called yeast, or thrush) is a fungus that occurs naturally in
the mucous membranes and on the skin. Use of antibiotics
promotes the overgrowth of yeast by killing off the ‘good’
bacteria that normally keep the yeast from multiplying too
quickly. During pregnancy, yeast infections are more common
because high levels of estrogen lead to elevated levels of
sugar, and yeast feeds on sugar.
If you or your baby have recently been on antibiotics, if
you have had a vaginal yeast infection during the last several
months (or anytime during pregnancy), or if your nipples are
cracked, then you and your baby are at risk for developing a
yeast infection. Other factors that make you more susceptible
to yeast include use of steroids or hormonal contraceptives,
or chronic illness such as diabetes or anemia.
of a yeast infection in your baby include creamy white spots
or patches on the mucous membranes inside the mouth (gums,
cheeks, or tongue). The spots may look pearly, and may be
surrounded by redness. If you gently scrape the spot, it may
be reddish underneath (unlike a coating of milk on the
tongue). Sometimes the inside of the lips or the saliva may
have a ‘mother of pearl’ appearance. The baby may be fussy and
gassy, and sucking may be uncomfortable for him. He may pull
off the breast, or may refuse to nurse at all. It is also
possible for him to have an overgrowth of yeast but have no
Yeast can also cause a rash in the baby’s diaper area. The
rash is red or bright pink, and may be scaly. The affected
area may contain small raised red spots or sore looking
pustules. The rash may be localized (the area looks like it
has been dipped in scalding water) or it may be diffuse and
lacy, covering a large area. Use of standard diaper rash
medications like petroleum jelly or Desitin does not clear up
a rash caused by yeast, and may actually make it worse,
because yeast feeds on the oils found in greasy ointments, and
also on the starch found in baby powders.
in the mother include severe stinging, burning pain, which may
be on the surface of the nipples, or may be felt deep inside
the breast. Pain often continues throughout the feeding and in
between feedings – especially immediately after. (Nipple pain
caused by incorrect positioning and latch on rarely hurts
except when the baby is nursing). Sometimes sharp, shooting
pain radiates from the nipple into the breast or into the back
or arm. Nipples are sensitive to light touch, so it may hurt
to have clothes rubbing against them, and it may be very
painful to take a shower and have the hot water spray touch
the breast. Mothers describe the pain as ‘liquid fire’, ‘hot
needles’, ‘razor blades’, ‘a piece of glass stuck in my
nipple’, etc. I’ve heard many mothers say that they would
rather go through labor again than have yeast on their nipples
or in their milk ducts, which gives you an idea of just how
painful this condition is.
The nipples may look puffy, scaly, flaky, weepy, or have
tiny blisters. They may be itchy. The color is often a deep
pink. The nipples may also look completely normal, but be
terribly painful (just as the baby’s mouth may be infected,
but not have white patches). Generally, the nipples don’t
“look as bad as they feel”, so there is often a tendency to
underestimate the severity of the problem based simply on
visual examination of the nipples. If you have yeast on your
nipples, or if your baby has it in his mouth, your milk supply
will often decrease. Pain inhibits the let-down reflex, and
babies with yeast often do not nurse as efficiently as they do
when their mouths are not sore. Yeast infections may also lead
to plugged duct and mastitis.
Once the infection is cleared up, you should be able to
build your supply up again quickly. It is important to note
that while yeast on baby’s bottoms or in their mouths may be
tender and irritated, it does not seem to cause extreme pain
like it does on the mother’s nipples or in her milk ducts.
Mothers may also have a vaginal yeast infection (itching,
cottage cheesy discharge), sores at the corners of the mouth
(angular chelitis), swelling or tenderness of the tissue
around the toes or fingernails (candida paronychia), or a rash
in the moist areas of the body such as under the arms or in
the groin (intertriginous candiasis). Athlete’s foot is also a
type of fungal infection.
Because yeast grows in warm, moist areas, it can be traded
back and forth between a mother and her nursing baby. Both
mother and baby must be treated together* in order to clear up
the infection. It is important to do this even if one of you
does not have symptoms. For example, your baby may have
the white patches in his mouth, but your nipples may not be
sore – or, your nipples may be sore but your baby’s mouth and
diaper area may be clear. If you treat one of you and not the
other, you may clear up the infection in one place only to
have it reoccur a week or two later in another. Occasionally,
other family members (especially your sexual partner)* may
need to be treated at the same time. *Treatments will vary
The diagnosis of yeast is most often made based on the
symptoms, and not on a definitive culture. It is sometimes
possible to culture for yeast from the surface of the nipple,
or from the milk, but the tests are not reliable and most
often give a false negative result.
