By Dr. Nancy Brent
Sore nipples are a common occurrence in breastfeeding women. This is most commonly due to difficulties positioning and latching the baby the breast. The earlier you correct the latch, the easier it is to relieve the pain. This can usually be corrected by working with a lactation consultant.
Pain in the breasts or nipples may also be due to an infection, either bacterial or fungal. This post will focus on fungal or yeast infections.
Yeast infections in healthy people are usually caused by the organism Candida Albicans. This is found on the skin and mucous membranes (mouth, nose, vaginal wall) of most healthy people. So why is it a problem? Yeast only becomes a problem when it grows too much and turns into an infection. This may occur after antibiotic treatment, which kills all the usual bacteria and lets the yeast overgrow. It can also occur after steroid treatment, which can alter the immune system, and in individuals with diabetes or anemia. In the breastfeeding woman, cracks on the nipples may be a source of contamination with either bacteria or yeast, and an infection may develop. In the absence of any of these conditions, a yeast infection is unlikely.
Yeast in the Baby
Oral thrush: In contrast to the above discussion, oral thrush (a yeast infection of the mouth) is very common in healthy infants. This is because the baby is feeding so often that there is often residual milk in the mouth. Yeast grows best in a warm, moist environment, and when you add the sugar from the milk, this explains why thrush is so common in both breastfed and formula fed babies. The baby will most often present with white patches on the gums and inside of the lips. White patches only on the tongue, even if they don’t come off with gentle scraping, are usually caused by residual milk, not thrush. Rarely, a yeast infection can occur that only involves the tongue, but this is unusual. Most of the time, thrush does not bother the baby at all, but occasionally it can cause difficulties sucking and feeding.
Diaper rash: The baby may also develop a yeast infection in the diaper area. This appears as a bright red area with small lesions surrounding the inflamed area. It usually does not respond to the common diaper creams.
Yeast in the Mother
Signs of a yeast infection of the nipples are often much more varied. The most common presentation is the sudden onset of bilateral nipple pain after the nipples have been pain free. The pain is most commonly sharp and burning and may be severe. However, pain is different for every person, and the type of pain is not necessarily a sign of its cause. The nipples may be itchy and flaking. There may also be small red satellite lesions surrounding the major part of the rash. On the other hand, the nipples may be completely normal in appearance. This makes the diagnosis of nipple yeast difficult.
There are several ways to treat yeast infections, but the most important thing in the breastfeeding pair is to treat both mother and baby at the same time, so that they don’t keep passing the infection back and forth to each other. The first treatment is usually an oral preparation for the baby and a topical skin preparation for the mother. The oral preparation is by prescription only, but there are several possible topical treatments, both prescription and non-prescription.
If you think you or your baby may have a yeast infection in the mouth, the diaper area or the breasts, call your primary care provider or the Breastfeeding Center of Pittsburgh at (412) 247-4726.
Dr. Nancy Brent is the former Medical Director of the Breastfeeding Center of Pittsburgh.