Every now and again women will complain of pain in their breasts which is related to thrush.

About breast and nipple thrush
Thrush is a fungal infection caused by the organism Candida albicans which can occur in the nipples and/or breast tissue (as well as other places in the body). It may cause significant nipple and breast pain. This pain may be severe enough to lead to early weaning if the condition is not appropriately treated.

If you are experiencing nipple pain which is not resolved by improved attachment, you should seek the advice of a lactation consultant
or other health care professional.

Early diagnosis and treatment of nipple and breast thrush will help you to enjoy your breastfeeding experience.

Causes
You may have a history of vaginal thrush, recent antibiotic use and/or nipple damage.

Symptoms
The most common symptom is nipple pain and/or breast pain.
Nipple thrush pain is often described as burning, itching, or stinging and may be mild to severe. The pain is usually ongoing and is not resolved with improved positioning and attachment of your baby to the breast. Your nipples may be tender to touch and even light clothing can cause pain.
Breast thrush pain can vary. It has been described as a stabbing or shooting pain, a deep ache or a burning sensation that radiates through the breast. It may be present in one or both breasts.
It is characteristic for this pain to be experienced both immediately after and between feeds.

Signs
There are usually no obvious signs of thrush on your nipples. However some signs may be present and include:
the nipple/s may appear bright pink; the areola may be reddened, dry or flaky. Rarely a fine white rash may be seen
nipple damage (e.g. a crack), which is slow to heal
signs of thrush may be present in your baby’s mouth and/or on your baby’s bottom. Thrush in the mouth appears as a thick white coating on the tongue and/or white spots on the inside of the cheeks. Thrush on the baby’s bottom appears as a bright red rash with spots around it which does not clear without anti-fungal treatment.

Once the diagnosis of thrush in either you or your baby is confirmed by your lactation consultant or other health professional, it is essential that both you and your baby be treated.

Management and treatment
Apply/take antifungal medication as directed
In May 2006, Janssen-Cilag (the manufacturers of miconazole oral gel) issued an alert advising pharmacists not to supply miconozole oral gel for use in infants less than six months of age. This alert is about the way that the gel is given to the baby rather than a concern about the medication itself.

It is important to apply miconazole oral gel correctly:

use the spoon supplied to measure a ¼ teaspoon dose. The spoon is NOT to be used for administering the gel
using a clean finger, apply small amounts of gel at a time to the inside of your baby’s cheeks and over the tongue
apply the gel four times a day after feeds for one week then once a day for a further one to two weeks
if you are unsure about using the gel or you are unable to purchase the product from your pharmacy, you could try another pharmacy or you could use nilstat oral drops. However, it should be noted that the drops are not as effective for oral thrush in infants as miconazole oral gel. If using nilstat oral drops, apply 1ml to your baby’s mouth four times a day for one week and then once a day for a further one to two weeks.
Treat any other site of fungal infection in the whole family, i.e. vagina, nappy rash, feet.
Keep your nipples dry by frequently changing breast pads as thrush thrives in a moist and warm environment
Once or twice a day rinse your nipples with a solution of sodium bicarbonate 1 teaspoon diluted in 1 cup of water
Clean teats and dummies thoroughly after use and boil for 5 minutes. Replace weekly if possible
To prevent the spread of thrush wash your hands thoroughly after nappy changes and before and after applying any creams/lotions
Wash towels, bras, cloth nursing pads etc in hot soapy water and air dry outside.

Dietary recommendations
It is important to maintain a healthy, well balanced diet.
Try to completely avoid or reduce the following foods:
refined sugars
alcohol
dried fruit and peanuts
cantaloupe (rockmelon) and grapes
fruit juice
Vegemite.

Add Lactobacillus acidophilus to your diet: Take the maximum recommended dose of capsules or powder available from health food stores and pharmacies.

Where to get further information
Breastfeeding Service
Contact us at Myprivatemidwife midwife

this information is obtained from the womens hospital in Melbourne
Disclaimer
The Royal Women’s Hospital does not accept any liability to any person for the information or advice (or use of such information or advice) which is provided in this fact sheet or incorporated into it by reference.