Thrush is a common fungal infection caused by an overgrowth of Candida albicans, a yeast naturally present on the skin and within the body. It often affects breastfeeding parents and their infants simultaneously, creating a cycle of infection and reinfection known as a breastfeeding dyad infection. The fungus thrives in warm, moist environments, making the nipple and the infant’s mouth particularly susceptible.
Visual and Physical Signs
The visual presentation of thrush on the nipple and areola can vary, and in some cases, there may be no obvious visible signs at all. When signs are present, the skin often appears unusually shiny or flaky, sometimes with a deep pink or reddish hue, particularly in lighter skin tones. Tiny white patches resembling dried milk may be visible, but unlike milk residue, these spots typically resist being wiped away. Cracking or peeling of the skin, especially at the base of the nipple, which does not heal despite improved latching technique, can also be a sign of a fungal overgrowth.
The physical sensation experienced by the parent is often the most significant symptom. A deep, burning, or stinging sensation is common and often persists long after a feeding session has ended. Some individuals report a sudden onset of pain after a period of comfortable nursing, which distinguishes thrush from discomfort caused by a poor latch. The pain can also manifest as a shooting or stabbing sensation deep within the breast that may radiate toward the back or armpit.
Identifying Oral Thrush in Infants
Identifying the infection in the baby is an important step, as the infant’s mouth is a common reservoir. The primary symptom of oral thrush in infants is the presence of white, creamy patches inside the mouth that resemble curds of cottage cheese. These patches are typically found on the tongue, gums, roof of the mouth, and the inner cheeks. A reliable way to differentiate thrush from a simple milk coating is that the Candida patches cannot be easily scraped or wiped off.
Beyond the oral lesions, the infection can also cause the baby to become fussy or irritable during feeding because their mouth is sore. Some infants may repeatedly pull away from the breast or refuse to feed due to this discomfort. The fungus can also pass through the baby’s digestive tract, sometimes leading to a stubborn diaper rash that is bright red with well-defined borders and small, raised bumps surrounding the main rash area.
Treatment and Management Strategies
Effective treatment for thrush requires a simultaneous approach for both the parent and the infant to successfully break the cycle of cross-infection. For the parent, the first line of treatment often involves topical antifungal creams, such as miconazole or clotrimazole, which are applied sparingly to the nipples and areola after each feeding. These creams should be massaged gently into the skin and usually do not need to be removed before the next feeding.
If the pain is severe or the topical treatment is unsuccessful, a healthcare provider may prescribe a systemic oral antifungal medication, such as fluconazole. For the infant, treatment typically involves an oral antifungal suspension. Nystatin drops are applied directly to the affected areas in the baby’s mouth, while miconazole gel, when used in infants over four months old, is applied with a clean finger to the inside of the cheeks and tongue.
Preventing Recurrence
Preventing the recurrence of thrush centers on maintaining a dry environment and rigorous hygiene. All items that come into contact with the infant’s mouth or the parent’s breast must be sterilized daily during the treatment period and for a week after symptoms resolve. Sterilization can be done by boiling for five minutes.
Items to Sterilize
- Breast pump parts
- Pacifiers
- Bottle nipples
- Teething toys
The parent should change breast pads frequently and ensure they do not have plastic liners, as these trap moisture against the skin. Washing bras, clothing, and reusable nursing pads in hot water with bleach, and air-drying them in the sun if possible, helps kill the yeast spores. Air-drying the nipples after each feeding by remaining topless for a few minutes can also significantly reduce the moisture. Reducing the intake of processed sugars and refined carbohydrates may also be a helpful measure, as yeast feeds on sugar, making the body a less favorable environment for its overgrowth.