If your baby has white patches in his mouth, or breastfeeding is suddenly more painful for him, you and/or your baby could have a yeast infection — but not the vaginal kind you may have gotten in the past. This harmless-but-annoying fungus known as oral thrush sports cottage cheese-like spots in and around your baby's mouth, and can make breastfeeding difficult for all parties involved.
Don't panic! Here's what you need to know about thrush and breastfeeding, including treatment and prevention tips so you can both get through this temporary rough patch.
What is thrush?
Thrush is a fungus that's present on just about everyone's body, but often flares up in babies under 6 months old, because their developing immune systems aren't yet able to fight off many infections.
Thrush is caused by an overgrowth of the yeast fungus called Candida albicans, which your newborn may have picked up while traveling through the birth canal. Thrush can also appear in babies who are born prematurely (before 37 weeks), in those with a very low birth weight and in infants who have been treated with antibiotics.
Thrush is common and easy to treat, but may make breastfeeding difficult for you and your baby. It thrives in warm, damp conditions, which is why it sometimes also appears as diaper rash.
Signs of thrush while breastfeeding
Breastfeeding is skin to skin, so nursing a baby with thrush could mean the infection gets passed along to you — and, in turn, it can travel right back to your baby. Here are the signs of thrush in both breastfeeding mothers and their babies.
Thrush symptoms in breastfeeding people
If you have a case of candida on your nipples, breasts or areolas, you may experience:
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- Sensitive or itchy skin
- Red or cracked nipples
- Flaky skin around the areola
- Sharp pain in your breasts or nipples between feedings
It's also possible to develop thrush under your breasts, as candida loves a dark, moist place to grow — and this is an ideal spot. If you have an infection under your breast, you may note some of the same signs as above, including an itchy or burning sensation as well as red or flaky skin.
Thrush symptoms in babies
If your baby has thrush, you may notice the following:
- The main symptom of oral thrush is white spots on your baby's mouth, tongue and sometimes the corners of the mouth. These spots will look a bit like cottage cheese, and won't come off easily if you wipe his mouth with your finger or a soft cloth.
- Fussiness is another common sign, so if your infant starts to suck and then turns away or cries, it could be thrush.
Be careful not to confuse thrush with an oral coating of your breast milk, which can also show up as white spots. How to tell the difference: Milk curds wipe away, but thrush does not.
Treatments for thrush while breastfeeding
Treatments for thrush in breastfeeding people
Thrush can be passed back and forth, so your practitioner may recommend that both you and your baby get treated. If you have thrush on your nipples, areolas or breasts, your doctor will likely recommend that you apply a prescription antifungal cream. The infection should clear up after about a week, but let your doctor know if it doesn't.
Treatments for thrush in babies
Oral thrush in babies can be treated with an antifungal medication (such as Nystatin), which can be applied topically to the inside of the mouth and tongue. Oral fluconazole (Diflucan) given by dropper may also be prescribed in tough cases. (If thrush is on your breasts or your baby's bottom, you may use a different kind of medication.)
Common questions about thrush and breastfeeding
- Can your baby still breastfeed if he gets thrush? Your baby can breastfeed during an outbreak of thrush, but if he has sore patches in his mouth, he may avoid latching on or be reluctant to feed at all (if your baby is on a "nursing strike," check to see if thrush could be the cause). Others aren't bothered by thrush, and happily nurse away. The challenge comes if your baby's thrush passes to your breasts and makes them sore, too. If breastfeeding is your baby's primary source of nourishment, and he's turning his head or crying when it comes time to nurse, call your practitioner to see how you can speed up healing.
- Can your baby give you thrush if you're breastfeeding? Yes, oral thrush from your baby can be transmitted to your breasts from your baby's mouth or skin during feeds, but you can also potentially get it in sneakier ways, like changing diapers, touching his pacifier to your skin or wiping his drool. If you are susceptible to getting vaginal yeast infections or have one already, you may be more likely to get thrush from your baby while breastfeeding.
- Can breastfeeding cause thrush in your baby? Candida can live on your breasts, in your nipples or in your breast milk, making it easy for it to pass to your baby through feedings. Candida can also spread to anything that touches your baby's mouth, including your hands, milk, burp cloths or your clothing, and can potentially end up causing thrush in your baby. The presence of candida can result in an overgrowth — oral thrush. Those with relatively weak immune systems — such as newborns, premature babies, very low birth weight babies and children with cancer — are more susceptible to developing it. Taking antibiotics can also result in a loss of "good" bacteria that help fight off fungal infections. On the other hand, if your breastfeeding baby has oral thrush, it's possible you got the infection from him.
- What if thrush makes breastfeeding too painful? If breastfeeding is too painful while you or your baby has thrush, check in with your pediatrician to get treatment, fast. You may find it more comfortable to pump rather than breastfeed. It might also help to talk to a breastfeeding or lactation consultant to help you find ways to continue that aren’t too uncomfortable.
- Can you give your baby pumped breast milk if you have thrush? Mothers are encouraged to keep up their nursing routine during the treatment of thrush — and some prefer to continue pumping and serving stored or frozen milk, too. There’s some research that indicates using frozen pumped milk while having thrush doesn’t pose a risk to healthy babies, especially if the milk is scalded before serving it. However, since freezing your milk won’t kill yeast, discuss the best approach with your pediatrician, especially if you’re an exclusive pumper. They may recommend scalding the pumped milk and allowing it to cool before offering it to your baby as a conservative approach.
How to prevent thrush while breastfeeding
It's not always possible to prevent your baby from getting thrush. But you can try to avoid it by keeping things as clean, dry and unconducive to fungus growth as possible using these tactics:
- Wash your hands thoroughly after changing your baby's diaper, as thrush can be spread through the digestive system and thrives in the warm folds of his bottom. You can also make sure to change your baby’s diaper frequently and keep his bottom and thigh folds as clean and dry as possible.
- Thoroughly clean your bottles (including bottle nipples), your pumping equipment, pacifiers and toys (especially the ones that might go in baby's mouth) between uses.
- Practice nipple and breast hygiene, such as by wearing cotton bras and tanks, which are less likely to trap moisture, and allowing your nipples to dry completely between feedings. Change nipple pads and shields often.
- Have a separate towel for each family member. Wash all linens in hot water, and dry well.
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