Candida infections of the nipples may occur any time while the mother is breastfeeding. Candida albicans likes warm, moist, dark areas. It normally lives on our skin and other areas, and 90% of babies are colonized by it within a few hours of birth. It, like many other germs that live on us normally, only becomes a problem under certain circumstances.
Candida infections of the skin or mucous membranes are more likely to occur when there is a breakdown in the integrity of the skin or mucous membrane-one of the reasons why a good latch is very important from the very first day. Many Candida infections would, perhaps, not have occurred if the mother had not had sore nipples and a breakdown of the skin of the nipples and areola. The oozing of liquid that occurs often from cracked nipples encourages Candida albicans to change from its harmless form to an invasive form.
The widespread use of antibiotics also encourages the overgrowth of Candida albicans. Many pregnant women, women in labor, and new mothers, as well as their babies receive antibiotics, which can increase the chances of yeast occurring. (this is per Dr. Jack Newan's reference 2009.)
- If you have nipple pain that begins after a period of pain free nursing, yeast should be ruled out by mother and baby MD.
- If you have burning nipple pain that continues throughout the feeding and sometimes continues after the feeding if though the baby is nursing well, yeast should be ruled out.
- If you have pain in the breast that is "shooting" or "burning" and it seems to go through to the mother's back and shoulder and tends to be much worse at night, call your MD.
Once treatment is begun, you should see some improvement in 1-2 days.
Remember that both Mother and baby must be treated at the same time. Ask baby's MD to check for both oral thrush & candida diaper rash.
Wear a clean washed cotton bra daily. Use disposable bra pads without waterproof liners. Change pads after each feeding. If using disposable breast pads, boil them in vinegar water solution for 5 minutes after washing.
- Wash hands frequently. Keep nails clean and short. Use a nail brush to scrub under your fingernails.
- Use a clean towel for each bath or shower. Do not let damp towels hang in bathrooms or kitchen. Consider paper towels for drying hands.
- Wash all bras, towels, wash clothes, and baby's burp clothes in hot soapy water daily.
- Wash all breast or pumping equipment that touch your breasts or breast milk in hot soapy water after each feeding/use. Boil 5 minutes daily in the vinegar water solution. You may wish to consider using a microwave steam sterilizer bag which quickly sterilizes baby bottles and parts.
- Boil infants nipples &/or pacifiers or toys that go in baby's mouth in vinegar solution for 5 minutes daily (or use a microwave steamer bag). Replace nipples/pacifiers after 10 days of treatment. Clean baby's toys with vinegar and water to prevent another infection.
- Avoid sugary foods, cheeses, breads or alcohol until treatment is complete.
- Add live culture to your diet once or twice a day. Try yogurts low in sugar, probiotics or acidophilus (viable units) (1 capsule TID x 4 days).
- While you and baby are being treated for yeast, your refrigerated, fresh, or milk frozen during thrush treatment can be used safely for baby.
- Freezing deactivates yeast, but does not kill it, so label all milk pumped and frozen during a thrush outbreak.
- If you wish to further minimize baby's risk: when you thaw/use the frozen "thrush" milk, dilute it by mixing it with milk expressed at a different time, or "heat treat" the defrosted "thrush" milk by heating it for a couple of minutes to a temperature of 122 degrees F (50 degrees C.). Some "scald" milk which heats milk just until it begins to steam. (This is a much higher temperature and destroys most of the antibodies in breast milk, but it is still much more nutritious than formula)
- Use oral Nystatin liquid medication as prescribed by MD. You may wish to try using half the dose 8 times a day instead of 4 as usually prescribed. Place medication in a small cup, coat all over the inside of baby's mouth with a Q-tip or clean finger. Give any leftover medication to baby from the dropper. Use medication for at least 14 days.
- Some MD's prescribe diflucan for baby to treat thrush.
- The pharmacist will direct you on how to give it to your baby.
- Call baby's MD if baby gets a rash in the diaper area
If the above recommendations are not effective, and nipples remain sore, call St. Luke's Lactation Service at (319) 369-8944. The Lactation Consultant will discuss your concerns and decide if an office visit is needed.