Monday, April 21, 2008

Out of the mouths of babes: Getting rid of thrush

Welcome to April's carnival of breastfeeding. This month I am sharing my experience with Thrush. I have always intended to share my story, even before I started blogging. However, I need to point out that the purpose of this post isn't to provide medical advice on how to treat thrush. It is simply my story, and I may have left out some details about thrush that were not relevant to my case, but that may be important to someone else's. Nonetheless, I hope it will provide insight and encouragement to those who read it. So here it is!

Here's my simplistic definition of thrush: it's the white patches in an infant's mouth caused by a yeast infection. However, the infection can also be present on the mother's nipple and the infection can also cause terrible diaper rashes. It is fairly common in infants, and not usually harmful, but it can be hard to get rid of and in some cases it can be quite painful.

The picture above is my daughter with thrush. She was about 10 weeks old. It was taken the weekend before I realized we had it.

All my kids had white tongues. I think for every child, my mother would see that their tongues were white and would mention they might have thrush. Nothing came of it with the first two, but with my third child, I noticed that my nipples would get really hot and itchy. I thought it was the humidity, but then I decided to look at my daughter's mouth. Sure enough, I found some white patches inside her cheeks that couldn't be wiped away. So when I figured it was thrush, I rushed her to the doctor to get rid of that thing! And so my adventure with thrush began...

In our case, it really wasn't that bad. My daughter wasn't having trouble breastfeeding and I wasn't in any pain. But this wasn't an easy time in my life either. My daughter had caught her first cold when she was 3 weeks old. This set off a chain of reactions and needless to say, I was worn out by the little booger :-) Adjusting to a new baby is hard enough as it is, and when a baby that young gets sick, they have a harder time fighting it off. It was really hard to think clearly during that time, especially when you are trying to make the best decision for your baby. So very specific information is important when a parent is stretched so thin.

These were the main questions I had:

  • If it is not that big of a deal, then why is treatment necessary?
  • If it generally goes away on its own, why is treatment necessary?
  • How should I apply the treatment?
  • When should I discontinue the treatment?

The biggest hurdle for me was treating her in the first place. Although I will give my kids medicine, I am not one to habitually medicate my kids. I don't even give them vitamin supplements. So I thought, if it wasn't that big of a deal, then do I need to treat it? To add to my confusion, the MedlinePlus Medical Encyclopedia (run by the National Institutes of Health) stated that treating it is "usually NOT necessary" and that it "generally resolves on its own." (I only include the link to it because it currently says "within two weeks." and I do not recall them specifying a time back then, but I could have been wrong. After all, it was a hard time for me.) Given that I was feeling the itching on my nipples and they started to look dry and cracked, I thought it best to go with the first round of nystatin treatment for my daughter. Gentian Violet is another treatment. It is what was used back when I was a baby, but now Nystatin is usually the default treatment. I really don't know why it has fallen out of style. I went with Nystatin by default because I was too worn out to consider any other alternatives.

It was unclear to me, however, the proper way to apply the medicine. How often should I apply it? I think the bottle said four times a day, but I had read in other places that it should be after every feeding. I take my kids to a family practice. I love having the same doctors as my kids do. They also have a different perspective when it comes to interventions, as they see a wide range of people with a wide range of ailments. So I don't expect them to be experts on thrush, especially when it is a fairly minor condition when compared to other ailments in a lifetime. It just happened that I had to ask the physician assistant I saw that day what I should do to treat my nipples. She looked it up and said that I could apply Monistat. Well, I ended up not using that because there are several different types available, I didn't know which one to get, how to apply it and I really didn't want to call back and ask. The pharmacist said I could apply the Nystatin directly to my nipples. So, after every daytime feeding, I applied Nystatin on myself and squirted the recommended dose inside my baby's cheeks.

The next challenge was figuring out when in fact it was totally gone. It only takes a few yeast cells in the right environment for it to grow back to where it was. So, after a few days of it looking like it was gone, I would stop the treatment. Only to have it reappear several days later.

So, given the MedlinePlus information, I decided to see if it would resolve on its own. I did ask the doctor about it. After making sure it would not hinder the baby's feeding (and it wouldn't because neither one of us were in pain), he allowed me to give it a try.

And, of course, it didn't go away on its own.

So I tried Nystatin again. By this time, my daughter, although maybe just 3-4 months old, was well familiar with the routine and would do all she could to keep from getting that dropper in her mouth. She would even try to spit (razzing style) to keep me from giving her the medicine. So I dreaded giving it to her.

Then finally things changed. After I was almost done with the second round, I decided to call the counseling mother who had helped me with some breastfeeding problems that came about because of my daughter's cold. I wish I had called her first and I have no idea why I took so long to call her. I think we were 6 weeks into this before I did. Not only did she give me the most practical directions, she helped me think through the other treatment options, and asked the lactation consultants in her network about the "resolving on its own" statement (which, by the way, they said that in their experience it is quite unlikely, especially in the warm southern climates).

So this is how I finally got the thrush out of the mouth of my babe:

  • After every daytime feeding, I drew the recommended Nystatin dose in the dropper, then put a small amount from it in a spoon.
  • Then, I put some on my finger and apply it directly inside her cheek, making sure I applied it in ever nook and cranny. Sometimes I used Qtips, but it was easier with my finger.
  • I would also apply some on my nipples. I'd also apply some just before I went to bed.
  • [update] Another important thing is to sanitize clothes (especially bra and nursing pads - don't use disposeable pads), toys and other things that go into the baby's mouth.

After the symptoms disappeared, I kept applying it, although I can't remember how long that was. You can always ask your health care provider about that. When all was said and done, my daughter was 5 months old.

