Persistent sore nipples: Is it thrush?

My 10-week-old baby is breastfeeding but my nipples have never "toughened up." They are pink and sore and periodically I feel pain deep in my breast, as if a duct is being pulled on, even when he is not nursing. My OB/GYN prescribed an antibiotic at my six week checkup just in case I had an infection, but it did not clear up my problem. I see no evidence of thrush, and his latch-on is correct 90 percent of the time. What could be causing my nipples to remain tender?

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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

It was once thought that mothers would need to "toughen" their nipples to breastfeed comfortably. It is now known that this is not true. It is really impossible to toughen the nipples and areola. Nipples need no preparation prenatally and other than passing nipple soreness during the first week, breastfeeding should be comfortable.

It is really very difficult for you to determine on your own whether or not you have thrush, or even if your baby's positioning and attachment is right. It is very common for mothers to believe that all is okay (though they are still in pain), while in reality, something is going on to make breastfeeding uncomfortable for them. You really do need to be evaluated in person by an IBCLC, to get to the cause of your breastfeeding difficulty. Candidiasis is not a condition that can be adequately diagnosed over the phone.

You may be more prone to nipple or breast candida because of your treatment with antibiotics. Pink, sore nipples and deep breast pain are consistent with symptoms of thrush. Not all babies have white plaques in their mouth or a yeasty diaper rash. If it is determined that thrush is the culprit, both you and your little one will need to be treated simultaneously (Lawrence 1994). It is recommended that treatment with an antifungal be continued until you (and baby) have been symptom-free for one to two weeks (Amir, Hoover and Mulford 1995). Best wishes!

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