Information Sheet and Care Plan for Yeast (Candida)
By Anne Smith - IBCLC
Candida (also called yeast,
or thrush) is a fungus that occurs naturally in the mucous membranes and on
the skin. Use of antibiotics promotes the overgrowth of yeast by killing
off the ‘good’ bacteria that normally keep the yeast from multiplying too quickly. During
pregnancy, yeast infections are more common because high levels of estrogen
lead to elevated levels of sugar, and yeast feeds on sugar.
If you or your baby have
recently been on antibiotics, if you have had a vaginal yeast infection during
the last several months (or anytime during pregnancy), or if your nipples are
cracked, then you and your baby are at risk for developing a yeast infection.
Other factors that make you more susceptible to yeast include use of steroids
or hormonal contraceptives, or chronic illness such as diabetes or anemia.
Symptoms of a yeast infection
in your baby include creamy white spots or patches on the mucous membranes inside
the mouth (gums, cheeks, or tongue). The spots may look pearly, and may
be surrounded by redness. If you gently scrape the spot, it may be reddish underneath
(unlike a coating of milk on the tongue). Sometimes the inside of the
lips or the saliva may have a ‘mother of pearl’ appearance. The baby may
be fussy and gassy, and sucking may be uncomfortable for him. He may pull
off the breast, or may refuse to nurse at all. It is also possible for
him to have an overgrowth of yeast but have no visible symptoms.
Yeast can also cause a
rash in the baby’s diaper area. The rash is red or bright pink, and may
be scaly. The affected area may contain small raised red spots or sore
looking pustules. The rash may be localized (the area looks like it has been
dipped in scalding water) or it may be diffuse and lacy, covering a large area. Use
of standard diaper rash medications like petroleum jelly or Desitin does not
clear up a rash caused by yeast, and may actually make it worse, because yeast
feeds on the oils found in greasy ointments, and also on the starch found in
baby powders.
Symptoms in the mother
include severe stinging, burning pain, which may be on the surface of the nipples,
or may be felt deep inside the breast. Pain often continues throughout
the feeding and in between feedings – especially immediately after. (Nipple
pain caused by incorrect positioning and latch on rarely hurts except when the
baby is nursing). Sometimes sharp, shooting pain radiates from the nipple
into the breast or into the back or arm. Nipples are sensitive to light
touch, so it may hurt to have clothes rubbing against them, and it may be very
painful to take a shower and have the hot water spray touch the breast. Mothers
describe the pain as ‘liquid fire’, ‘hot needles’, ‘razor blades’, ‘a piece
of glass stuck in my nipple’, etc. I’ve heard many mothers say that they
would rather go through labor again than have yeast on their nipples or in their
milk ducts, which gives you an idea of just how painful this condition is.
The nipples may look puffy,
scaly, flaky, weepy, or have tiny blisters. They may be itchy. The color is
often a deep pink. The nipples may also look completely normal, but be
terribly painful (just as the baby’s mouth may be infected, but not have white
patches). If you have yeast on your nipples, or if your baby has it in
his mouth, your milk supply will often decrease. Pain inhibits the let-down
reflex, and babies with yeast often do not nurse as efficiently as they do when
their mouths are not sore. Yeast infections may also lead to plugged duct and
mastitis.
Once the infection is
cleared up, you should be able to build your supply up again quickly.
It is important to note that while yeast on baby’s bottoms or in their mouths
may be tender and irritated, it does not seem to cause extreme pain like it
does on the mother’s nipples or in her milk ducts.
Mothers may also have
a vaginal yeast infection (itching, cottage cheesy discharge), sores at the
corners of the mouth (angular chelitis), swelling or tenderness of the tissue
around the toes or fingernails (candida paronychia), or a rash in the moist
areas of the body such as under the arms or in the groin (intertriginous candiasis). Athlete’s
foot is also a type of fungal infection.
Because yeast grows in
warm, moist areas, it can be traded back and forth between a mother and her
nursing baby. Both mother and baby must be treated together in order
to clear up the infection. It is important to do this even if one of you
does not have symptoms. Consult your doctor regarding a treatment plan.
