Posted by: Admin | June 2, 2011

Dear LC – Nursing is really painful, the doctor said I might have thrush. What is it, and how can I get rid of it?

Many mothers say breastfeeding hurts their nipples, but it should not be painful to breastfeed your baby. It can be normal to feel some discomfort for the first few days after birth, but it should never be painful and the “discomfort” should never last longer than the 4th day postpartum.

So why is it that so many women find their nipples painful?

There are a few things that can cause painful nipples. The first and most common one is what I call the “awkward” period. A new mother always needs a few weeks before she is completely comfortable handling her baby. The baby also needs some time to get used to living outside of his mom’s belly! He needs to learn how to cope with many new things, such as breathing, swallowing, managing noise, light and feelings of hot and cold, and so on. A newborn baby instinctively knows how to latch on and suckle at his mother’s breast, but sometimes his suck is a little immature or he is a bit sleepy because of the medication his mother received during labor. So when you put together the new mother’s awkwardness and the baby’s immaturity, sore nipples happen! It this case, correcting the position and being extra careful with the baby’s latch, especially by making sure he opens his mouth really wide, will heal the nipples quickly.

The second most common reason of nipple pain is a disruption in the baby’s sucking mechanism. Usually, this disruption is caused by a bottle or a pacifier introduced before the baby was able to acquire a mature suck. On rare occasions, it is the baby’s anatomy (such as a tongue-tie or a high palate) that is the cause.


Another cause of sore nipples is thrush, which is what we commonly call an infection caused by a fungus (it is not a bacteria). The fungus that causes this infection is usually present before the birth of the child, especially if the mother is prone to vaginal infections (also called yeast infections). Antibiotics can also cause a fungal infection as they diminish the body’s defense mechanisms. Thrush can also be transmitted. For example, if your baby puts another baby’s teething toy in his mouth, your baby can catch a yeast infection and transmit it to your nipples during breastfeeding. Thrush thrives in moist and dark environments and it lives in our body in balance with other organisms. It is only when you are sick, during pregnancy or if you use antibiotics that thrush can thrive. It also grows in a baby’s mouth or diaper area because the baby does not yet have a full immunologic system.

The symptoms

While the symptoms of thrush in a baby can sometimes be overlooked, it is usually quite painful on a mother’s nipples. In a baby’s mouth, thrush may cause small white patches on the inside of the cheeks, on the gums and on the tonsils. Some babies are not bothered by these at all, while others find them painful and have feeding problems. A diaper rash can also be present. The symptoms on a mother’s nipples are sometimes less apparent, but some mothers present redness, a burning sensation on the nipple and, sometimes, a stabbing pain in the breast.

When the baby has white spots in her mouth that cannot be wiped off (do not rub hard, as they might bleed), and/or the mother has a painful burning sensation with a shiny or flaky red area on the areola all around the nipple, thrush may be the culprit. However, it is rarely so evident. The baby’s mouth can seem clear of thrush or the mother’s nipple can have only a slight redness. In those cases, it is the mother’s pain that will help us to evaluate what is happening. Mothers always describe a burning sensation, and, in bad cases of thrush, a shooting sensation inside the breast itself. In addition, this pain is present when the baby breastfeeds AND in between feedings. When a mother has sore nipples because of an incorrect latch of the baby at the breast, she will feel pain when the baby latches. If the baby is positioned wrong or if he has an immature suck, she will feel pain during the whole feeding, but once the baby is off the breast, the pain subsides. A burning sensation that does not go away in between feedings is typical of a fungal infection.

What is the treatment?

If the baby or the mother has symptoms of thrush, both must be treated at the same time. Otherwise, the infected one will contaminate the other. For the baby, an antifungal liquid will be prescribed and will need to be applied in his mouth a few times a day for at least 14 days. If the baby has a diaper rash, an antifungal cream will also be prescribed. For the mother, an antifungal cream or ointment will need to be applied on the nipples and areolas, more often in the beginning and then 2 to 4 times a day for 14 days. The length of the treatment needs to be respected even if the infection seems to be healed. Frequently, a cream containing both an antifungal agent and an anti-inflammatory agent is prescribed, as the first one can be irritating to the skin of the nipple and areola. Some doctors prefer to prescribe gentian violet, a tincture that has antifungal properties. This tincture can be applied to the baby’s mouth and on the mother’s nipples and areolas. If this is what is prescribed for your baby, make sure the concentration of the gentian violet is no more than 0,5% to 1% and that it is applied not more than twice a day for 3 to 7 days in the baby’s mouth. A stronger concentration or a too frequent use can lead to ulcers in the baby’s mouth. It should be stopped after 4 days if the symptoms are gone. Gentian violet can also be applied to the areola, but you need to remember it will stain all clothing purple. Some studies on rats show that, if taken in large amounts daily, gentian violet can be carcinogenic.

The success of the treatment not only involves compliance with the medication, but also demands rigorous attention to all actions and objects that can be a cause of recontamination. Here are a few things you need to watch out for:

–       Make sure your partner is treated if you have been diagnosed with a vaginal yeast infection.

–       Wash your hands often, especially after changing diapers and going to the toilet.

–       Wash your baby’s hands often.

–       Always wash bath towels after your shower or the baby’s bath. Having someone use your or the baby’s towel, or even reusing your own towel, might cause recontamination.

–       Wash any cloth or blankets the baby might bring to his mouth or suck on.

–       Use hot water with added vinegar to wash all clothes, blankets, towels and diapers that come into contact with your breasts or your baby’s mouth and diaper area.

–       Use only disposable breast pads while you have thrush and throw them away after each feeding. If you need to use cotton pads, they must be washed in hot water with vinegar.

–       Boil for 20 minutes daily all pacifiers and wash with hot soapy water any toys the baby puts in his mouth. Throw pacifiers away after a week and check toys and pacifiers often for any deterioration of the plastic.

–       Do the same for all breast pump parts that touch the breast or breastmilk.

–       Avoid using breast creams or lotions.

–       Wash your breasts and your baby’s diaper area with mild soap and water.

–       Do not keep any breastmilk expressed during that time. You can express and give the milk to your baby right away but you should not freeze it and give it to your baby once the thrush is healed. Thrush in breastmilk might survive to freezing (we’re not sure of this, but why take the risk?).

–       If you have an older child, watch that this child does not put toys or pacifiers in his mouth and then back again in the baby’s mouth (remember you should never “clean” a pacifier by putting it in your own mouth).

In mild cases of thrush, the mother might feel relief quickly but when thrush has been around for awhile, it might take up to a week of treatment before any change is felt. Also, many mothers feel a worsening of the symptoms in the first 2 days of treatment before the symptoms start to subside. Whatever happens, make sure to follow the full course of the treatment! You wouldn’t want the thrush to reappear…In very resistant thrush in the mother, the doctor might prescribe an oral medication for her and some experts recommend that she avoid yeast and foods with high sugar contents.


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