BREAST AND NIPPLE THRUSH
Thrush is a fungal infection caused by the organism Candida albicans which can occur in the
nipples or breast tissue or both (as well as other places in the body). It may cause significant nipple
and breast pain. This pain may be severe enough to lead to early stopping of breastfeeding if not
appropriately treated.
If you have nipple or breast pain, seek advice from Signs
your midwife, lactation consultant, maternal and child
health nurse or other health care professional. If your There are often no obvious signs of thrush on your nipples.
pain is caused by thrush, early diagnosis and treatment However some signs may be present and include:
will help you to continue to breastfeed and enjoy your »» your nipple may appear bright pink
breastfeeding experience.
»» your areola may be reddened, dry or flaky
Causes »» rarely a fine white rash may be seen
You may have a history of vaginal thrush, recent »» nipple damage (e.g. a crack), which is slow to heal
antibiotic use or nipple damage. Often the cause »» signs of thrush may be present in your baby’s mouth
is not known. or on your baby’s bottom, or both
»» thrush in the mouth appears as a thick white coating
Symptoms
on the tongue or white spots on the inside of the cheeks,
»» The most common symptom is nipple pain and or both
breast pain.
»» thrush on your baby’s bottom appears as a bright red
»» Nipple thrush pain is often described as burning, rash with spots around it which does not clear without
itching, or stinging and may be mild to severe. antifungal treatment.
The pain is usually ongoing and is not resolved with
If you or your baby have been diagnosed with thrush you
improved positioning and attachment of your baby
will both need to be treated.
to the breast. Your nipples may be tender to touch
and even light clothing can cause pain.
Treatment
»» Breast thrush pain can vary. It has been described
as a stabbing or shooting pain, a deep ache, For mother
or a burning sensation that radiates through the breast.
It may be present in one or both breasts. You will be prescribed an antifungal cream or gel,
usually miconazole oral gel or cream or nystatin cream.
»» Often the pain is experienced both immediately after If necessary your doctor may prescribe antifungal tablets
and between feeds. as well, take these as directed.
»» Apply antifungal cream or gel as directed to both nipples,
after each feed during the day, for at least seven days.
»» The gel or cream should be applied thinly and does not
need to be wiped off before the next breastfeed.
»» Keep your nipples dry by frequently changing breast
pads as thrush grows well in a moist warm environment.
BREAST AND NIPPLE THRUSH D14-096 JULY 2014 PAGE 1 OF 2
[Link]
For baby Gentian violet for nipple thrush
Your baby may be prescribed gel or drops for the Some mothers will be advised to use gentian violet
mouth, and possibly cream for the buttocks. Apply for their nipple thrush. Gentian violet is an antifungal and
as directed. If miconazole oral gel is prescribed, antibacterial agent for use on the skin and is effective
it is important to apply correctly*. against fungi (such as Candida albicans which causes
thrush) and bacteria (such as Staphylococcus aureus).
In the past, it was commonly used to treat thrush
The spoon provided with miconazole oral gel is for infections in babies’ mouths and on their nappy area.
measuring the dose only.
How to use gentian violet
Do not use the spoon to give your baby the gel. »» The recommended use is as a 0.5 per cent aqueous
(water-based) solution. A prescription is required for this
and can be made up in some pharmacies.
How to apply miconazole oral gel
»» Apply twice a day to the nipples using a cotton bud.
»» Use the spoon supplied to measure a quarter
Breastfeed your baby before each application.
teaspoon dose.
»» Apply for three to four days and no more than
»» Using a clean finger, apply small amounts of gel
seven days.
at a time to the inside of your baby’s cheeks and over
the tongue. When not to use gentian violet
»» Apply the gel four times a day after feeds for one week »» If there is a known hypersensitivity to gentian violet.
then once a day for a further one to two weeks. »» Do not use on ulcerated, open or broken wounds,
»» If you are unsure about using the gel or you are unable for example, cracked nipples.
to purchase the product from your pharmacy, you »» Do not use near the eyes.
could try another pharmacy or use nystatin oral drops.
However, the drops are not as effective for oral thrush Side-effects
in infants as miconazole oral gel. »» Temporary staining of the skin and clothing.
»» If using nystatin oral drops, apply 1ml to your »» Skin irritation.
baby’s mouth four times a day for one week and then
Note: Gentian violet is a purple dye and may stain
once a day for a further one to two weeks.
any material it comes into contact with, for example,
*Note: In May 2006, Janssen-Cilag (the manufacturers bathroom basin.
of miconazole oral gel) issued an alert advising pharmacists
As with all medications it is important to store in a safe
not to supply miconazole oral gel for use in infants less
place away from children.
than six months of age. This alert is about the way that the
gel is given to the baby rather than a concern about the
medication itself. Where to get more information
Australian Breastfeeding Association
Other considerations
Tel: 1800 686 268 - Breastfeeding Helpline (24 hours)
»» Treat any other site of fungal infection in the whole family, Web: [Link]
for example; vagina, nappy rash, feet.
Maternal & Child Health Line
»» Clean teats and dummies thoroughly after use and boil Tel: 13 22 29 (24 hours)
for five minutes. Replace weekly if possible
Women’s Health Information Centre (WHIC)
»» To prevent the spread of thrush wash your hands Royal Women’s Hospital
thoroughly after nappy changes and before and after Tel: (03) 8345 3045 or 1800 442 007 (rural callers)
applying any creams or lotions. Email: whicinfo@[Link]
»» Wash towels, bras, cloth nursing pads etc. in hot soapy
water and air dry outside.
DISCLAIMER The Royal Women’s Hospital does not accept any liability to any person for the information or advice (or use of such information or advice) which is provided in this fact sheet
or incorporated into it by reference. We provide this information on the understanding that all persons accessing it take responsibility for assessing its relevance and accuracy. Women are
encouraged to discuss their health needs with a health practitioner. If you have concerns about your health, you should seek advice from your health care provider or if you require urgent care
you should go to the nearest hospital Emergency Department. © The Royal Women’s Hospital, July 2014
BREAST AND NIPPLE THRUSH D14-096 JULY 2014 PAGE 2 OF 2
