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Nipple Thrush Treatment Plan

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I realize that for many of my normal readers talking about nipple thrush and breastfeeding is kind of off our normal topics. It is my hope however that some desperate mom out there may stumble upon this post and find some relief from her agony. Plus it’s a lot easier for me to send a link to a post to friends then type this all out each time.

When I had Noah I was so excited albeit nervous about the idea of breastfeeding. I knew it was best for him though and really wanted to give him the absolute best nutrition possible. Plus the idea of having a sweet nurturing nursing relationship brought up all kinds of happy visions while I was pregnant. I had read a lot of books so I had the basics pretty well squared away and knew I would be delivering in a hospital with a lactation consultant and midwives so I assumed we would do just fine.

I didn’t realize however that I would begin a very slow and extremely painful battle against an unseen enemy in the process: breastfeeding thrush. When labor didn’t go as fast as the hospital’s schedule said it should after my water broke I was placed on IV antibiotics for multiple hours.

It is my belief that this alone was probably enough to wipe out all of the bacteria in my body that was holding the yeast at bay and cause serious implications. But a UTI the week after delivery got me more antibiotics from the pharmacy and a double ear infection for Noah the following week left us one hot mess.

As he was a first baby I had no idea what breastfeeding was supposed to be like but I had heard people say over and over again, “breastfeeding is not supposed to hurt.” As such it became an obsession of mine to try to figure out why the thing that was supposed to be natural and easy just plain hurt. 4 1/2 months of crying through nearly every nursing session took me through quite a journey and I am happy to say that we made it through and did nurse pain-free after that.

Here are a few things that helped in my process of eliminating why things were so painful:

  • Start with the latch. Is the baby properly latching? Read up on proper latches and get help from a lactation consultant if you are unsure. If you’ve been nursing quite a while and NEVER have a pain-experience, it’s probably not the latch. Still it’s definitely the first thing to rule out with a lactation consultant.
  • Could the baby have physical problems nursing? Have a lactation consultant help you evaluate baby’s mouth for high palette’s, tongue-ties, lip-ties, etc.
  • Milk blisters, Raynaud’s phenomenon or vasospasms, cracked or bleeding nipples and lots of other things can cause nursing pain.
  • Realize you may have those problems AND thrush. Noah had a severe upper lip-tie and clucked when he nursed but that was not the primary source of my pain. It definitely threw me off though thinking it was all him.
  • If you have never nursed before and have constant pain, and have an experienced nursing friend who does not struggle with thrush, who is currently nursing AND your child is asymptomatic for thrush, consider asking them to nurse your baby. I realize this will be a very minor number of folks and that some may view this as irresponsible as you can pass thrush from person to person, but it was the ONLY way I was able to realize that I had the problem and that it wasn’t Noah’s problem. I had already been on medication for thrush a full 2 weeks (but Noah had not) without any improvement in pain and was convinced it WASN’T thrush.
Common misconceptions about thrush:
  • Breastfeeding pain from thrush has to start after a pain-free period of nursing.
    This is SO UNTRUE. You can have pain from Day #1 and have it be from thrush. You also go through a period in the first weeks of being toughened up a bit and can often get sore/cracked/bleed at that point. Easy entry point for thrush and it can be hard to identify any period where it was pain-free.
  • If we have thrush, baby will have white in his mouth that you can’t wipe away.
    Babies do not have to have thrush in order for you to have it, they can also be asymptomatic visually.
  • My nipples must be red, scaly, itch, burn or have a rash on them to be thrush.
    Nope. All that happens for me is a very very slight color change and pain. If you can’t go bra-less around the house or run your hands down the front of your body without gasping you might have thrush. I describe it as hyper-hyper-sensitive to everything and achy even when not being touched. It also hurts the whole time you are nursing and hurts after you are finished.
  • Deep breast pain is always caused by mastitis or a plugged duct….not thrush.
    Wrong. While it is important to rule out either of those, thrush can infiltrate your milk ducts causing deep deep pain, burning, swelling in one or multiple areas and chills/fever. Twice it was in my ducts and twice within 24 hours responded to Fluconazole treatment.

Nipple Thrush Treatment Plan:

Thrush is a multi-layered problem in my opinion. I believe there needs to be complete care for the mother and child and that this care has many different elements that must be combined in order to be effective in severe cases.

One of the most overlooked issues in thrush treatment is the understanding that the problem is not just yeast. Everyone has yeast in their bodies naturally. Your immune system keeps the yeast in check and you balanced. So we need to simultaneously kill off some yeast AND get your immune system back up to par. There are many less involved treatment suggestions out there but after trying many of them with no success these are my recommendations.

