PREVENTION OF SORE NIPPLES: To prevent sore nipples, ensure a large amount of areola enters baby’s mouth! Do not coat a thrush infected nipple with expressed milk for healing- it actually feeds the yeast and makes it worse. A simple rinse will do.
PROBIOTICS: You want the fancy “Women’s Health Probiotics” ; the one I like most is call Raw vaginal Care by Garden of Life. These are for the mother to take.
THRUSH: TREATMENT OF Candida Infection NIPPLES will need the care of your OBGYN for APNO ointment for signs of Thrush. Wipe off excess. The following link is a sheet to print out for your Dr.
http://www.breastfeedinginc.ca/content.php?pagename=doc-APNO but if that link is not working you can link my directions for healthcare providers for APNO found on my blog.
This will have dosing directions but typically you apply a shin sheen over the nipple and areola each time after nursing. This means use a ½ pea sized amount and rub your fingers together until it disappears, then use it on your nipples. In this amount it is compatable with breastfeeding.
If the APNO does not resolve the thrush alone:
“Persistant Pain” Academy of Breastfeeding Medicine 2016,
"Oral fluconazole (200 mg once, then 100 mg daily for 7–10 days) may be used for resistant cases. Before prescribing fluconazole, review all maternal medications and assess for drug interactions. Do not use fluconazole in combination with domperidone or erythromycin due to concern of prolonged QT intervals.”
Evidence of Pediatric Thrush:
If the Baby has a small amount of light white on the tongue that will not wipe off, Contact the Pediatrician so the infant and the mother get concurrent treatment and do not pass it back and forth. Remember the goal with oral nystatin is to paint the inside of the babies mouth, vs put it alongside one cheek just to be swallowed. Spread it around!
LAUNDRY: when you have thrush will need Grapefruit seed extract and it into your wash to help kill candida on clothes. Dry on hot, or sun dry. Bleach if you need to. Be aware that anything that touches your breast may hold onto the spores, so separate the towels; you get your own. Boil things that go into your baby’s mouth or steam them in a sterilizer bag (Bottle nipples, chewwies, pacis, pump flanges) I think a steamer bag is easier than boiling everything. Please carefully reconsider the instructions from anyone to apply grapefruit seed extract to your nipple neat- it is a great way to chemically burn your nipple.
NONE OF THAT WORKING? TRY GENTIAN VIOLET PER DR. NEWMAN:
“We believe that gentian violet (combined with “all purpose nipple ointment”, see the information sheet Candida Protocol) is a good treatment of nipple soreness due to Candida albicans for the breastfeeding mother. This is because it often works even when used alone (though we don’t recommend this, see first paragraph), and relief is rapid. It is messy, and will stain clothing (actually, it will usually wash out eventually or may be removed from clothing with rubbing alcohol), but not skin. The baby's lips will turn purple, but the purple will disappear after a few days. Gentian violet is available without prescription but is not available at all pharmacies. Call around before going out to get it. If you are in the US: gentian violet seems to be sold commonly as a 2% solution rather than a 1% solution. This is too strong a concentration and probably accounts for the mouth ulcers that some babies get after being treated with it. The pharmacist should dilute it for you. It’s easy to do on your own: just add an equal amount of water to the gentian violet 2% and you have gentian violet 1%.
1. About 10 ml (two teaspoons) of gentian violet is more than enough for an entire treatment.
2. Many mothers prefer doing the treatment just before bed so that they can keep their nipples exposed and not worry about staining their clothing. The baby should be undressed to his diaper, and the mother should be uncovered from the waist up. Gentian violet is messy.
3. Your baby will be less purple if, before you apply gentian violet, you rub some olive oil into the baby’s cheeks and around his mouth.
4. Dip a clean ear swab (Q-tip) into the gentian violet.
5. Paint one of your nipples and the areola and let dry for a few seconds.
6. Put the baby to the breast. In this way, both the baby's mouth and your nipple are treated.
7. When baby is finished on that side, touch up the gentian violet on the nipple if necessary, place a breast pad over top, and cover up that side.
8. Repeat for the other side
9. If, at the end of the feeding, you have a baby with a purple mouth, and two purple nipples, there is nothing more to do. If only one nipple is purple, paint the other one with the ear swab and the gentian violet. In this way, the treatment is finished in one go.
10. A cotton pad can then be used to wipe the excess gentian violet from baby’s face
11. 11. Repeat the treatment each day for at least three or four days t see if it is working and then continue for the rest of the week if it is seen to be working (see the Candida Protocol information sheet for how long to use gentian violet).
12. There is often some relief within hours of the first treatment, and the pain is usually gone or virtually gone by the third day. If it is not, it is unlikely that Candida was the problem, though it seems Candida albicans is starting to show some resistance to gentian violet, as it already has to other antifungal agents. Of course, there may be more than one cause of nipple pain, but after three days the contribution to your pain caused by Candida albicans should be gone. However, if your pain is virtually gone after three or four days, but not completely, you can use gentian violet a few more days if necessary.
13. All artificial nipples that the baby uses should be boiled daily during the treatment, or well covered with gentian violet, or rinsed in a solution with grapefruit seed extract. Consider stopping artificial nipples. Artificial nipples can interfere with the way the baby latches on and may contribute to your pain.
14. There is no need to treat just because the baby has thrush in his mouth. The reason to treat is the mother's and/or the baby's discomfort. Babies, however, only very occasionally seem to be bothered by thrush.
15. Uncommonly, babies who are treated with gentian violet develop sores in the mouth that may cause them to reject the breast. If this occurs, or if the baby is irritable while nursing, stop the gentian violet immediately, and contact the clinic. The sores clear up within 24 hours and the baby returns to feeding.
16. It is advisable that a mother with a recurring infection take probiotics orally for a few weeks and or grapefruit seed extract orally for at least 2 weeks. In this case, the baby should probably be treated with probiotics as well (see the Candida Protocol information sheet).
If the infection recurs, treatment can be repeated as above. But if the infection recurs a third time, a source of re-infection should be sought out. The source may be the mother who may be a carrier for the yeast (but may have no sign of infection elsewhere), or from artificial nipples the baby puts in his mouth. See the Candida Protocol information sheet.
Questions? First look at the website nbci.ca or drjacknewman.com. If the information you need is not there, go to Contact Us and give us the information listed there in your email. Information is also available in Dr. Jack Newman’s Guide to Breastfeeding (called The Ultimate Breastfeeding Book of Answers in the USA); and/or our DVD, Dr. Jack Newman’s Visual Guide to Breastfeeding (available in French or with subtitles in Spanish, Portuguese and Italian); and/or The Latch Book and Other Keys to Breastfeeding Success; and/or L-eat Latch and Transfer Tool; and/or the GamePlan for Protecting and Supporting Breastfeeding in the First 24 Hours of Life and Beyond.
To make an appointment online with our clinic please visit www.nbci.ca. If you do not have easy access to email or internet, you may phone (416) 498-0002.
Gentian Violet, Revised 2009
Written and Revised by Jack Newman, MD, FRCPC 1995-2005
Revised by Edith Kernerman, IBCLC, and Jack Newman, MD, FRCPC © 2009
All of our information sheets may be copied and distributed without further permission on the condition that it is not used in ANY context that violates the
WHO International Code on the Marketing of Breastmilk Substitutes (1981)
and subsequent World Health Assembly resolutions.”
Here is where to get it: https://www.walgreens.com/store/c/de-la-cruz-gentian-violet-first-aid-antiseptic-liquid/ID=prod1550372-product#
The Thrush Plan:
Serena Meyer, RN, IBCLC, RLC