Yeast Troubles & Breastfeeding
by Susan Miller, BScNYeast infections occur in about 20 per cent of nursing mothers and their babies, creating exceedingly uncomfortable and discouraging situations for breastfeeding. This type of yeast infection is caused by an overgrowth of a fungus called candida albicans, which is found in the mouth, vagina and stool of most people. Ninety per cent of healthy newborns have this type of normal yeast colonization within hours of birth. At certain times however, the candida can overgrow causing a yeast diaper rash or oral thrush for the baby and/or a yeast infection on the mother’s nipples. While these conditions are unpleasant, they are not dangerous to a healthy mother or baby but interfere with successful breastfeeding. Yeast infections need prompt attention as they severely limit a mother’s ability to breastfeed her baby due to the extreme nipple and breast pain caused by the yeast. A baby with a yeast infection of the mouth (thrush) will often have discomfort while nursing, causing him to nurse in an ineffective way that can leave him hungry and dissatisfied.
Mothers can be more prone to developing nipple yeast infection if they have had a prior yeast infection such as vaginal yeast, if they have recently taken antibiotics, or if they have sustained damage to the nipples due to the baby’s poor latch. It is also possible to develop a yeast infection without any of these conditions being present. Babies can develop oral thrush within days of birth without obvious visible signs. If either the mother or baby has the condition, both must be treated. If both are not treated at the same time, the yeast will be passed back and forth between mother and baby in a vicious cycle. It is important that yeast infections are identified early, and treated vigorously so that mother and baby can continue to breastfeed comfortably.
Signs of Yeast InfectionSigns of nipple yeast in the mother vary from woman to woman but any of the following are significant indicators:
• Increasing soreness of the nipples even when baby is positioned and latched correctly
• Nipple tenderness that occurs after a previous crack or sore has healed, or cracked nipples that will not heal
• Burning nipple pain or a deep jabbing breast pain that occurs during or after nursing. This pain my radiate to the mother’s back and shoulders as well
• Nipples that have a burning sensation when exposed to warm water spray such as in the shower
• Extreme nipple tenderness, itchiness and/or reddening of the nipples and sometimes white patches on the nipples.
It can be hard to make an absolute diagnosis of yeast infection in the beginning, as poor latch and nipple yeast have similar initial symptoms. Typically, poor latch pain occurs in the early days and resolves as the latch is improved. If after a period of comfortable nursing the mother begins to have nipple soreness and pain again, it is very likely that nipple yeast is to blame.
A baby cannot tell us that her mouth is sore, but we can look into the baby’s mouth to check for white patches. Oral thrush may be seen on the tongue, lips or inside of the cheeks. A white, coated tongue is an early sign of thrush. If the thrush is not treated at this point it will progress to white patches on the tongue and insides of the cheeks. These white patches do not wipe away. Babies with oral thrush can have a sore throat and tongue, causing them to pull off of the breast frequently during the feeding. In other cases the baby may feed in an awkward way that causes trauma to the mother’s nipples. Babies can exhibit other signs that they may be suffering from oral thrush even if there are no visible white patches in the mouth. Think of the possibility of oral thrush if your baby has any of these signs:
• The baby suddenly nurses poorly, latching eagerly onto the breast, then pulls away as if something is wrong, or the baby refuses to feed
• A red spotty or patchy diaper rash that does not respond to the usual diaper creams
• Baby is gassy and cranky
• Baby may have a slow weight gain
What To DoIf you suspect that you, your baby or both of you have a yeast infection, talk to your doctor, midwife or a lactation consultant about this. There are a lot of treatment options for nipple yeast and oral thrush. Even though various antifungal preparations can be bought without a prescription, it is best to consult with a medical professional about the different treatment choices. The treatment will depend on how long the condition has persisted, how severe it seems to be and other individual factors about you and your baby. No matter what is decided as a treatment, it is crucial that both mother and baby are treated at the same time. This would include treating any suspected “yeasty” diaper rash, and in some cases the woman’s partner if vaginal yeast is involved as well. An oral antifungal medication called Fluconazole (Diflucan) can be prescribed by your doctor for very stubborn yeast infections.
Yeast infection can be a miserable and painful experience for both mother and baby. After treatment has started you will likely notice that the most painful symptoms have gone away within three to four days. In order to make sure that the yeast does not return, the treatment must be continued for two weeks, as the infection can still be present without symptoms.
There are many practical measures that you can use to help prevent re-infection. This includes washing clothing in very hot water, good hand washing, boiling baby’s soother or bottle nipples each day and carefully cleaning and sterilizing all breast pump attachments. Your Public Health Nurse can provide many useful tips on how to cope with nipple yeast and oral thrush. Be sure to contact your Public Health Unit to talk to a lactation consultant or a nurse specializing in breastfeeding support. Also, check out this website for up-to-date breastfeeding information, including the treatments for yeast infection by Canadian pediatrician and breastfeeding expert Dr. Jack Newman
www.breastfeedingonline.com.Susan Miller R.N. BScN is a Perinatal Educator and Certified Breastfeeding Counsellor. She works with prenatal and post-natal families in the Greater Victoria area.
