Candida, Also Called Yeast, Or Thrush, Is A Fungus That Occurs Naturally In The Mucous Membranes And

Candida, also called yeast, or thrush, is a fungus that occurs naturally in the mucous membranes and on the skin. If you or your baby have recently been on antibiotics, if you have had a vaginal yeast infection during the last several months or anytime during pregnancy or if your nipples are cracked, then you and your baby are at risk for developing a yeast infection. Certified Lactation Consultant Anne Smith offers some advice.
Anne Smith, IBCLC

Use of antibiotics promotes the overgrowth of yeast by killing off the "good" bacteria that normally keep the yeast from multiplying too quickly. During pregnancy, yeast infections are more common because high levels of estrogen lead to elevated levels of sugar, and yeast feeds on sugar. Other factors that make you more susceptible to yeast include use of steroids or hormonal contraceptives, or chronic illness such as diabetes or anemia.

Symptoms of a yeast infection in your baby include creamy white spots or patches on the mucous membranes inside the mouth (gums, cheeks or tongue). The spots may look pearly, and may be surrounded by redness. If you gently scrape the spot, it may be reddish underneath unlike a coating of milk on the tongue. Sometimes the inside of the lips or the saliva may have a "mother of pearl" appearance. The baby may be fussy and gassy, and sucking may be uncomfortable for him. He may pull off the breast, or may refuse to nurse at all. It is also possible for him to have an overgrowth of yeast but have no visible symptoms.

Yeast can also cause a rash in the baby's diaper area. The rash is red or bright pink, and may be scaly. The affected area may contain small raised red spots or sore looking pustules. The rash may be localized (the area looks like it has been dipped in scalding water) or it may be diffuse and lacy, covering a large area. Use of standard diaper rash medications like petroleum jelly or Desitin does not clear up a rash caused by yeast, and may actually make it worse, because yeast feeds on the oils found in greasy ointments, and also on the starch found in baby powders.

Symptoms in the mother include severe stinging, burning pain, which may be on the surface of the nipples, or may be felt deep inside the breast. Pain often continues throughout the feeding and in between feedings -- especially immediately after. Nipple pain caused by incorrect positioning and latch on rarely hurts except when the baby is nursing. Sometimes sharp, shooting pain radiates from the nipple into the breast or into the back or arm.

Nipples are sensitive to light touch, so it may hurt to have clothes rubbing against them, and it may be very painful to take a shower and have the hot water spray touch the breast. Mothers describe the pain as "liquid fire", "'hot needles", "razor blades", "a piece of glass stuck in my nipple", etc. I've heard many mothers say that they would rather go through labor again than have yeast on their nipples or in their milk ducts, which gives you an idea of just how painful this condition is.

A painful condition
The nipples may look puffy, scaly, flaky, weepy or have tiny blisters. They may be itchy. The color is often a deep pink. The nipples may also look completely normal, but be terribly painful (just as the baby's mouth may be infected, but not have white patches). If you have yeast on your nipples, or if your baby has it in his mouth, your milk supply will often decrease. Pain inhibits the let-down reflex, and babies with yeast often do not nurse as efficiently as they do when their mouths are not sore. Yeast infections may also lead to plugged duct and mastitis.

Once the infection is cleared up, you should be able to build your supply up again quickly. It is important to note that while yeast on baby's bottom or in their mouths may be tender and irritated, it does not seem to cause extreme pain like it does on the mother's nipples or in her milk ducts.

Mothers may also have a vaginal yeast infection (itching, cottage cheesy discharge), sores at the corners of the mouth (angular chelitis), swelling or tenderness of the tissue around the toes or fingernails (candida paronychia) or a rash in the moist areas of the body such as under the arms or in the groin (intertriginous candiasis). Athlete's foot is also a type of fungal infection.

Because yeast grows in warm, moist areas, it can be traded back and forth between a mother and her nursing baby. Both mother and baby must be treated together to clear up the infection. It is important to do this even if one of you does not have symptoms. Consult your doctor regarding a treatment plan.

If you or your baby have any of the symptoms described above, especially if you have been on antibiotics, or if your nipples suddenly become sore after the first two weeks postpartum, you may have a yeast infection. If you believe you may have a yeast infection, here are some suggestions on how to treat it but always consult your health care provider before beginning any treatment. It is important to begin treatment only after ruling out other possible causes of severe nipple soreness, such as improper latch on and positioning, mastitis, eczema, herpes, ringworm and psoriasis.

If you have yeast on your nipples:

  • Wash hands often -- before and after nursing, after using the bathroom, and before or after changing the baby's diaper. Use hot, soapy water and paper towels.
  • Nurse frequently for shorter amounts of time. Start nursing on the least sore side. Numb the nipple with ice wrapped in a washcloth before beginning to nurse. Take ibuprofen (such as Advil or Motrin) (unless you are allergic to it) around the clock. If it becomes too painful to nurse, you may want to pump your milk temporarily and feed it to your baby by cup or bottle until the pain lessens. Try drinking green tea three or four times a day. It may help cleanse your system of excess yeast, and all evidence points to its benefits, so it certainly won't hurt to try.
  • Decrease consumption of foods containing high amounts of sugar and/or yeast (such as beer, wine, sodas, bread, desserts, etc.). Dietary supplements that may be helpful include: Lactobacillus acidophilus (helps promote the growth of "friendly bacteria"). Usual dose 1/4 to ? tsp. of powder or one to two capsules, one to four times daily. Bifadophillus also works well, and does not contain apple pectin, which may limit the supplement's effectiveness. Acidophilus supplements of up to 24 tablets a day are not harmful, and may be helpful in severe or chronic cases. Eating yogurt, while helpful, is not enough to treat a yeast infection by itself.

    Another supplement that is often helpful is Caprylic acid. The usual dose is one to two capsules with each meal. These products can be found at most health food stores. Working with a herbal specialist to adjust the dosages may be helpful.

  • After nursing, rinse the nipples with a solution of one cup of water plus one TBSP of vinegar. Air dry well. Apply antifungal creams like Lotramin AF or Gyne-Lotramin (containing clotrimazole) or Monistat (containing miconazole). These are available without a prescription. Your doctor may also prescribe an antifungal cream like Nizoral (containing ketoconazole). Although Nystatin has been the most popular prescription antifungal used for many years, it is no longer the first choice of treatment due to resistant strains of yeast that have developed.

    If pain is severe, apply the cream sparingly after each feeding (six to eight times per day) for 24 hours. Then apply three to four times daily. The cream is absorbed quickly, and does not have to be removed before baby nurses. If you feel that some ointment remains on your nipple, you may want to gently press a damp warm washcloth on the nipple and areola before nursing. Avoid wearing nursing pads, but if you have to use them be sure to change them at every feeding. Keep the nipples as dry as possible.

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