Breastfeeding and thrush: Persistent nipple thrush or just sore nipples?

I have an eight-month-old son. When he was six weeks old we were diagnosed (over the phone) with thrush. We started the whole treatment: Mycolog cream for me, nystatin oral suspension for him. I boiled everything, from breast pump parts to bottle nipples and pacifiers. I used washcloths and towels only once before laundering, washed my hands all the time and rinsed clothing in a vinegar solution. This went on for three months when I stopped in frustration. Almost seven months later I am still having sore nipples, with reddened tips. I cannot find any spots in my son's mouth. Maybe this isn't thrush at all.

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Debbi Donovan

Debbi Donovan is a Board Certified Lactation Consultant, as well as a retired La Leche League Leader. For more than a decade, Debbi... Read more

Seven months is too long to be in pain!

Thrush really needs to be diagnosed by physical assessment during an office visit and you nany should be seen too. This is also very important for breastfeeding moms with persistently sore nipples. Candidiasis is not a condition that can be adequately diagnosed over the phone (or over the Internet). Though the medication sometimes used to treat early cases of oral thrush (Nystatin) is quite safe, there is much talk today that thrush is being overdiagnosed. (It is important to also know that Nystatin is not effective in treating all cases of thrush.) There is no use in taking a medication when it is not warranted.

You have been consistently working to get rid of thrush. It is persistent, but without a proper history and assessment it is impossible to say whether or not you are really dealing with candidiasis. It may be something else entirely. That could be the reason your treatment of the condition did not work.


Reddened nipple tips can also be caused by:

  • Eczema of the Nipples -- If eczema is present, you probably have a history of dry, sensitive skin. Your nipples may be red and you may experience burning and itching. Itching is not commonly experienced with thrush.
  • Improper Positioning -- If your baby doesn't have a good mouthful of your breast throughout the feed (about one inch or more of your areola), your nipple tips can take a beating. Adjust your positioning and attachment and hug your baby in closely to your breast. Be careful not to point your nipple upwards. It may be rubbing against the roof of your little one's mouth.
  • Tongue-Tie -- This inherited condition (where the baby has a short or tight lingual frenulum) can cause continued nipple soreness, often accompanied over time by insufficient milk supply. Can your baby extend his tongue past his lower gum line? If he is unable to stick out his tongue, he may be physically unable to cup your breast and draw it well into his mouth. A newborn's frenulum can be easily clipped, but clipping is rarely recommended in a child over six months of age. Even if the frenulum was clipped, babies of this age are often so set in their nursing pattern that it might not make any appreciable difference.

Find a  lactation consultant in your area. After taking a complete history, examining your nipples and baby's mouth for signs of thrush and watching a complete feed, she will be able to make appropriate recommendations based on your special circumstances. She can then work along with your doctor to assure appropriate treatment.

 

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