Spiritual considerations:

  • Realize that there may be a spiritual component to why your immune system is not functioning properly. Your thought life has a direct correlation to your chemical makeup as a human being. Consider the following prayerfully:
    Am I being fearful of ____? Trying to control everything or ____? Am I beating myself up because I feel inadequate because I can’t nurse like normal people? Are there situations or relationships that are causing me to lose my peace? Am I holding unforgiveness towards anyone that I need to release? Etc.
  • Early motherhood is such a hormonal, emotional time it is very important to have a supportive family or social network rallying around you. Allow for encouragement or suggestions to come your way but realize that everyone has a different way of doing things and SOMEONE will think you’re doing it wrong. Don’t take it to heart. Evaluate your choices, make a decision and stick with it for a while.

    You reserve the right to change your mind at any point and you WILL change your mind on certain things so be gracious as you give and receive opinions on how to do things…it’s easier to change your mind if you aren’t so stubborn to start with.

  • More help on the spiritual aspect of why your body may not be functioning properly can be found through www.beinhealth.com

Physical considerations:

  • (Have a recently had or the baby had lots of antibiotics? This info is even more important if so.) We need to help boost all the good bacteria that keeps the yeast levels in your body in check. Get a REFRIGERATED live probiotic for you AND baby. If you can’t find or afford a baby probiotic break open your capsules and put the powder on your finger for baby to suck off several times a day.
  • Buy or (preferably) make your own Keifer. You can generally find keifer grains through Craigslist or friends or order them dried online. Make keifer smoothies with small amounts of fruit and/or greens if you can’t handle it straight. If you are purchasing it from the store make sure that there is not additional sugar added to it. Drink 1-3 glasses daily. Yogurt is not nearly as potent but is better than nothing. Any fermented foods with probiotic benefits will help some. If you can get raw milk for making your kefir or yogurt that is even better.
  • Try to limit consumption of sugary and cheap white starch products. Realize you are human and trying to 100% eliminate sugar/starch from your life may lead to a guilt-self-hatred cycle that is much more damaging then the sugar is. If you can make less sugary choices during treatment then try your hardest to do so.
  • Allow yourself some bra-lesstime and get some sunlight if possible (lying under a window is a good choice….walking around the neighborhood topless….haha maybe not so much).
  • Some women swear by the Lanolin or other creams and some say stay far away with thrush. Experiment with what works best for you. Coconut oil can be a great substitute for Lanolin and it is anti-fungal naturally so is a better option in my opinion if you are battling thrush.

Possible supplements that can help:

  • Echinecea Plus Tea (drink several cups from same tea bag….I routinely forget my tea so I just let it steep continually and then remove bag to reheat tea. This hands down was the most immediate improvement for me shockingly.)
  • Oil of Oregano (capsules are easier to stomach but may be less effective)
  • Pau d’ Arco
  • Golden Seal
  • Extra B vitamins

Possible topical applications that can help. If your thrush is stemming from you or baby internally these applications may help but WILL NOT solve your problem long term.

  • Genetian Violet (Didn’t work for us and was very messy. Cheap and over the counter though)
  • Nystatin cream (Did not help)
  • Grapefruit Seed Extract (Helped some but was very drying and stung some)
  • Dr. Jack Newman’s APNO (Helped the most in combination with internal supplementation. It can be difficult to get mixed properly from pharmacy and can be expensive.)
    Dr. Newman also has an extensive treatment plan for thrush you can find here as well as the APNO recipe for a compounding pharmacy.

Medications that can help:

  • Dr. Newman’srecommendations on the use of Fluconazole are very good:

    Fluconazole: If pain continues and it is likely the problem is Candida, or at least reasonably likely, add fluconazole 400 mg loading, then 100 mg twice daily for at least two weeks, until the mother is pain free for a week. The course of treatment with fluconazole is not two weeks. The nipple ointment should be continued and the gentian violet can be repeated. Fluconazole should not be used as a first line treatment, especially if you have sore nipples. If used, fluconazole should be added to above topical and oral treatments, not used alone. Fluconazole takes three or four days to start working, though occasionally, in some situations, it has taken 10 days to even start working. If you have had no relief at all with 10 days of fluconazole, it is very unlikely it will work, and you should stop taking it. Other Medications: For deep breast pain, ibuprofen 400 mg every four hours may be used until definitive treatment is working (maximum daily dose is 2400 mg/day).

  • It is VERY important to get your OB or Midwife and your child’s Pediatrician working TOGETHER to help eliminate thrush. You must BOTH be treated simultaneously for treatment to be effective EVEN IF YOUR CHILD IS ASYMPTOMATIC. I don’t know how to say this strongly enough. After 2 rounds of Fluconazole and Noah being treated at a separate time (even though no symptoms on him) it was only when we were treated together that we were able to successfully get the thrush under control. Don’t let them tell you otherwise (because they may try to) insist on simultaneous treatment. You are passing the yeast back and forth every time you nurse! Do not assume that it is not thrush if you have been treated with no improvement, if they did not treat your child simultaneously.

