The Bottom Line on Yeast and Thrush in Mothers and Infants.

Yeast is an inescapable part of our environment, a fungus with durable spores that has been around much longer than we have! Right now, yeast is getting a ton of attention on the internet, and has become a catch-all scapegoat for many unrelated breastfeeding ailments.

In fact, Candida is commonly found as a friendly passenger in the mucous membranes of humans and other warm-blooded animals. A certain measure of yeast is ever-present. Sometimes these same strains can become pathogenic. The yeast cells sprout a hyphal outgrowth, which locally penetrates the mucosal membrane, causing irritation and shedding of the tissues, know as candidiasis.

Several species of yeasts, such as Candida albicans (white yeast), are occasionally opportunistic pathogens and can cause infections in humans oral and vaginal infections in humans. Again, this can ONLY happen when yeast grows out of control, since they are ever-present in our environments and bodies.

Infections of the mouth are most common among children less than one month old, the elderly, and those with weak immune systems. Vaginal yeast infections occur more commonly during pregnancy. Infants born by cesarean, of low birthweight, or from mothers who have been treated with antibiotics during delivery (such as Group B Strep positive mothers) are more prone to yeast imbalances, since the antibiotics create an environment conducive to yeast overgrowth. Other risks include wearing dentures, corticosteroid treatment, surgical recovery, or being in an intensive care unit (ICU, NICU).

There is some frightening advice that has been proffered that I feel is destructive and needs to be addressed urgently!

Destructive yeast myths:

1. You must cleanse your home of yeast spores.
   You can never, ever get rid of yeast! It's everywhere, so don't waste your time boiling and cleansing equipment. The one exception is cloth diapers. These can be successfully treated.
2. You must trash your stored milk.
   When I hear this, it is the equivalent to hearing, "My milk has ghosts in it. I had to throw it out!" SUPERSTITION!! Throwing precious milk away is needless and destructive.
3. My baby has thrush because his/her tongue is white.
   If a baby has a white tongue coating, it is NOT thrush! Thrush is accompanied by white plaques on the inside of the baby's bottom lip and cheeks that don't rub off, and usually bleeds due to irritation. Babies with thrush are usually unhappy, because their mouth really hurts.
4. My nipples have a yeast infection, causing me pain.
   Not likely! This idea has been disproven by research (Hale study on Candida albicans). The nipples are hostile to yeast infection, since yeast thrives only in moist, dark environments (like mouths and vaginas). When nipples sting, check first if they are being irritated by laundry soap (allergy, contact dermatitis), plastic bra pads, or a bacterial irritant (such as staph aureus, treatable with triple antibiotic ointment, such as Polysporin).
5. I can cure my yeast infection by treating the location on my body with yeast symptoms.
   Yeast infection is a systemic problem. It is remedied by a resistant immune system, and sometimes the following treatments: reduction in intake of sugary, starchy foods that feed yeast, grapefruit seed extract, garlic, aloe, and intake of probiotics (friendly, helpful bacteria) to edge out the yeast holding onto all the real estate in the moist areas of the body.
6. Nystatin works for a mother and baby who have thrush.
   Nystatin is not effective on sore nipples, and placebo (no treatment) works just as well to cure symptoms in 4 days. Alternative therapies, like gentian violet may work quicker and more effectively. Jack Newman has a great handout describing how to use this over the counter product on baby's mouth for true thrush cases. You can buy gentian violet at Walgreens or Amazon. 
7. Using Monistat on my nipples is okay.
   Miconazole is not harmful to breastfeeding babies, but it is not effective against thrush either. There are better and cheaper treatments.

What you SHOULD do if you have symptoms of yeast on the nipples:

• No soap or tea bags on the nipples, this will dry them out.
• Coconut oil is a good, natural lubricant, that is yeast resistant (apply sparingly).
• Stop using lanolin! Applied to broken skin, it can transmit infection and cause mastitis (usually what happens is that your finger carries germs from container to nipples).
• Warm saltwater nipple soaks twice daily- for comfort and to reduce bacteria on skin.
• Triple antibiotic ointment applied several times 2-3 days in a row, after feedings. This is not harmful to the baby; just wipe it off prior to nursing or pumping.
• 1% over the counter hydrocortisone applied several times 2-3 days in a row, after feedings. This reduces itching and burning symptoms while the nipples heal. It is not harmful to the baby; just wipe it off prior to nursing or pumping.
• Probiotics, garlic, lecithin, and grapeseed extract are all helpful nutritional supplements, as well as rest and hydration.
• Breast shells can allow nipples to air dry with milk on them. This is protective, as breastmilk has antifungal properties.

Another perspective on thrush can be found here.

If thrush symptoms persist beyond one week, consider treating for mastitis to clear symptoms. Contact us if you have questions or concerns about nipple pain, thrush, mastitis symptoms, and alternative treatments.