References:

1. Toronto Public Health – Breastfeeding Protocols for Health Care Providers | Protocol #15: Candidiasis (Thrush)
2. Caring for Kids – Thrush

What is thrush (Candidiasis)?

• A common fungal infection caused by a yeast called Candida albicans
• It can infect the baby’s mouth or bum
• The parent’s nipples and milk ducts, vagina/genitals, or hands can be infected
• The infection can pass from mother to baby and from baby to mother through breastfeeding or chestfeeding
• Can cause problems with breastfeeding or chestfeeding

Causes

• A current yeast infection in feeding parent or baby
• A history of repeated vaginal yeast infections
• A vaginal yeast infection during pregnancy or after delivery
• Nipple trauma
• Diabetes
• Recurrent mastitis
• Recent or repeated use of antibiotics with either parent or baby
• Repeated use of plastic-lined nursing pads
• Use of birth control pills containing estrogen
• Repeated use of steroids (e.g., for asthma)
• Repeated use of a pacifier

Signs and symptoms

Treatment

• See your health care provider
  • May provide antifungal treatment
    • Both mother and baby need to be treated at the same time with antifungal medication even if one doesn’t have symptoms

Breastfeeding with Thrush

• Before:
  • Use strategies to ensure that the release of milk or “letdown” occurs when you feed
    • Use of relaxation strategies – e.g., warm shower, heat on the back/shoulders, breathing, supportive positions, or a warm drink
    • Breastfeed in a quiet, comfortable space
    • Breastfeed early when the baby shows signs of hunger
    • Skin-to-skin contact
    • Manage pain to support comfort and relaxation
    • Feed with the child in a vertical position with baby’s nose to nipple
    • Heat and massage breasts
    • Stimulate nipples by rolling them between index finger and thumb
    • Feed on the pain-free side first
    • Numb the nipple – apply ice to the nipple right before feeding
• During:
  • Ensure proper position and latch
  • Ensure baby is sucking and swallowing well
  • Make sure to break the suction when taking baby off the breast
• After:
  • Wash hands often
  • Wash breasts/chest and air dry
  • Put cool cloth on chest
  • Try to avoid the use of breast pads
    • If used, use 100% cotton and change as soon as they become wet
  • Use breast shells that have good ventilation
  • Express breast milk from both breasts if baby is not feeding properly
    • This milk can be used on the day it is expressed but do not save or freeze to use at a later date

Prevention

• Wash hands frequently
• Wash and sterilize items that go in the baby’s mouth
• Sterilize all tools that touch the breast each day
• Throw any items that go in a baby’s mouth (pacifiers, bottle nipples, teethers) and replace with new ones 1 week after antifungal treatment
• Avoid using antibiotics
• Avoid bathing with others
• Avoid sharing objects with others that touch areas where thrush can be present
• Inform sexual partner of yeast infection
• Use condoms
• Eat a well balanced diet

Further Your Learning:

1. Toronto Public Health – Breastfeeding Protocols for Health Care Providers | Protocol #15: Candidiasis (Thrush)
2. International Breastfeeding Centre – Candida Protocol

Shareable Resources for Clients:

1. Caring for Kids – Thrush
2. Best Start - Thrush

Referral Sources:

1. Niagara Parents - Infant Feeding Appointments with a Public Health Nurse - 905-684-7555
2. Health811 - Breastfeeding advice and referrals - 1-866-797-0007
3. La Leche League Canada – Mother-to-mother breastfeeding support - 613-238-5919