Oral thrush, or candidiasis, is a common fungal infection in infants caused by an overgrowth of the yeast Candida albicans. This yeast creates painful lesions inside the baby’s mouth, making sucking and swallowing uncomfortable. For breastfeeding caregivers, the infection can pass back and forth, leading to significant nipple pain. Successfully feeding a baby with thrush requires specific adjustments to minimize soreness and friction while ensuring the baby receives adequate nutrition and the infection cycle is broken.
Identifying Thrush Symptoms
Recognizing the infection quickly is the first step toward relieving feeding discomfort. The most distinct sign of oral thrush in an infant is the presence of creamy white or yellowish patches inside the mouth. These patches often resemble curds of milk but cannot be easily wiped away. Attempting to wipe them may cause the tissue underneath to bleed slightly.
The lesions may appear on the tongue, inner cheeks, gums, or the roof of the mouth, causing the baby to become unusually fussy or irritable during a feed. If the infection has passed to the breastfeeding parent, they may experience burning or shooting pain deep within the breast during or after feeding. The nipples or areola may also appear shiny, red, or flaky, and the pain may persist even with a corrected latch.
Adapting Breastfeeding for Comfort
Adjusting the timing and technique of breastfeeding can reduce the pain associated with oral thrush. Offer the breast when the baby first shows hunger cues, rather than waiting until they become upset and latch aggressively, which increases friction on the sensitive oral lesions. Keeping the feeding session efficient is helpful; limiting the time a baby spends actively sucking to about 20 minutes per side minimizes irritation to the mouth lining.
Focusing on a deep, comfortable latch is important, as a shallow latch exacerbates pain for both the parent and the baby. The baby’s mouth should cover as much of the areola as possible to position the nipple far back, bypassing the most sensitive areas on the tongue and cheeks. If the parent is experiencing nipple pain, applying a cool, clean cloth to the nipple area briefly before latching may temporarily numb the surface. Ensure the nipple is completely dry before the baby takes the breast, as yeast thrives in moist conditions.
Modifying Bottle Feeding Practices
For babies who are bottle-fed, the mechanics of the bottle nipple require careful consideration. The friction and pressure from a standard nipple can irritate the sensitive white patches inside the baby’s mouth, leading to refusal or discomfort. Switching to a slower-flow nipple reduces the baby’s sucking effort and the friction inside the mouth during a feed.
Offering smaller, more frequent feeds is better tolerated than attempting large volumes, as pain increases the longer the baby feeds. If the baby is refusing the bottle nipple due to severe oral pain, temporarily using an alternative method like a syringe or a small cup feeder ensures hydration and calorie intake. This bypasses the painful sucking action until the antifungal treatment begins to take effect.
Essential Hygiene to Prevent Reinfection
Thrush is easily spread, meaning strict hygiene is necessary to prevent the infection from cycling between the baby and items that enter their mouth. All feeding equipment, including bottle nipples, rings, pacifiers, and breast pump components that contact milk or skin, must be sterilized after every use. Boiling these items for five to ten minutes effectively kills the yeast spores.
Caregiver hygiene is important in preventing reinfection. Always wash hands thoroughly before and after every diaper change, feeding, and application of medication to avoid spreading the yeast. If the parent is breastfeeding, changing nursing pads frequently and wearing a clean bra daily, washed in hot water, helps eliminate yeast that thrives in warm, moist environments.
When to Seek Medical Treatment
Comfort measures alone are not enough to eliminate a thrush infection, as it requires antifungal medication to fully clear the overgrowth. Contact a pediatrician immediately if you suspect your baby has thrush, especially if the baby is under four months old. If you are breastfeeding, the parent must also contact their healthcare provider, as both the baby and the parent require simultaneous treatment to prevent the infection from passing back and forth.
The typical treatment involves an antifungal solution, such as nystatin drops or gel, applied to the baby’s mouth several times a day. The breastfeeding parent may be prescribed a topical cream for the nipples or, in some cases, an oral antifungal medication. Continue the prescribed course of medication for the full duration, even if symptoms appear to improve quickly, to ensure complete eradication of the Candida yeast.