If you or your baby have any of the symptoms described
above, (especially if you have been on antibiotics, or if your
nipples suddenly become sore after the first two weeks
postpartum), you may have a yeast infection. If you believe
you may have a yeast infection, here are some suggestions on
how to treat it (always consult your health care provider
before beginning any treatment). It is important to begin
treatment only after ruling out other possible causes of
severe nipple soreness, such as improper latch on and
positioning, mastitis, eczema, herpes, ringworm, and
If you have yeast on your nipples:
- Wash hands often (before and after nursing, after using
the bathroom, and before or after changing the baby’s
diaper). Use hot, soapy water and paper towels.
- Nurse frequently for shorter amounts of time. Start
nursing on the least sore side. Numb the nipple with ice
wrapped in a washcloth before beginning to nurse. Take Advil
(unless you are allergic to it) around the clock. If it
becomes too painful to nurse, you may want to pump your milk
temporarily and feed it to your baby by cup or bottle until
the pain lessens.
- Try drinking green tea 3 or 4 times a day. It may help
cleanse your system of excess yeast, and all evidence points
to its benefits, so it certainly won’t hurt to try.
- Decrease consumption of foods containing high amounts of
sugar and/or yeast (such as beer, wine, sodas, bread,
- After nursing, rinse the nipples with a solution of one
cup of water plus one TBSP of vinegar. Air dry well. Apply
HCL Colloidal Silver via a spray bottle or salve.). Although
Nystatin has been the most popular prescription antifungal
used for many years, it is no longer the first choice of
treatment due to resistant strains of yeast that have
- If pain is severe, apply the salve sparingly after each
feeding (6-8 times per day) for 24 hours. Then apply 3-4
times daily. The salve is absorbed quickly, and does not
have to be removed before baby nurses. If you feel that some
ointment remains on your nipple, you may want to gently
press a damp warm washcloth on the nipple and areola before
nursing. Avoid wearing nursing pads, but if you have to use
them be sure to change them at every feeding. Keep the
nipples as dry as possible.
After 24-48 hours, you should feel some improvement.
(Sometimes you can tell a difference after just one
application.) In some cases, symptoms temporarily get worse
before they get better - so be sure to continue the
treatment for at least the full 48 hours.
- Another effective antifungal treatment that is
inexpensive and available without a prescription is gentian
violet. It can be used on your nipples and in the baby’s
mouth or diaper area. Be sure to consult your health care
provider before beginning treatment, because it is strong
medicine and be dangerous if used improperly or too long. It
is very messy (it looks like purple ink and stains anything
it touches, including baby’s mouth and lips, and clothing or
bedding). It usually comes in a one percent solution, which
you may want to dilute down to a 1/2 percent solution,
especially if using it in the baby’s mouth. Apply to
nipples, baby’s mouth or diaper area once or twice daily for
no more than three days. You may continue to use a topical
ointment at the same time. Apply with a cotton swab,
especially at bedtime when the baby is more likely to go for
a longer stretch without nursing. Wear old clothing, since
it does stain. If you get stains on clothing, try alcohol,
bleach, or aerosol hairspray to remove them. Stains on the
skin will usually fade in a few days. Applying a thin
coating of lanolin to the baby’s lips may minimize staining
on his face when gentian violet is applied to his mouth or
- Expressed milk should be fed to the baby while you are
both being treated for yeast, and not saved for later use,
since refrigerating and freezing the milk does not kill all
- If chronic or extreme candida and yeast problems are
present or suspect, use our sledgehammer
Candida Elimination Kit
For a vaginal yeast infection, ask your doctor which
medication he suggests. Non-prescription medications like
Gyne-Lotramin and Monistat 7 are often effective, or your
doctor may prescribe a medication like Terazol 7 (tercoconazole).
Rinsing the vaginal area with a vinegar and water solution
after using the toilet may be helpful. Expose the affected
area to air as much as possible by wearing cotton (or no)
panties and avoiding tight clothes like pantyhose and
swimsuits. A single dose of Diflucan oral medication (fluconazole)
is also often used to treat vaginal yeast infections. It is
available by prescription.
For yeast in the baby’s diaper area, ask your doctor which
medication he suggests. Often the same antifungal ointment
used on your nipples, whether prescription or over the
counter, can be effective in clearing up the baby’s bottom. If
the area is extremely inflamed, ask your doctor about an
ointment containing cortisone (such as Mycolog or Lotrisone).
If the rash does not seem to be responding to antifungal cream
within a few days, ask your doctor about using a 1/2 percent
solution of gentian violet in addition to the cream once or
twice a day for a few days.
