In the early days of breastfeeding it is normal to experience some nipple tenderness. This usually subsides in the second week of breastfeeding. However if you have persistent sore and/or cracked nipples that don't respond to standard sore nipple treatment (see section SORE NIPPLES), while your baby is correctly positioned and latched on well, thrush or candidiasis is a likely possibility.

Thrush is caused by a yeast called Candida Albicans and it thrives on warm, moist areas such as the baby's mouth and diaper area and a mothers nipples and vagina. Thrush can also affect other parts of the body where skin touches skin, like under the arms, in the groin or under the breasts.

Thrush should be suspected if you have been breastfeeding without pain and suddenly develop extremely sore nipples. The pain is typically a burning or stinging sensation that lasts through out the feeding and may continue afterwards as well. The nipple is especially sensitive to touch and can be deep pink or red, sometimes with tiny blisters, white spots or flaking skin. The areola can be shiny, but in some cases the nipple area appears normal. When you have also an intense stabbing or burning pain in your breasts during and between feedings a secondary yeast infection may have invaded either your milk ducts or areas of the breast surrounding the milk ducts. The let-down reflex is often very painful in this cases and the breast may ache all the time.

If you suspect you may have thrush it is a good idea to check your baby for thrush as well. A baby with thrush may have a diaper rash with raised, red, sore looking patches and/or red scalded looking buttocks. The symptoms don't respond to ordinary diaper rash remedies. Inside baby's mouth (on the tongue, gums and inside of cheeks) you may find creamy, white patches. Your baby may also be gassy or fussy, frequently pulling off the breast or making clicking sounds while sucking. Your baby may also be without symptoms but will still need to be treated together with you.

Candida is a naturally occurring yeast that normally lives harmlessly in humans, however, at times, an overgrowth of candida may occur, for example if you have just finished a course of antibiotics ( antibiotics kill also the beneficial bacteria that keep yeast under control) leading to infections such as vaginal thrush in women or oral thrush in babies. A newborn baby can acquire thrush in the birth canal during delivery if the mother had vaginal thrush at the time of birth and in this way the baby can infect the mother's nipples during breastfeeding. It takes about 1-2 weeks for thrush to appear in baby's mouth.

OTHER FACTORS THAT PROMOTE THE OCCURRENCE OF THRUSH

* Pregnant women are more susceptible to vaginal thrush due to hormonal changes
  that raise sugar levels in the vagina.

* Babies are more vulnerable to candida because their immune systems are still
  immature.

* Damage of the nipple can provide an entrance for invading candida.

* Thrush infections often occur when a mother is over-tired or run down.

* Women with diabetes or anemia are more susceptible to thrush infections.

* Use of anti-bacterial soaps decrease the amount of normal bacteria that help protect
  against thrush.

* Use of corticosteroids change the body's immune response.

* Damp breast pads, synthetic underwear and tight jeans create warm, moist areas where   yeast can thrive.

* Diets high in sugars, alcohol, yeast and diary products may promote the growth of yeast.

* Diets low in iron, folic acid and vitamins A,B,C,K may play a role as well.

If you suspect you may have thrush you should contact your doctor for medication both for yourself and for your baby and continue with the treatment for the full course since thrush can recur if you stop the medication too soon. Nystatin cream and liquid is most often prescribed for mother and baby. Usually drugs need to be continued for 1-2 weeks after symptoms disappear. Symptoms may be worse for the first 1-2 days after starting medication before they improve. To help speed up relief you can rinse your nipples with clear water and air-dry them after each feeding, as thrush thrives on milk and moisture. Afterwards you apply the cream prescribed by your doctor.

Before the pain is gone, the following suggestions may help to make breastfeeding more comfortable:

* Give short, frequent feedings, nurse baby first on the least sore side (if there is one).
* Make sure to break baby's suction before taking him from the breast.
* Try numbing the nipples before breastfeeding by applying ice wrapped in a damp cloth.
* If your nipples are so sore that you can not tolerate the baby nursing at your breast,
  pump your milk and feed it to your baby. Avoid using bottles if your baby is
  under 4 weeks old because of the risk of nipple confusion, use instead a cup, spoon,
  eyedropper or syringe.
* If your nipples are too painful to tolerate clothing you can try wearing ventilated breast
  shells during the day.

Since thrush can easily spread among family members, careful personal and family hygiene is essential to reduce exposure to candida and thus reducing the possibility of reinfection.

The following precautions can help you prevent recurrence:

* Wash your hands before and after breastfeeding, toilet use and diaper change.
* Use wash cloths and towels only once before washing them and don't share them with   family members.
* Wash laundry in very hot water, add 1 cup of vinegar to the rinse water, hang
  laundry in the sun to dry
* Wear cotton bra and underwear.
* Change breast pads at every feeding, avoid the ones with plastic backing.
* Boil pacifiers, bottle nipples, teethers and any breast pump parts that come in contact
  with your milk or baby's mouth every day for 10-20 minutes.
* After each feeding you can rinse your nipples with a solution of 1 table spoon vinegar in
  1 cup of water or l tea spoon baking powder in 1 cup of water. After air drying the nipples
  you can apply the anti fungal cream prescribed by your doctor.
* If your baby has oral thrush rinse or wipe your baby's mouth with water after every
  feeding   before giving the medication.
* If your baby has a diaper rash, wash baby's bottom at every diaper change with warm
  soapy water, rinse and dry well, use a clean cloth every time. Apply the anti fungal
  cream as prescribed by your doctor. Expose your baby's bottom to the air as much
  as possible by leaving his diaper of.

If your thrush is very persistent or recurrent your partner may have thrush as well, without having the symptoms, and may re-infect you during sexual contact. In this case your partner needs to be treated as well.

Dietary changes can help in several ways:

* Eating yogurt containing lactobacillus bacteria help to reduce the body's colonization with   candida.
* Avoiding or decreasing the consumption of sweets reduces the intake of sugars on which   yeast thrives.
* Eating vitamin-rich foods boosts the body's immune responds.
* Reducing the amount of yeast in your diet by avoiding fruits such as grapes and melons,   breads and fermented foods such as wine, cheese and vinegar.
* Reducing the amounts of diary products in your diet.

When you improve your daily hygiene practices and alter your diet, your response to pharmacological treatment usually improves.

In recent years an increase of the incidence of yeast infections have been reported. This increase could be explained by the development of more resistant strains of yeast, an increased amount of sugar in the average diet and a general lowering of the resistance caused by the increased use of antibiotics.

For information regarding individual Breastfeeding Consultation by online lactation consultant please click here.