Do we have thrush?

by Tanya Lieberman, IBCLC, sponsored by Motherlove Herbal Company.

Having thrush is be painful and frustrating.  And trying to figure out if you have thrush can be confusing.  Here’s our guide* to aid in determining whether you and your baby have thrush. 

Please note that we are not discussing treatment options in this post. For information on treatment please see Dr. Jack Newman’s Candida Protocol.

 

What is thrush?

Candida albicans is a fungus lives in our bodies.  Some conditions such as antibiotic use and illness can cause it to grow out of balance, and this overgrowth can cause painful infections, generally in moist areas such as the mouth, nipple area, vagina, and diaper area.

 

How is thrush diagnosed?

Diagnosing thrush is difficult, because skin tests are considered unreliable, and the results aren’t available for several days – a lifetime when you have pain!  Most doctors diagnose thrush based on symptoms and not diagnostic tests.  So you may hear that thrush is diagnosed through treatment – if it responds, it must have been thrush!

 

What makes me more likely to have thrush?

You and your baby may be at higher risk for thrush if you or your baby have recently used antibiotics (often used for a cesarean birth), have been ill, or perhaps have been in a very warm and moist environment.  Thrush takes time to develop, and may not be obvious until a few weeks after this trigger, so pain in the first week or so after your baby is born is unlikely to be thrush, and is much more likely to be caused by a shallow latch or one of the other causes mentioned below.

 

What symptoms are strongly associated with thrush?

Mother symptoms:

One study of mothers between 2 and 9 weeks postpartum found that mothers who have two or more of the following five symptoms are likely to have thrush.  Having three or more makes it even more likely.

  • shiny or flaky skin of the nipple/areola
  • burning pain on the nipple/areola
  • sore (but not burning) nipples
  • stabbing pain in the breast
  • nonstabbing pain in the breast

 

And a mother is highly likely to have thrush if those symptoms include:

  • shiny skin of the nipple/areola with stabbing pain, or
  • flaky skin of the nipple/areola in combination with breast pain

 

The study also found that mothers were likely to have symptoms on both breasts, though sometimes not right away.

 

Baby symptoms include:

  • White patches on the baby’s cheeks, gums, palate, tonsils, and/or tongue.  If you try to wipe off these patches they will appear “stuck” there, and may bleed.
  • A yeast diaper rash, which may be red or red with raised dots

 

Can you have yeast inside your breasts? 

Shooting and/or burning pain deep inside the breast is sometimes diagnosed as intraductal thrush – thrush in or around the milk ducts inside the breast.  This diagnosis is controversial, as recent research has found that mothers with suspected yeast infections may actually have bacterial infections or Raynaud’s vasospasm, and that yeast hasn’t been cultured in the milk of mothers with suspected interductal thrush.

 

If it isn’t thrush, what could it be?

Other causes of pain which may make you suspect thrush:

  • Shallow latch
  • Raynaud’s Phenomenon
  • Bacterial infection
  • Mastitis
  • Skin problems such as eczema, psoriasis, dermatitis

 

My baby’s tongue is white.  Does that mean he has thrush?

Babies’ tongues normally have a white coating.  This in itself is not an indication of thrush.  If your baby has white patches on the inside of his cheeks or gums (if you try to wipe them off they may look red or bleed), this is an indication of thrush.

 

My doctor said that my baby doesn’t have white patches in her mouth, so we couldn’t have thrush.  Is that right?

Some babies who have thrush do not have white patches in their mouths.  Some may have a yeast diaper rash and no symptoms in their mouths.

 

I was treated with Nystatin and it didn’t work.  Does that mean I don’t have thrush? 

Nystatin is ineffective at treating thrush in an estimated 68% of cases.  So if the symptoms didn’t go away using it, you may still have thrush.  Consult this guide to thrush treatment for other treatment options.  See this study for more information on the use of Nystatin in treating thrush.

 

My doctor said that since I have symptoms but my baby doesn’t, she doesn’t need to be treated.  Is that right?

If thrush has been diagnosed in either of you, you both should be treated to prevent recurrence.

 

I keep getting thrush over and over.  Could it be something else?

If you have repeated cases of thrush, or if treatment doesn’t resolve your symptoms, you may want to explore whether your symptoms are caused by some other problem instead or, or in addition to, thrush.

 

I think I have thrush.  What should I do now?

Contact your health care provider and explain your symptoms. You may also wish to consult this guide to thrush treatment.

 

*This information is provided for educational purposes only, and should not be construed as medical advice.  For care suited to your own situation, please consult your health care provider.

 

References: 

 

Mohrbacher, Nancy.  Breastfeeding Answers Made Simple: A Guide for Helping Mothers.  (Amarillo: Hale Publishing, 2010), pp. 652-53

 

Jimi Francis-Morrill, M. Jane Heinig, Demosthenes Pappagianis and Kathryn G. Dewey.  “Diagnostic Value of Signs and Symptoms of Mammary Candidosis among Lactating Women,” J Hum Lact August 2004 vol. 20 no. 3 288-295

 Tanya Lieberman is a lactation consultant (IBCLC) who has helped nursing moms  in hospital and pediatric settings.  She writes and produces podcasts for several  breastfeeding websites, including  Motherwear,  Motherlove Herbal Company, and  the Best for Babes Foundation.  Tanya recently authored Spanish for Breastfeeding Support, a guide to help lactation consultants support Spanish-  speaking moms.  Prior to becoming a lactation consultant she was senior  education policy staff to the California legislature and Governor, and served as a  UN civilian peacekeeper.  Tanya is passionate about supporting nursing moms, and especially to eliminating the barriers so many moms face in meeting their breastfeeding goals. She lives in Massachusetts with her husband, her 8 year old son and her 1 year old daughter.
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Comments

  1. Jayne says:

    Just thought I would let you know, you have a typo on the home page before clicking on this link. ‘Determining if it is actually thrush YOUR dealing with’ should say, you’re, as in, you are. ‘Expert advice’ should probably have correct spelling and grammar :)

    • theleakyb@@b says:

      Thanks for spotting that, being human I make mistakes. Being a mom of 6 with another full time job I’m prone to a lot of them at times. I appreciate your help in spotting this mistake. Thankfully having read many text books and other serious materials with typos and mistakes (the NY Times is notorious!) I feel confident that a missing apostrophe and letter e didn’t entirely undo the credibility of this article. Thanks for your concern and I’ve corrected the mistake. ~Jessica

  2. Heather Thrapp says:

    My LO got thrush when he was a few weeks old, and we fought with it for weeks. It would go away, and then a few days later it would come back again. He was prescribed Nystatin (at least three or four times). I asked my doctor if I should be treated for it too, and she asked me if I had any of the symptoms you mentioned, the only problem I had was some mild pain in one breast. She didn’t think I had it and didn’t want to treat me. I didn’t push the issue, and I should have…FINALLY after over a month of dealing with this problem, which was obviously uncomfortable for LO, I asked again, this time insisting that I should probably be treated since LO’s thrush just kept coming back. My doctor agreed (finally) and prescribed difflucan. Within a few day’s both LO and I were cleared up and it never came back. A lot of discomfort could have been avoided if doc would have just treated us both to begin with. Thank you for sharing this blog, and pointing out that BOTH baby and mom should be treated if one is diagnosed, I hope this helps other mother’s avoid the drawn out experience LO and I had.

  3. Lox says:

    Would both nipples be painful when breastfeeding or is it possible for only one to hurt?

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