If you or your baby have
any of the symptoms described above, (especially if you have been on antibiotics,
or if your nipples suddenly become sore after the first two weeks postpartum),
you may have a yeast infection. If you believe you may have a yeast infection,
here are some suggestions on how to treat it (always consult your health care
provider before beginning any treatment). It is important to begin treatment
only after ruling out other possible causes of severe nipple soreness, such
as improper latch on and positioning, mastitis, eczema, herpes, ringworm, and
psoriasis.
If you have
yeast on your nipples:
Wash hands often (before and after
nursing, after using the bathroom, and before or after changing the baby’s
diaper). Use hot, soapy water and paper towels.
Nurse frequently for shorter amounts
of time. Start nursing on the least sore side. Numb the nipple with ice
wrapped in a washcloth before beginning to nurse. Take Advil (unless
you are allergic to it) around the clock. If it becomes too painful to
nurse, you may want to pump your milk temporarily and feed it to your baby
by cup or bottle until the pain lessens.
Try drinking green tea 3 or 4
times a day. It may help cleanse your system of excess yeast, and all
evidence points to its benefits, so it certainly won’t hurt to try.
Decrease consumption of foods
containing high amounts of sugar and/or yeast (such as beer, wine, sodas,
bread, desserts, etc.). Dietary supplements that may be helpful include: Lactobacillus
acidophilus (helps promote the growth of ‘friendly bacteria’). Usual
dose”1/4 to ½ tsp. of powder or 1-2 capsules, 1-4 times daily. Bifadophillus
also works well, and does not contain apple pectin, which may limit the supplement’s
effectiveness. Acidophilus supplements of up to 24 tablets a day are not harmful,
and may be helpful in severe or chronic cases. Eating yogurt, while helpful,
is not enough to treat a yeast infection by itself. Another supplement
that is often helpful is Caprylic acid. The usual dose is 1-2 capsules
with each meal. These products can be found at most health food stores.
Working with a herbal specialist to adjust the dosages may be helpful.
After nursing, rinse the nipples
with a solution of one cup of water plus one TBSP of vinegar. Air dry
well. Apply antifungal creams like Lotramin AF or Gyne-Lotramin (containing
clotrimazole) or Monistat (containing miconazole). These are available
without a prescription. Your doctor may also prescribe an antifungal
cream like Nizoral (containing ketoconazole). Although Nystatin has
been the most popular prescription antifungal used for many years, it is no
longer the first choice of treatment due to resistant strains of yeast that
have developed.
If pain is severe, apply the cream
sparingly after each feeding (6-8 times per day) for 24 hours. Then
apply 3-4 times daily. The cream is absorbed quickly, and does not have
to be removed before baby nurses. If you feel that some ointment remains
on your nipple, you may want to gently press a damp warm washcloth on the
nipple and areola before nursing. Avoid wearing nursing pads, but if
you have to use them be sure to change them at every feeding. Keep the
nipples as dry as possible.
After 24-48 hours, you
should feel some improvement. (Sometimes you can tell a difference after
just one application. In some cases, symptoms temporarily get worse before
they get better - so be sure to continue the treatment for at least the fill
48 hours. If you don’t see improvement by then, try a different
antifungal cream.
Another effective antifungal treatment
that is inexpensive and available without a prescription is gentian violet.
It can be used on your nipples and in the baby’s mouth or diaper area.
Be sure to consult your health care provider before beginning treatment, because
it is strong medicine and be dangerous if used improperly or too long. It
is very messy (it looks like purple ink and stains anything it touches, including
baby’s mouth and lips, and clothing or bedding). It usually comes in
a one percent solution, which you may want to dilute down to a ½ percent solution,
especially is using it in the baby’s mouth. Apply to nipples, baby’s
mouth or diaper area once or twice daily for no more than three days. You
may continue to use a topical ointment at the same time. Apply with
a cotton swab, especially at bedtime when the baby is more likely to go for
a longer stretch without nursing. Wear old clothing, since it does stain.
If you get stains on clothing, try alcohol, bleach, or aerosol hairspray to
remove them. Stains on the skin will usually fade in a few days.
Applying a thin coating of lanolin to the baby’s lips may minimize staining
on his face when gentian violet is applied to his mouth or your nipples.
Expressed milk should be fed to
the baby while you are both being treated for yeast, and not saved for later
use, since refrigerating and freezing the milk does not kill all the yeast.
