Thrush and Yeast on Nipples. What you need to know
Do you have sharp, stabbing pain in your nipples? Does your baby have a thick white coating on their tongue that is not easily removed with your clean finger?
You might want to be seen to evaluate for thrush in your baby's mouth and also yeast on your nipples. Mom and baby are almost always treated together unless mom exclusively pumps.
Thrush usually continues to worsen over time unless treated. Moms may not believe they have yeast on their nipples because they are waiting to see white plaques like the baby's tongue. Don't keep waiting for that to appear! Moms usually have shiny skin on their nipples, irritated red or bright pink nipples.
Many times, the first thing I hear is, "I think the latch has gone bad." If the latch was well established and randomly is painful-- and the baby may be refusing to latch, there's my sign to be particularly looking for yeast. If you have a brand-new baby, a newborn- yes, the baby can get yeast in the mouth right away. A 4-day old infant could possibly have yeast growing on their tongue.
If mom was leaking milk prior to delivery and may not have been changing her breast pads often or washing her bras in hot soapy water, then the yeast will grow.
Yeast is normally found on our bodies. It grows and flourishes in wet, warm, and dark places. Yep, your bra is a wonderful place for yeast to feel at home.
How do we prevent thrush/yeast infections? Air out your nipples whenever possible, especially at night. Change your nipple pads often, just like you would a feminine pad. Wash your bras every day, especially if they are damp. Wash in hot, soapy water.
How is thrush treated?
There are several ways to treat. It usually depends on what the provider is used to. Most commonly I see moms prescribed an oral antifungal called Diflucan. (Don't drink alcohol when you take this, it will make you sick!) Or they will prescribe APNO, also known as Jack Newman's all-purpose nipple ointment, also known as triple nipple ointment, also known as magic nipple cream (mostly by me, lol). I prefer to see moms treated for yeast on nipples locally with APNO, so the other healthy yeast in their body stays put.
APNO needs to be sent to a compound pharmacy which is a special pharmacy that puts powders and liquid medication together and makes special creams and concoctions. They're pretty much wizards. It may take several hours before your APNO is ready for pick up.
Compound pharmacies in the Des Moines area include:
Hy-vee Windsor Heights
5 Star Pharmacy Des Moines
Central Iowa Compounding Urbandale
Precision Compounding Urbandale
On top of APNO after feeds, clotrimazole 1% is usually encouraged prior to feeds on your nipples. This way it also coats the baby's mouth when they latch. Where do we buy clotrimazole? Pretty much any pharmacy or store. It is over the counter and may be found in the foot fungus isle. Yes, it could be used for foot fungus. Not that foot fungus is on your nipple--or is it :)
For oral thrush in babies the go to medication used to be liquid nystatin. Yay Nystatin! Recently doctors realized that babies kept returning after being treated with nystatin. So, sometimes they treat with fluconazole or gentian violet. But it is a practical option to start out with the least invasive antifungal, so yes, your baby may start out with Nystatin treatment.
They will tell you to use the dropper to drop the liquid in the sides of their cheeks and on the tongue. We don't want the medicine to be put in a bottle and bypass the mouth all together, then we are defeating the purpose, TREATING THE MOUTH!
Speaking of the mouth. Commonly we see the yeast travel down the digestive tract all the way to the anus. The yeast will set up shop around the rectum and look bright red with red raised spots. Oh yeah, it's very contagious and will find other warm, dark, wet places to grow.
Wash any binkies or nipples with hot soapy water and boil them every day. Change your nipple pads often, wash your bras often, air out your nipples at night, even if it gets messy!
Thanks for reading!
Crystel Corbin, RN, IBCLC
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