Cleanliness madness (as if you aren’t already tired and in enough pain lets clean EVERYTHING obsessively):

  •  Wash and Sterilize EVERYTHING that comes in contact with baby’s mouth, your nipples or your milk. Paci’s, bottles, pumps, etc must all be boiled or run through super hot cycle in dishwasher as often as physically possible. Preferably after EVERY use…..do your best with this. Consider purchasing extra’s so that you can have help in keeping up on this process.
  • Consider changing out your plastic backed nursing pads for cloth. (I did not do this as I leaked so badly but in hindsight I think it could have contributed to perpetuating the cycle.)
  • Wash any clothing that touches your breasts or breast milk (bra’s, pads, towels, burp clothes etc) in hot water. Consider adding vinegar or Grapefruit seed extract to your laundry loads to help kill any bacteria. Consider purchasing extra’s so that you can get help with the laundry without being out of what you need. Ironing your bra’s can provide extra killing power also.

Hopefully some of this will help someone. Feel free to chime in if you have any additional tips and tricks or would like to share your story.

 

Liability notes: I am not a doctor or a trained medical professional in any way and cannot assume any responsibility for what happens if you follow my suggestions. Be sure to discuss these things and all your medical needs with your health care provider to create a plan for your needs. 


By on November 6th, 2012

About Dani Meyer

Hi, I’m Dani! I’m most importantly mama to 3 wild little dudes. I spend my days cooking, photographing and exploring the Pacific Northwest. I'm a full time food blogger and online business coach.

I’m the author of Stress Free Camping, a 120+ page guide on making epic food in the woods. I’m also the founder of Food Blogger Entrepreneurs, the leading online academy and private community for food bloggers. → More About Dani

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5 thoughts on “Nipple Thrush Treatment Plan”

  1. I have been battling thrush with my two month old for almost a month. I am on my 18th day of fluconazole and almost 4 weeks into using APNO. I also rinse my breasts after every feed, wash our clothes/burp cloths/ towels every night with hot water, vinegar and tea tree oil. I have cut out sugar and wheat from my diet, greatly reduced other grains and am eating TONS of veggies. I take a refrigerated probiotic with acidophilus and eat kefir daily. Baby was on oral nystatin but after almost two weeks of zero improvement we switched to painting a small amount of probiotic yogurt called Bio K in her mouth and the white tongue was gone in just two days. We have continued to give her it once a day as I’m not sure thrush is gone from me. I have had improvements with the deep breast pain, a reduction in milk blisters/blebs, and thought I was almost nipple pain free but I realized after one day of not using the APNO and only using a miconazole cream that the pain is still there, it’s just being covered up. Baby’s latch is good, I have seen a lactation consultant twice. She has steadily gained weight, seems full after feeding, and can drain the first breast.
    My question is: Shouldn’t the pain by gone by now?

    Reply
    • Oh love I feel for you! I’m just about to deliver our third and already feeling thrushy. Some of us just struggle with this deeply and I don’t know entirely why. I start feeling this way as soon as I get pregnant and it seems to be hormone driven. Pregnancy suppresses the immune system so it makes sense.

      My momma advice (so not a doctor): Keep using the APNO ointment. Keep on the flucanozole. Ask the pediatrician if they can give baby a fluconazole suspension too….nystatin may just not cut it and then you are passing it back and forth. Keep painting the mouth with the yogurt and pop open one of your probiotic pills and let her suck the probiotics off you finger. I also culture a small amount my breast milk with kefir in the fridge for a few days and would give them little doses of that with a dropper.

      The biggest thing to remember is the immune system SHOULD be keeping this in check. So all the immune system support you can provide to your body the better. Deeply steeped echinacea tea, vitamin support, nourishing bone broths, extra iron/greens etc.

      Give yourself permission to really love on yourself physically and emotionally and encourage your body to heal vs being angry at it for being this way. We can be so very hard on ourselves. Getting as much sleep as humanely possible and asking for help. If you can pump a bit for some night feedings or do an occassional night bottle (if baby tolerates that of course) that will only help you to support your body in battling this back to appropriate levels.

      I found pumping to be a relief some days when I just couldn’t tolerate the irregular suction of him nursing and popping off.

      Good luck! You aren’t alone and you aren’t crazy that it really does hurt and it really shouldn’t. <3

      xoxo

      Dani

      Reply
  2. Great information!

    Ugh. We’ve been battling with this off and on for about 5 weeks now. Gentian violet and Jack Newman cream worked about 1.5 weeks ago and I thought we were in the clear until today. No signs on my daughter yet, but I have it back.

    Here we go again! Thank you for the great info!

    Reply
    • April,

      I would definitely try to see about getting an oral prescription of thrush meds for you and baby simultaneously if it’s coming back. If you catch it early and treat aggressively you have a much stronger chance of keeping it under control the rest of the time. The docs might skirt around the issue but make sure they treat you both together mandatory. Good luck! Feel free to message me here if you need any other momma input <3 <3

      xoxo,

      Dani

      Reply

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