For a vaginal yeast infection, ask
your doctor which medication he suggests. Non-prescription medications
like Gyne-Lotramin and Monistat 7 are often effective, or your doctor may prescribe
a medication like Terazol 7 (tercoconazole). Rinsing the vaginal area with
a vinegar and water solution after using the toilet may be helpful. Expose
the affected area to air as much as possible by wearing cotton (or no) panties
and avoiding tight clothes like pantyhose and swimsuits. A single dose
of Diflucan oral medication (fluconazole) is also often used to treat vaginal
yeast infections. It is available by prescription.
For yeast in the baby’s diaper area,
ask your doctor which medication he suggests. Often the same antifungal
ointment used on your nipples, whether prescription or over the counter, can
be effective in clearing up the baby’s bottom. If the area is extremely
inflamed, ask your doctor about an ointment containing cortisone (such as Mycolog
or Lotrisone). If the rash does not seem to be responding to antifungal
cream within a few days, ask your doctor about using a ½ percent solution of
gentian violet in addition to the cream once or twice a day for a few days.
After each diaper change, wash the
baby’s bottom with warm soapy water. Rinse and dry well. Avoid using
commercial baby wipes (they keep the skin moist, and may contain irritating
chemicals). Expose the baby’s bottom to air as much as possible.
For yeast (thrush) in the baby’s
mouth, your doctor will probably prescribe oral nystatin drops. After each
nursing session (or however often your doctor suggests) rinse the baby’s mouth
with water, offer him a drink of water from a cup, or wipe the inside of his
mouth with a damp washcloth. Milk that remains in the baby’s mouth can
be a source of food for yeast. Then apply the medication according to
directions. Put the medicine in a spoon or paper cup and use a Q-tip to
swab it in the baby’s mouth. Don’t put the dropper directly in his mouth
and then back in the bottle, to avoid contaminating the medication. A
complete course of treatment usually takes several weeks. If there is
no improvement in a few days, ask your doctor about using a ½ percent solution
of gentian violet for a few days.
Boil any object that goes in the
baby’s mouth (such as pump parts, bottles, nipples toys, and pacifiers) for
20 minutes each day. Add some vinegar to the boiling water. Continue using
the medication for at least 2 weeks after symptoms are gone. If nystatin
and gentian violet do not seem to be clearing up the thrush in the baby’s mouth,
ask your doctor about pediatric Diflucan suspension.
In certain cases, yeast infection
on the mother’s nipples does not respond to topical treatments. In these
cases, pain is severe and unrelieved. Pain may begin as burning or stinging
on the surface of the nipples, primarily during breastfeeding, and progress
to deep stabbing internal pain inside the milk ducts. This type of deep,
sharp pain continues throughout the day and may be worse at night, interfering
with the mother’s sleep. Pain may radiate into the armpit or back. If
topical treatments are ineffective, you may need to talk to your doctor about
the possibility of using a systemic treatment which is taken orally, and is
available only by prescription. You may want to ask him to prescribe a prescription
painkiller as well.
Be persistent in treating yeast.
Once you have it, it tends to stick around and not go away by it self, because
it thrives on moisture and sugar, and nipples and baby’s mouths provide the
perfect environment for it to grow. It is also important to note
that if you have yeast on your nipples or in your milk ducts, weaning your baby
will not necessarily make it go away and you will still need to treat the problem.
Be sure to remain in close contact
with your health care provider during treatment, because yeast presents a variety
of symptoms an requires continuing reassessment and adjustment of treatments
to provide optimal relief and effect a cure in the shortest period of time.
Try not to become discouraged.
NOTE: The text of this article was
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About the Author
Anne Smith, anne@breastfeeding-basics.com http://www.breastfeeding-basics.com
Anne Smith is an IBCLC – International Board Certified Lactation Consultant
and La Leche Leader since 1978. More importantly, she is a mother to 6 breast
fed kids with twenty plus years experience of counseling nursing mothers. Her
site, www.BreastfeedingBasics.com
, provides expert advice and solutions to breast-feeding problems and gives
basic information on how to breast feed. Anne also features her recommended
breast feeding products and breast pumps.
if you have any questions or comments!