So, in all, what could probably have been resolved in 2-3 weeks lasted about 3 months. What a difference it would have made if I had just picked up the phone and called lactation support. If you live in the US and you don't know of any lactation groups around, call the La Leche League's 24-hour Hotline at 1-877-4-LA LECHE. I cannot overstate how much easier it is when you have someone to help you through any lactation challenge you may have.

I also have read claims that unrefined coconut oil has antifungal properties, but the nystatin was cheaper (even after 3 rounds) and more accepted. I already had some refined coconut oil in my pantry for cooking purposes, so at one point I used the oil on myself, as I felt it provided an additional protective barrier, and the nystatin is somewhat sticky.

Among websites, KellyMom and the La Leche League's website were very helpful. For additional experiences with breastfeeding challenges, check these posts from other carnival participants (updated throughout the day):

Jen at Mama's Magic
Half Pint Pixie
Stephanie at Speech Act
Barbara at Mom on the Go
Sinead at Breastfeeding Mums
Tanya at Motherwear Breastfeeding Blog
Donna at Blessed Nest Perch
Lauren at Hobo Mama
Angela at Breastfeeding 1 2 3


  1. Wow... how odd that you write this today and I googled "thrush" and your site came up.

    I have been treating myself and my DD (who is 13 weeks) for thrush since she was 6 weeks old. Ugh.

    What a pain.

    We tried Nystatin for her (2x), diflucan for me (now its up to 2x a day) and the gentian violet.

    The last round I just about had the white gone out of her mouth, but nope. I had to stop using GV because I had used it for 7 days.

    I too, thought I could just leave it and it would resolve on its own. Unfortunately, I can't, since I am nursing and I'm getting more than the itchy breasts you got. I get shooting pain and a whole other plethora of problems.

    So.... why am I writing? I'm just glad that there was someone else out there that has treated this aslong as I have.

    P.S. I am in almost weekly consult with my physician and LCs on how to get rid of it. Hopefully, soon, we'll be through it.

    Thanks for your story!

  2. Hi Karla,

    Thanks for leaving a comment. It's encouraging for me to post a story into internet oblivion and then know that someone got the encouragement they needed. Hopefully, the Gentian Violet gave it the jump start in healing you needed. If you can, post another comment when it is all over so that we can celebrate together.

  3. I especially appreciated the tip to talk to a knowledgeable mother/La Leche League advisor. Sometimes I ask for a "professional" solution when what I need is practical advice from someone with experience blended into the knowledge they possess.

  4. This is a great post, full of very useful information. Thankfully, I never went through the thrush thing but it sounds pretty unpleasant! When he was a baby my brother was admitted to hospital suffering from thrush and I vividly recall him standing in a cot with a very purple mouth which I later learnt was gentian violet! It worked though as he was released very soon afterwards :)

  5. Renata,

    Thank you so much for this post at just the right time. God has always sent through you some major medical solutions to my problems. I did not know what was happening to my breast. I have had all the symptoms you described and more. Do you have to get a prescription for the medicine or can you just get it over the counter. Love ya and enjoy getting such practical advice from you. Thank you again for sharing your story, its an answer to prayer right now with Hannah.

  6. Hey Nicole,
    I don't have your email or phone number handy right now, but I'll give you a call this morning. If you have my number on hand, call me. I'll fill you in on the local info.

  7. mom on the go:
    Getting support was the most valuable lesson I learned from this experience. When we have so much information in front of us, it is so much easier to have someone who is outside of the situation to guide us through. It's so much harder to think through everything and remember to ask all the questions in one doctor's visit.

  8. Sinead,
    For me, it wasn't the worst thing to go through, but as you see in Karla's comment it can get pretty nasty. But the little things add up. Funny that one used to be hospitalized for thrush! It seems like we've gone to the other extreme now.

  9. AMEN for the importance of support -- and the validity of practical experience. It's totally true that exhaustion can play such a role in the decisions we make, isn't it? I'm so glad you found the support and techniques you needed to resolve this. Thanks for sharing your story with other folks! Thankfully I've avoided thrush so far, but we're not done nursing yet and I will definitely keep this in mind!!

  10. well done for persisting and finally beating the thrush! I agree LLL or lactation consultants really are a wealth of knowledge when it comes to breastfeeding, especially, I've found, when it comes to breastfeeding older children.

  11. Thank you for posting this! I'm currently dealing with thrush with my 7 week old's only been a few days that we've been treating her, but it's good to know that it will eventually go away! Did you put all of the dosage in her mouth with your finger?

  12. Hi Jessica,
    If I recall correctly (it seems like ages ago), I applied quite a bit with my finger, but then just gave her the rest. The useful part of applying it with your finger is so that you can get into those little folds and crevices. If you sense you have applied it enough with your finger, then give her the rest however you were before.

  13. Wow, your experience seems a lot like mine. I have been treating my son for thrush since he was 1 week old, he is now 9 weeks old. We are on our third round of Nystatin, and have already been on 2 rounds of Dyflucan and one round on Gentian Violet. I was strep b positive when I delivered him, and was given a lot of antibiotics in the hospital, which is what caused it. Thank you for your tip about putting the Nystatin on my nipples, I have been applying Monistat, so I am hoping Nystatin will work better. Thanks again~ Jami

  14. Your welcome Jami. I hope it helps too. The comments add a lot more to my post too.
    Keep reminding yourself that this too shall pass.

  15. Read Jack Newman's protocol online. He has a lot of other great breastfeeding articles also.

  16. Thank you for your post!! One question! Putting Nystatin on the nipple, as you said its quite sticky, do you wash off afterwards? Or leave it sticky with the bra on?

    1. Anonymous,
      It is kind of sticky but I didn't wash it off. It seems so long ago, but I think I was using the cotton breast pads so that made it a bit better than just sticking to the bra. I don't know how effective it is at washing it off. It does go away, so hang in there!