days, stop and consult with your doctor.

Over-the-counter creams

  • Miconazole 2% (Micatin, Monistat)
  • Clotrimazole 2% (Lotrimin, Mycelex)

Apply a pea-size amount to your nipples and areolae (brown area around your nipple) and rub in gently before and after all breastfeeds. Continue for at least two days after your pain and burning and the patches in your baby’s mouth are gone. If symptoms are still present after seven days, stop and consult your doctor.

Prescription treatment options

Dr. Newman’s All Purpose Nipple Ointment

Dr. Newman’s combination cream contains medicines that fight yeast, bacteria and inflammation. A doctor's prescription is required.

  • Mupirocin 2% ointment (15 gm)
  • Betamethsasone 0.1% ointment (15 gm)
  • Miconazole powder to a final concentration of 2%

A small amount is applied after each feeding and does not need to be removed. If symptoms persist after seven days, consult your doctor.

Diflucan

An oral antifungal treatment. The initial dose for mother is 200-400 mg, followed by 100-200 mg twice daily for two weeks. Note the dose for a yeast infection in the breast is much higher than for a vaginal yeast infection. Continue to use until symptoms disappear for at least one week.

Initial dose for baby is 6 mg/kg followed by 3 mg/kg (one dose daily) for the same duration as mother.

Other prescription medication

Your doctor may prescribe oral and topical antifungal medicines, such as nystatin.

Steps to prevent spread

  • Wash your hands before and after feedings and diaper changes. Use regular (not antibacterial) soap. Use paper towels or change towels often. Hand sanitizer can also be used.
  • Rinse nipples with plain water and air dry after feeds.
  • Wash bras, cloth breast pads and diapers in very hot water and dry well in hot drying or sunlight. Change cotton breast pads when moist, or at least once a day. Disposable breast pads may be a better option. Change at every nursing. Wear a clean bra and clothing each day
  • Items such as bottle nipples, soothers, bottles and sippy cups should be boiled continuously for 20 minutes every day. Any used breast pump parts in contact with breast milk must also be boiled.
  • Wash baby’s toys in hot, soapy water and rinse well.
  • Wash baby’s hands often if he sucks on them.
  • If your baby has diaper rash, wash well with water, air dry and apply antifungal ointment at each change.
  • Discard any extra milk which is pumped during a yeast infection and is not used within a day. Saved milk that contains yeast may re-infect your baby.
  • If yeast keeps coming back, check all family members, including pets.

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