The Best Ways to Treat Thrush in Nursing Parents

If you're a breast or chest feeding parent experiencing nipple pain or itchy, burning nipples, you might be wondering if you have thrush. Thrush is a yeast infection that strikes breastfeeding parents and their little ones from time to time. But not all nipple pain can be blamed on thrush.

Here's what thrush is, what it feels like, how to distinguish it from other types of nipple pain and, most importantly, how you can treat it.

What Is Thrush?

Thrush is a yeast infection that can happen during breastfeeding. It's usually caused by a fungus called Candida albicans. Thrush can occur alone, but may also occur in conjunction with a bacterial infection, according to the Academy of Breastfeeding Medicine (ABM).

Certain factors might make it more likely that you will develop thrush, including:

• If you are prone to yeast infections
• If you or your baby have recently taken a course of antibiotics
• If your baby has thrush in their mouth or diaper area

Thrush is often improperly diagnosed. A 2021 study published in Breastfeeding Medicine found that in most cases where thrush is suspected, the nipple pain had other causes. For example, nipple pain can be caused by poor latch from your baby, broken nipple skin, nipple blebs, vasospasm, engorgement, or a bacterial infection.

Proper diagnosis of thrush involves a visit to your healthcare provider and, in many cases, a culture of your nipple to figure out what pathogen—if any—is causing the issue.

What Are the Signs of Thrush in Nursing Parents?

When thrush is involved, both breastfeeding parents and their babies may have signs—though sometimes, only the breastfeeding parent has symptoms.

Chest- and breastfeeding parents may experience "itchy nipples, red swollen nipples, and/or a burning sensation after nursing or pumping," says Dominique Gallo, IBCLC, RLC, a lactation consultant in private practice. They may also experience sharp, shooting pains in their breasts, particularly after feeding.

In babies, thrush usually starts in the mouth. You'll see small, white, irridescent dots or clusters on your baby's inner lips or inner cheeks, says Rachelle Markham, IBCLC, a lactation consultant in private practice. Sometimes thrush looks a little fuzzy, too, she adds.

Most of us think of thrush being on a baby's tongue, says Markham, but this is not always the case. "Thrush is not typically on the tongue and is not ever just on the tongue," she describes. "Thrush is commonly misdiagnosed when a parent sees a white tongue, but a white tongue is a sign the baby's tongue isn't resting on their palate." If the tongue can't rest on the palate, it will be white, she says, something often referred to as "milk tongue."

According to La Leche League, thrush thrives in damp, warm places, so if your baby has thrush, you may also see white spots in their diaper area or between their fingers or toes. You may experience thrush in the area under your breasts, where it can get warm and sweaty. Armpits are another area where thrush can grow.

How Is Thrush Transmitted from Baby to Parent—and Vice Versa?

Thrush can be transmitted from babies to parents, or parents to babies. "Thrush is transmitted via contact so if the baby or parent has thrush and is nursing directly, it can get transferred that way," Gallo says. But thrush thrives best when it's given the right environment to grow, Markham adds.

"Thrush is an out of balance biome where the yeast is able to grow unchecked," she describes. "It is not as easily transmitted as we once thought, but if the parents system is stressed or weakened it can transfer to the nursing parent, or from parent to baby."

What Are the Best Ways to Treat Nipple Thrush?

There are both physician-prescribed medications that can treat thrush, as well as at-home treatments. It's often best to combine the two. Thrush can be hard to get rid of, so being diligent about creating an environment where the fungus isn't able to thrive is key.

Thrush medications

If you believe you have thrush, you'll want to go to your healthcare provider to get a diagnosis. Once diagnosed, you will likely be given medicine to treat thrush in you, your baby, or both.

According the the Academy of Breastfeeding Medicine (ABM), the following medications can be used to treat thrush:

• Topical antifungal cream or ointment for your nipples
• Miconazole oral gel or nystatin suspension or for your baby's mouth
• For particularly hard-to-treat cases, oral fluconazole may be prescribed

ABM also notes that there is some indirect evidence that probiotics can help balance the microflora on the breast. There is also some evidence that gentian violet—an antiseptic dye—can be used to treat thrush, but it shouldn't be used for more than a week. (Warning: Gentian violet can stain your clothing or bedding purple, so use with care.)

At-home treatments

When it comes to treating thrush, it's important to remember that thrush doesn't just live on your body. Thrush can survive on anything you come into contact with. That's why it's suggested that you clean your baby's pacifiers, bottle nipples, and your pump parts thoroughly—really anything involved in feeding. "I suggest using white vinegar wash for the pacifiers, pump parts, and bottles," says Gallo.

Besides vinegar, baking soda may be an option. "For babies, a baking soda and water rinse dabbed on the white dots can help tap down the overgrowth, often within two to three days," says Markham. She suggests using 1/4 teaspoon of baking soda to 1 cup of water. "With a clean Q-tip, dam the water on the white spots after every feeding," she describes. Of course, you should check with your doctor before cleaning your baby's mouth this way.

Finally, you want to make sure that your breast area is not a place where yeast likes to grow. To that end, keeping your breasts dry and cool can be helpful, Markham offers. Some breastfeeding parents go topless for a few days, or at least stop wearing bras. She also suggests changing breast pads frequently and to stop using nipple gels or creams because these can make the environment more favorable to yeast overgrowth.

If these methods fail, or if you still have signs of thrush even after using doctor-prescribed medications, it's important to follow up with your healthcare team. Making an appointment with a lactation consultant is also a great idea because they may be able to help you figure out what else could be contributing to your pain and discomfort.