Thrush: It hurts to nurse!

My daughter is five weeks old and only nurses on the left side.I feel like I am not making enough milk. She is gaining okay but I have no idea how much she is getting and I tend to take her off after 15 minutes because my nipples hurt so much. She was diagnosed with a mild case of thrush and has been on Diflucan for one week. After I nurse her my breasts and nipples burn and throb. I feel like giving up because it has just been so difficult. I nursed my son for one year and I was looking forward to nursing again but I hate it now!

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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

I can really understand why you are feeling so discouraged. It hurts you to feed your baby, and while experiencing painful feeds, I can bet that it makes you reluctant to nurse as much as you'd like to. That can make anyone feel like giving up.

It is really important to have your situation evaluated. I would recommend contacting a Board Certified Lactation Consultant in your area, who will be able to take a complete history and observe a full feed, to rule out any other cause of breast pain that may be impacting your situation. Contact ilca@erols.com to get the name of an IBCLC working in your area. Working with an IBCLC and your Health Care Provider to resolve your situation will help you to feel less out of control and begin to turn your breastfeeding relationship around. You want to begin nursing without pain!

Let's first address the issue of thrush. Thrush is a fungal infection. It thrives in the warm, moist areas of a mother's nipples and a baby's mouth (and bottom.) Since your daughter was diagnosed with a mild case of thrush and is now being treated with Diflucan, it is very likely that you are also suffering from thrush. Are you also being treated with Diflucan? Since your breasts and nipples still burn and throb for a long time following a feed, you may not only have candidiasis on your nipples, but also a secondary yeast infection in your milk ducts. There are many other causes for breast pain, this is one possibility that needs to be investigated. It is necessary to treat both you and your little one simultaneously for a period of at least two weeks, even if one seems to be free of symptoms. (Breastfeeding and Human Lactation, Riordan and Auerbach, 1993) If you and your baby are not treated at the same time, you may be reinfecting one another. Candida is a family disease that can be easily passed from one person to another.

If a medication such as Nystatin or Miconazole is recommended by your Health Care Provider for use on your nipples, rinse your nipples gently with warm water following a feed. Allow to air dry and then gently apply the medication, smoothing in well. Most of the medication will be absorbed before the next time your baby nurses, though I still feel it is wise to gently rinse the nipples with water prior to the feed to remove any remaining residue.

If Nystatin suspension is used for your baby following her treatment with Diflucan, pour the amount needed into a small (bathroom-sized) paper cup. Use a clean cotton swab each time you dip into the medication. Swab all areas of your baby's mouth, including gums, roof of mouth and tongue. Repeatedly dipping into the bottle that holds the medication can contaminate the solution.

Whenever an infection is present, it becomes especially important to wash your hands thoroughly. Use hot, soapy water, and dry your hands with paper towels, before and after feeds, diaper changes, using the bathroom, and other times throughout the day. This is very important in helping to get rid of thrush. While infected with thrush, do not freeze your expressed milk for future use. It must only be used while you and your baby are being treated for thrush, or reinfection may occur. Change your bra daily and wash in hot, soapy water (with bleach, if possible.) If you wear nursing pads, change at each feed. If you use breast shells, pacifiers, pump parts (that are in contact with your milk), etc., they must be boiled at least five minutes each day while thrush is still present. Each week, throw away any used bottle nipples and pacifiers, and replace with new ones.

In regard to your milk production, it is not unusual to see less milk produced in one breast. In your case, it may very well be the result of feeding less on the right side. There is still a good chance you can build up your supply on that side if your baby starts nursing more effectively. If your baby did totally refuse your right breast, your milk supply in your left breast should build to fulfill her needs.

Many moms are worried they are not producing enough milk for their babies. You can really put your worries to rest if your baby is healthy and has good output and weight gain. At this age, five to six wet diapers each day is the norm, with bowel movements transitioning from several each day to regular, substantial bowel movements. Good weight gain is considered to be four to eight ounces (113 to 227 grams) each week until the age of three to four months. Even though you experienced different sensations with your first baby it does not indicate to me that you have an insufficient milk supply.

Once you have been evaluated and treated for thrush (if that is the problem), and your breasts are feeling more comfortable, you can allow your little one to nurse on one side until she comes off on her own. Then offer her the other side. Nursing at least 10 to 12 times a day, and expressing milk if needed for times of separation will help to keep your milk supply abundant. Best wishes for a happy and comfortable nursing relationship with your little one!

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