The following excerpt on the common breastfeeding problem thrush, a yeast-like infection caused by the fungus Candida albicans, is from 'Amy Spangler's BREASTFEEDING: A Parent's Guide.'

"Fungal infections are common in breastfeeding mothers and babies," said Amy Spangler, author and breastfeeding expert. "While fungal infections are seldom serious, they can be quite painful.  Infected areas can be treated with antifungal medications.  Encouragement and support from health care providers will assure continued breastfeeding".


SIGNS:

Baby: The baby can become infected during vaginal birth or while breastfeeding.  Signs of infection often appear 2-4 weeks after birth and include small, white patches in the mouth (thrush) and a bright, red rash in the diaper area.

Mother: The mother can become infected while breastfeeding.  Signs of infection include small red or white patches on the breast, red or purple nipples, and sharp, shooting pain in the breast. Frequently severe pain is the only symptom.  Some women also have a thick, white, vaginal discharge with redness, itching and burning in the vagina.

Father or sexual partner: Your partner can become infected during sex.  Signs of infection include a red rash on or around the penis and small white patches in the mouth.


CAUSE:

Candida is a yeast-like fungus that grows in dark, damp places and is found in the birth canal of most women.  As a result, babies can become infected during vaginal birth.  While the infection is not serious, it can be very painful.  Sometimes a baby will refuse to breastfeed.


RECOMMENDED TREATMENT:

Treat both mother and baby, even if only one has symptoms.  You may need to call your doctor as well as your baby's doctor.  Treat your sexual partner or any family member (siblings) with signs of infection.

Mother:

       Rinse the breasts with clear water after each breastfeeding.

       Your doctor will recommend one of the following 
          medications: Nystatin (mycostatin), Monistat (miconazole), 
          or Lotrimin (clotrimazole).  Put the cream on the nipple and
          areola of both breasts after each breastfeeding for 14 days.

       If the pain is severe, use one of the above medications with
          cortisone (Mycolog, Lotrisone) for the first 1-3 days.  Gently
          massage the cream into the nipples.  It is not necessary to
          remove the cream before breastfeeding.

       Wash bras in hot, soapy water each day and rinse well.  Boil
          all pump parts for 20 minutes each day.

       Wash your hands carefully before each breastfeeding and
          after each diaper change.

       Use condoms during sex.  Do not let your partner's mouth
          come into contact with your breasts.

Baby:

       Your baby's doctor will prescribe medication in liquid form,
          Nystatin (mycostatin) for the baby's mouth, and in cream
          form, Monistat (miconazole) or Lotrimin (clotrimazole) for
          the baby's diaper area.  The cream used on the mother's
          nipples also can be used on the baby's bottom.

       Paint the liquid on the inside of the baby's mouth (cheeks,
          gums, tongue, and roof) after each breastfeeding, using a
          clean cotton swab for each part of the mouth.  Do not put a
          used cotton ball back into the medicine bottle.

       Put the cream on the red rash in the diaper area during each
          diaper change.

       Boil all rubber nipples and pacifiers daily for 20 minutes.
          Replace with new ones after the first and second week of
          treatment.

Mother and baby:

       Expose your breasts and your baby's bottom to air and
          sunlight.  Avoid sunburn.

       Change breast pads and diapers frequently.  Do not use pads
          with plastic liners.

If the infection continues:

       If signs of infection remain after 14 days of treatment, the
          fungus may be resistant to the medicine in the cream.  You
          can choose a different cream and treat for 4-6 weeks or
          apply a 1 % solution of gentian violet once a day for 3 days.
          Using a cotton swab, paint the solution on the nipple and
          areola of both breasts and on the inside of the baby's mouth
          (cheeks, gums, tongue, and roof).  The purple solution will
          stain the skin and clothing, so wear an old bra and T-shirt.

       Resistant infections that do not respond to creams or solutions
          can be treated with pills or tablets taken by mouth.  Your
          doctor may prescribe fluconazole (Diflucan), 100-200mg a
          day for 14 days.  You may want to avoid foods that support
          the growth of fungus, such as alcohol, sugar, dairy products,
          wheat, nuts, peanut butter, dried fruits, and fruit juices.

PREVENTION:

       Wash your hands carefully before each breastfeeding and
          after each diaper change.

      Expose your breasts and your baby's bottom to air and
         sunlight whenever possible. Avoid sunburn.

      Change breast pads and diapers frequently. Do not use pads
         with plastic liners.

      Avoid the use of nipple creams and lotions that may encourage
         the growth of yeast-like fungus or bacteria.

      Air dry nipples after each breastfeeding whenever possible.