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Expert Q&A

	By Karen Zeretzke IBCLC, Lactation Consultant

I am breastfeeding my 3-month-old, and I think that I have thrush. I am familiar with thrush, because I had multiple brushes while nursing my first-born. I wonder if there is anything I can do to put healing and pain relief into gear while I wait for the doctor's office to call me back? What should I be doing the minute I suspect thrush?

Yeast – a very opportunistic and persistent organism – exists in a benign form on the skin of many people. When there is some insult to the immune system (taking antibiotics, which kill bacteria which normally keep yeast in check is very common), yeast can become pathogenic (disease producing). Yeast becomes hyphal (has roots) and can dig itself deep within tissue, so early treatment is important to limit the infection. Yeast on nipples can be extremely painful!

Yeast on a Mother's nipples and thrush – white plaque which cannot be wiped away – in Baby's mouth need to be treated as soon as possible. If either Mother or Baby has yeast symptoms, both should be treated simultaneously to prevent reinfection.

Yeast on nipples can be treated by home remedies until one can get a prescription from the doctor. One tablespoon of white vinegar in a cup of water, stirred, then applied with a cotton ball (and never dip the same cotton ball back in the vinegar solution!) will change the pH of the skin to become more acidic and make it more difficult for the yeast to reproduce and/or survive. If the baby indicates he doesn't like the taste of vinegar, the nipples can be rinsed to remove the residue.

This should not be done in a baby's mouth; wait for the call back from the baby's doctor.

Another thing to note is that many, many strains of yeast exist which are resistant to Nyastain, the first line yeast treatment for many doctors. If you are not experiencing relief after using it for 24 to 48 hours, call your doctor back and ask for another medication before you rule out yeast.

Note: This mom is familiar with yeast and its symptoms because she has had prior experience. There are lots of causes other than yeast for sore nipples, and these must be ruled out before yeast can be assumed to be the culprit. Yeast on nipples is difficult to culture, so yeast is often a diagnosis of exclusion. It's important for mothers to communicate with health care providers so the mother and her HCP can be a team to solve nipple problems.

Karen Zeretzke, MEd, IBCLC, RLC"

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