After each diaper change, wash the baby’s bottom with warm
soapy water. Rinse and dry well. Avoid using commercial baby
wipes (they keep the skin moist, and may contain irritating
chemicals). Expose the baby’s bottom to air as much as
For yeast (thrush) in the baby’s mouth, your doctor will
probably prescribe oral nystatin drops. After each nursing
session (or however often your doctor suggests) rinse the
baby’s mouth with water, offer him a drink of water from a
cup, or wipe the inside of his mouth with a damp washcloth.
Milk that remains in the baby’s mouth can be a source of food
for yeast. Then apply the medication according to directions.
Usually, the directions say to use 2cc in each cheek four
times a day. Since yeast multiplies so quickly (as often as
every hour), you may want to ask the doctor if you can use 1cc
for the whole mouth 8 times a day. Put the medicine in a spoon
or paper cup and use a Q-tip to swab it in the baby’s mouth.
Don’t put the dropper directly in his mouth and then back in
the bottle, to avoid contaminating the medication. Once there
are no visible signs of yeast in his mouth, ask your doctor
about cutting back to a lower dose. A complete course of
treatment usually takes several weeks. If there is no
improvement in a few days, ask your doctor about using a 1/2
percent solution of gentian violet for a few days.
Boil any object that goes in the baby’s mouth (such as pump
parts, bottles, nipples toys, and pacifiers) for 20 minutes
each day. Add some vinegar to the boiling water. Continue
using the medication for at least 2 weeks after symptoms are
gone. If nystatin and gentian violet do not seem to be
clearing up the thrush in the baby’s mouth, ask your doctor
about pediatric Diflucan suspension. As of November 1995, it
has been approved for pediatric use in treating babies six
months or older, and has an FDA Safety Profile for newborns
one day and older. The clinical cure rate for oropharyngeal
candidiasis in pediatric patients is reported at 86% with
Diflucan (2-3 mg/kg/day) as opposed to 46% of patients treated
In certain cases, yeast infection on the mother’s nipples
does not respond to topical treatments. In these cases, pain
is severe and unrelieved. Pain may begin as burning or
stinging on the surface of the nipples, primarily during
breastfeeding, and progress to deep stabbing internal pain
inside the milk ducts. This type of deep, sharp pain continues
throughout the day and may be worse at night, interfering with
the mother’s sleep. Pain may radiate into the armpit or back.
If topical treatments are ineffective, you may need to talk to
your doctor about the possibility of using a systemic
treatment which is taken orally, and is available only by
prescription. You may want to ask him to prescribe a
prescription painkiller as well. The systemic treatment which
seems to be most effective is Diflucan (fluconazole). Discuss
the following treatment plan with your doctor, as this is
strong medication and should be used only when topical
treatment has failed to prove effective, or when the yeast has
spread into the milk ducts.
Diflucan is often used to treat vaginal yeast. For
treatment of a vaginal yeast infection, 150 mg in a single
dose is the current FDA recommendation. Unfortunately, this
therapy is not sufficient for ductal candidiasis in lactating
women. For the treatment of systemic (ductal) yeast, 400 mg
STAT (loading dose on the first day) followed by 150-200 mg
daily for periods of up to four weeks is generally recommended
by many clinicians.
Of antifungal medications, Diflucan is well tolerated.
Adverse effects (such as vomiting, diarrhea, stomach cramps,
and rashes) have only been reported in 5-30% of patients, and
only 1-2% of patients had side effects severe enough to
require them to discontinue the medication. In rare cases,
adverse hepatic (liver) effects have been reported, but
usually in connection with high doses of the medicine over
long periods of time in severely ill patients with
immune-compromising diseases such as cancer or AIDS.
Diflucan is very effective, but also very expensive (over
$10.00 per tablet). Check with your insurance carrier for
coverage information. I don’t know of any cases of liver
problems in healthy nursing mothers at the doses recommended
in this article.
Be persistent in treating yeast. Once you have it, it tends
to stick around and not go away by itself, because it thrives
on moisture and sugar, and nipples and baby’s mouths provide
the perfect environment for it to grow. Some women seem to be
more prone to developing yeast infections than others. Yeast
infections during lactation can be very painful, and it is
easy to become discouraged and even consider weaning your
baby. Try to remember that yeast is a medical condition that,
with consistent treatment of both mother and baby, can be
cleared up completely, and hopefully will not reoccur. It is
also important to note that if you have yeast on your nipples
or in your milk ducts, weaning your baby will not necessarily
make it go away and you will still need to treat the problem.
Be sure to remain in close contact with your health care
provider during treatment, because yeast presents a variety of
symptoms an requires continuing reassessment and adjustment of
treatments to provide optimal relief and effect a cure in the
shortest period of time. Try not to become discouraged.
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