Candida or thrush of the nipple and breast

Herzl Family Practice Centre, Goldfarb Breastfeeding Clinic and Program Patient handout

Definition:

Candida albicans is a type of fungus that can cause infections in various warm and humid places, such as the nipples, breasts, skin, vagina, mouth, and baby’s bum → these infections are commonly called “thrush” or “yeast infections”.

Risk factors for developing thrush:

For mother:

• Recent use of certain medications like: antibiotics, birth control pills, or anything with cortisone or steroids.
• Cracked or damaged nipples.
• Vaginal infections.
• Diabetes.
• A weak immune system.
• Diet → very high in sugar and yeast, or low in vitamins and minerals.

For baby:

• Use of a bottle nipple or pacifier.
• Use of artificial infant formula.

If you have thrush, you may notice the following:

In the mother:

• Redness, shininess, irritation and/or peeling skin on the areola or nipple.
• Nipple and/or breast pain:
  • Often at the end of a feed, or anytime during or in between feeds.
  • Burning and/or itchiness of the areola or nipple.
  • Deeper pain, either burning, throbbing, or shooting.
  • Pain that does not get better even with a good latch.

In the baby:

• White plaques in the mouth or on the tongue that you cannot remove.
• A red rash on the bum and diaper area.
• A fussiness or refusal to take the breast, or general irritability.

Even if the baby has no signs of infection, the mother may still be infected, and needs to seek treatment from a health professional or lactation specialist.

How to treat a candida infection?

First of all, make sure your baby has a good latch and that you have no pain while nursing.

Home remedy:

It is important to seek professional help if you think you might have thrush. However, you can try this home remedy in the meantime.

Rince your nipples with 1 tablespoon (15 ml) vinegar in 1 cup water (250 ml), every hour for a 24-hour period.

Treatments that may be suggested by your health professional:

• The use of Advil™ or Motrin™ (ibuprofen) and/or Tylenol™ (acetaminophen) may be very useful to treat the pain of thrush. These medications are safe during breastfeeding.
• Gentian violet, in a 1% aqueous (water-based) solution:
  • Use a cotton-tipped Q-tip to apply the solution in the baby’s mouth (swab inside baby`s cheeks, gums, tongue, roof of the mouth and under the tongue) so that all areas are covered violet. Once that is done, let the baby feed on both breasts. Make sure you use a fresh Q-tip with every application.
  • Otherwise, you can paint both nipples and areola with a Q-tip of gentian violet, and let the baby feed afterwards. The baby`s inner mouth will also turn violet.
  • Note: You do not have to apply Gentian violet in the baby`s mouth AND on your breasts, one of the above is enough.
  • Apply once a day, before a feed, for a period of 4 to 7 days. Whether things are better or not, the treatment should be stopped in 7 days, and you should return to see your health professional.
  • Gentian violet is safe for breastfeeding mothers and babies. However, in rare cases, it can cause some irritation in baby’s mouth. If you suspect this, stop the treatment immediately and contact your health professional. ** Be careful, as Gentian violet can stain clothes.
• Grapefruit seed extract (GSE):
  • There are 2 ways of using GSE:
    1. Mix 2-5 drops of GSE in 30 ml (1 oz) of distilled water. Use a Q-tip to apply this diluted solution on the nipple/areola after every feed. If also using APNO (see below), you can apply it to the nipple/areola after the GSE. Remember to change the Q-tip with every new application.
    2. GSE can also be taken orally by the mother. The dose is 250 mg 3 times in a day in pill form, or 5 drops in water 3 times a day.
    3. GSE can be added to the laundry, in a dose of 15-20 drops in the rinse cycle.
  • Remember that certain medications do not mix with GSE, such as domperidone (used to increase breastmilk supply) and fluconazole (a medication for thrush, discussed below).
  • Grapefruit seed extract is safe in breastfeeding mothers and babies.
    • These treatments can be done together, and can continue for 2-4 weeks or more, depending on instructions from your health professional.
    • Probiotics can be useful to treat and prevent thrush. You can take them in the form of Bio-K in yoghurt or pill form, acidophilus pills, or yoghurt pills. You may take probiotics for weeks, based on instructions from your health professional. They are safe for breastfeeding mothers and babies.
• APNO (all-purpose nipple ointment):
  • APNO is available by prescription only, and is made of 3 ingredients, an anti-fungal, anti-bacterial, and anti-inflammatory.
  • A thin later of APNO should be applied on the nipple and areola after every feed.
  • Make sure to check with your health professional for long you can use APNO.
  • APNO is safe for breastfeeding mother and babies, but if you feel any burning, irritation or pain while using it, stop right away and contact your health professional.
• Fluconazole (DiflucanTM):
  • This is a pill to treat thrush which is usually reserved for severe, long-standing or repetitive cases of thrush.
  • The dose is 400 mg the first day, followed by 100 mg twice a day for 2-4 weeks or longer if instructed by your health professional.
  • Fluconazole cannot be taken with grapefruit or grapefruit seed extract, and is safe for breastfeeding mothers and babies.

Home hygiene:

For cases of severe or repetitive thrush, certain things can be done in the home to prevent the growth of fungus in general. Note that these things are not essential if your thrush is easily treated, only if it keeps on coming back, or does not go away easily:

• Wash your hands and baby’s hands often.
• Wash your breasts and nipples in the shower/bath daily with water and soap.
• Wear a fresh clean bra everyday.
• If you are using breast/nursing pads, use disposable ones, and change them after every feed.
• Wash all clothes and towels that come into contact with your breasts or baby in hot water.
• Any object which is put in baby’s mouth can come into contact with candida: o Boil pacifiers, bottle nipples, teething rings, baby’s tooth brush, and medication droppers for about 20 minutes, once a day. o After a week of treatment for thrush, throw out the above objects and buy new ones.
• If you are using a breast pump, boil all the pieces that come into contact with your milk, for 20 minutes every day.

More home hygiene:

If the above don’t work, and you are still dealing with recurrent thrush, you may want to try the following:

• Start using paper towels to wipe your hands, instead of the same towel.
• For laundry, you can add 1 cup (250 ml) of bleach in the wash cycle, and 1 cup (250 ml) of vinegar in the rince cycle to boost washing power.
• Clothes can be dried in the dryer or on a clothesline exposed to the sun (if possible). Ironing clothes can also kill candida.
• All family members should be checked and treated for any candidal infections.
• Pets can also get candida infections.

Normally, you should feel better with the treatment prescribed by your health professional. If you are not better, it is important that you return to see your health professional.

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The information contained in this patient handout is a suggestion only, and is not a substitute for consultation with a health professional or lactation specialist. This handout is the property of the author(s) and the Goldfarb Breastfeeding Clinic. No part of this handout can be changed or modified without permission from the author and the Goldfarb Breastfeeding Clinic. This handout may be copied and distributed without further permission on the condition that it is not used in any context in which the International Code for the Marketing of Breastmilk Substitutes is violated. For more information, please contact the Goldfarb Breastfeeding Clinic, Herzl Family Practice Centre, SMBD Jewish General Hospital, Montreal, Quebec, Canada. © 2009