Thrush and Breastfeeding: Symptoms, Treatment, and Prevention

By OBGYN Dr. Kenosha Gleaton

It’s common for breastfeeding parents to run into some challenges. There is a learning curve that comes with breastfeeding and a host of potential complications can arise. Some people will struggle to find a good latch, others may experience cracked nipples or clogged milk ducts. Let’s take a closer look at the causes, symptoms, treatments, and more for one of the complications that can occur during breastfeeding, an infection known as thrush. 

What Is Thrush?

Thrush is an infection commonly found in the mouth, throat, and tongue that is caused by an overgrowth of yeast. The type of fungus that causes oral thrush is candida, which is the same fungus that can cause vaginal yeast infections. [1] It’s normal to have a small amount of candida in the mouth, but the immune system and other germs usually prevent an overgrowth from occurring. Being in poor health, having a compromised immune system, having an underlying condition, and other circumstances can increase the risk of getting thrush. [2] 

Thrush can also impact breastfeeding parents and breastfed infants. It’s possible for thrush to impact the nipples, areolas, and breasts, which can lead to pain and discomfort. Nursing infants can also get oral thrush which may cause pain, leading to a fussy baby. Oral thrush is most often seen in infants under 6 months old. [2] 

Risk Factors for Thrush

As mentioned, thrush is more likely to occur if someone has a compromised immune system, underlying condition, or is subject to other risk factors. [1-3] Some potential factors that can increase the risk of thrush include [1,3]:

• Having a vaginal yeast infection
• Taking antibiotics, corticosteroids, or birth control pills
• Diabetes
• Cancer
• Old age 
• Under six months old
• HIV/AIDS
• Ill-fitting dentures
• Smoking
• Dry mouth
• Anemia

Symptoms of Thrush

Thrush tends to develop rather quickly and can lead to sores or discomfort in the mouth. Some common symptoms of oral thrush include [3]:

• Creamy white and slightly raised lesions in the mouth
• Redness or soreness inside the mouth or at the corners of the mouth
• Loss of taste
• A feeling of cotton in the mouth
• Pain or difficulty swallowing
• A feeling of food being stuck in the throat or chest
• Fever

For those who are breastfeeding, symptoms of thrush include [4]:

• Sore nipples that last more than a few days
• Sore nipples that occur randomly 
• Blistered, itchy, cracked, flaky, or pink nipples
• Achy breasts or shooting pains felt during or after nursing
• White spots on the inside of your baby’s cheeks, tongue, or gums.

Signs of thrush in an infant may include fussiness, lesions or patches in the mouth, irritated skin in the mouth, etc. It’s possible for thrush to spread to other parts of the body, although this is most commonly seen in people living with HIV, cancer, or other immunocompromised people. [3] Learn how long cracked nipples take to heal → 

Thrush and Breastfeeding

What many don’t realize is that thrush is very contagious and the probability of reinfection is high if someone doesn’t take the proper precautions. If you are concerned about thrush, be sure to visit a healthcare provider as soon as possible to get proper treatment for yourself and your child. If someone does have thrush, their breast milk and anything that touches the breasts can spread candida. [2,4] This includes nursing pads, clothes, towels, burp clothes, and so on. The same goes for anything the infant puts in their mouth, such as pacifiers, bottles, toys, and others. Sanitizing these items properly is the best way to prevent reinfection. [4-5] 

Can You Breastfeed With Thrush?

There are controversial opinions on whether or not someone should continue to breastfeed with thrush. It’s generally recommended that patients continue to breastfeed if they have thrush while treatment is given to both the infant and breastfeeding parent. To be safe, you should always check with you or your child’s healthcare provider to determine the best course of action. Are you struggling to produce or release breastmilk? Read about the letdown reflex 

How to Treat Thrush

There are a few ways to treat thrush depending on the severity and cause of the infection. Some people who notice minor signs of thrush may be able to fight off the overgrowth of candida by eating yogurt or taking over-the-counter medications. [1] In more severe cases, there are mouthwashes, lozenges, pills, topicals, and other types of prescription medications that can help clear out the infection. Most research suggests that taking fluconazole, a popular antifungal, is safe while breastfeeding. [2] Some topical creams or gels may also be given to apply to the breast and nipple, and infants are often given an oral gel that can be applied to the inside of the mouth. [2] Even if you have minor symptoms, it’s important to speak to a healthcare provider as soon as possible to receive proper treatment, as candida can grow rapidly.  

How to Prevent Thrush While Breastfeeding

In some cases, it may not be possible to prevent thrush while breastfeeding. However, practicing good hygiene, sterilizing toys, bottles, and other products regularly, and keeping your nipples dry between feedings may all be helpful in reducing the risk of thrush. [2,4,5] Maintaining a balanced diet and supporting your immune system can also help with breastfeeding and general postpartum health. If you’ve already had thrush, be sure to sanitize any products that were in contact with your breast or your baby to prevent reinfection, and throw out any milk you expressed prior to receiving treatment.  [2,4,5] 

How Do I Know If It’s Thrush or Something Else?

It’s easy to confuse thrush for another infection or complication, especially if you’re new to breastfeeding. A healthcare provider will be able to help you confirm if you have thrush by taking a culture or by examining you and your child. [3] Other potential complications that can arise while breastfeeding include mastitis, clogged milk ducts, cracked nipples, improper latch, and more. If you have any concerns or questions about your symptoms or lactation, you should speak to a healthcare provider. 

Support Your Breastfeeding Journey With Natalist

Breastfeeding can be a beautiful experience for many but has the potential to cause pain and discomfort from time to time. Whether it’s your first time breastfeeding or you consider yourself an expert, a little support can go a long way. Consider taking a postnatal vitamin (with your provider’s approval) to support your baby’s development, postpartum healing, and nutritional goals. Natalist Breastfeeding Essentials includes a high-quality postnatal vitamin as well as moisturizing nipple balm to soothe dry, sore, or cracked lips and nipples. Have more questions about postpartum life? Continue reading the Natalist blog. 

References:

1. Vyas, J. Thrush - children and adults. Medline Plus. September 2021. https://medlineplus.gov/ency/article/000626.htm 
2. Taylor M, Brizuela M, Raja A. Oral Candidiasis. [Updated 2023 Jul 4]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2023 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK545282/
3. Thrush. Cleveland Clinic. January 2023. https://my.clevelandclinic.org/health/diseases/10956-thrush
4. Plugged Ducts, Mastitis, and Thrush. WIC Breastfeeding Support. U.S. Department of Agriculture. Accessed September 2023. https://wicbreastfeeding.fns.usda.gov/plugged-ducts-mastitis-and-thrush 
5. Breastfeeding and thrush. National Health Service. September 2022. https://www.nhs.uk/conditions/baby/breastfeeding-and-bottle-feeding/breastfeeding-problems/thrush/