Breastfeeding: Thrush and gentian violet

At a doctor's visit three weeks ago we found out that my two month old has thrush. I thought that my red sore nipples were from improper latch-on, because he showed no signs of thrush. They have prescribed Nystatin to apply in his mouth, as well as on my nipples, but two weeks later it is not gone. Now I can see the white spots in his mouth. My nurse practitioner then prescribed Gentian Violet. This has become such a nightmare. It is a purple dye and makes a mess everywhere. How can I be sure this thrush is gone once and for all?


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

When a nursing mother's nipples suddenly become tender after weeks or months of breastfeeding, thrush may be the cause.

Other symptoms can include itchy, burning, swollen and/or cracked nipples. Deep, shooting breast pain may be present, particularly in more severe cases where there is involvement of the milk ducts. A baby may show no signs (yet), especially if under six weeks of age or he may have white plaques inside his mouth, that can't be easily wiped off. Thrush, a fungal (yeast) infection, thrives in the warm, moist areas of a mother's nipples and a baby's mouth and bottom. The infant's diaper rash can resemble a burn, or may look like small red pimples. The mother's nipples and the baby's bottom may peel and flake.

Gentian violet is a purple liquid that is a non-prescription antifungal. A 0.25 or 0.5% solution is "painted" on affected areas, such as the baby's mouth and bottom and the mom's nipples, using a clean cotton swab each time you need more medication. After the purple stain disappears the solution should only be reapplied once or twice. Though gentian violet is quite effective, it should be used with caution. Improper use can result in painful sores and irritation. It is normal for peeling of the skin, with accompanying redness, to occur a couple of days into this treatment. And yes-- gentian violet can be very messy and will stain anything it touches.

Though thrush is not a serious condition, it is remarkably persistent. If left untreated, it can continue indefinitely. It is necessary to treat both mom and baby simultaneously for a period of at least two weeks, even if one remains without symptoms. The most common treatment is the prescription medication, nystatin. Other medications, such as clotrimazole, miconazole, naftifine, oxiconazole and ketoconazole can be used if nystatin does not clear up the thrush. Talk to your doctor about alternatives.

When thrush is present, it's important to wash your hands thoroughly with hot, soapy water, before and after feeds, diaper changes and using the bathroom. If you are expressing your milk, do not save it. It must be used the same day. Change your bra daily and wash in hot, soapy water. Replace nursing pads, if worn, at each feed. Bras and nursing pads can be boiled for 5 to 10 minutes to kill spores. Brief exposure to the sun two to three times a day may aid in the healing of your nipples. If you use pump parts, breast shells, pacifiers, etc., they must be boiled 20 minutes each day while thrush is present.

It is also important to rule out a vaginal yeast infection. If yeast is present vaginally, both you and your sexual partner will need to be treated. Thrush is a family disease and it can readily be passed back and forth between you, your partner and your baby.

A yeast-free diet can be helpful in clearing up a persistent infection (ask your doctor for advice).

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