Taking antibiotics to treat mastitis, pelvic infections or other wound infections, is one of the most common reasons for breastfeeding women to get thrush.
This infection with the yeast-like fungus Candida albicans can make a nipple and areola sore. Some affected women report sharp burning pains that shoot deep into their breast during a feed and worsen immediately afterwards. Sometimes they continue between feeds.
You may also have itchy nipples, with flaky pink, red or purple areas. There may be fine cracks around the nipple, perhaps with white matter inside. The areola may be shiny and slightly swollen, and have a bright red ring around it. Very occasionally thrush shows up as white spots on the nipples.
Candida is a normal inhabitant of our skin and bowels but in certain circumstances it can multiply and cause infection. If a mother or baby has a thrush infection (for example, in the mother's vagina or the baby's mouth or nappy area), they can pass it backwards and forwards to each other.
Thrush in a baby's mouth may show up with white spots inside the cheeks or on the tongue or gums; a nappy rash infected with thrush may look shiny or have a bright pink raised edge.
Candida thrives in warm, moist situations and likes milk, so a baby's mouth and a mother's nipples and areolae (particularly if she wears a bra and uses a bra pad) make very suitable breeding grounds. You are more likely to get thrush if you have recently taken antibiotics, have sore or cracked nipples, or are on the Pill.
Both mother and baby need simultaneous, prompt and vigorous treatment of any infected areas. This is best carried out for two weeks even if the infected area seems better earlier. There is no need to stop breastfeeding. In fact whatever else, you should continue to breastfeed as normal.
A pharmacist or doctor can recommend suitable anti-fungal medications (such as nystatin, miconazole or clotrimazole) for you and your baby; nystatin is usually used for a baby's mouth, while miconazole seems more effective on the nipples. Certain medications are available only on prescription. If you have vaginal thrush, your partner may need to be treated too.
Rinse your baby's mouth carefully with water after each feed and put a little (one millilitre) nystatin suspension into his mouth. Wash your nipples and areolae after each feed, dry well, then apply anti-fungal cream. Continue the therapy until the symptoms have been gone for at least 10 days. If you have deep shooting pains, you may need to take tablets of anti-fungal medication for at least two weeks as well.
Ideally, avoid using breast pads as they can encourage thrush, but if you do use them change them after each treatment. Have a clean bath towel each day, and when laundering towels and bras use water that's as hot as is safe for the fabric, and put a cup of vinegar in the rinse water.
If thrush still doesn't clear, your doctor may prescribe 1% aqueous gentian violet solution for use on your nipples and in your baby's mouth. Apply it once a day and for no longer than three days. The stain will make your nipples and your baby's mouth look dramatically purple.
Things you can do to help. A baby can become reinfected from anything that has previously been in his mouth, so if he uses a dummy, for example, boil it daily for 20 minutes. If you have repeated vaginal thrush, cut down on added sugar and other refined carbohydrates in your diet, as well as yeast-containing foods and drinks, including alcohol.
Home remedies? Research shows that treating thrush on the nipples by applying a vinegar solution (made with a teaspoon of vinegar in one cup of water) after each feed, and treating thrush in a baby's mouth with a bicarbonate of soda solution (made by mixing a teaspoon of bicarbonate of soda in a cup of water) may help stop itching, but don't cure the thrush.