Thrush

This article is an excerpt from "The Nursing Mother's Problem Solver" by Claire Martin.

Thrush appears as white blisters, as red dots, or as a peeling rash. It is painful for both mother and baby. Yeast is a kind of fungus. Thrush is an overgrowth of yeast. It survives by consuming sugars digested from other sources. Mother and baby must be treated simultaneously. It is extremely contagious; if one of you has thrush, the other almost certainly has it too, or will soon.

Pediatricians or OB/GYNs typically suggest topical ointments, including clotrimazole (in 1 percent or 2 percent concentrations) and Nystatin, which often are used together in treatment. Clotrimazole will work on thrush. If you find the 1 percent cream too slow or ineffective, try the 2 percent miconazole cream. Wash off Clotrimazole before you nurse (use water, not soap), and reapply afterward.

This prevents the thrush yeast from reproducing; it must be applied to all affected areas four times a day, and you can't nurse for 10 minutes after you use Nystatin. Because it contains sugar, Nystatin can leave your nipples sticky: It never really dries. (If you thought your nipples were sore before, try peeling Nystatin- covered nipples from a nursing bra or nursing pads.)

If you put a little Lotrimin on your nipples, they won't stick to your bra. It's absorbed pretty quickly and thoroughly into the skin. You don't need to wash it off unless your baby wants to nurse the instant you've applied it.

An alternative treatment for thrush is gentian violet. You paint it on your nipples, inside the baby's mouth, on the baby's genitals, and on any other area affected by the thrush. Gentian violet works fast, and it's nearly foolproof, often better at resolving thrush than commercial medications. However, gentian violet has one drawback: Anything it touches will be permanently stained purple. And it takes several days for the gentian violet to work its way through a baby's system or wear off your skin. Plan on wearing dark clothing, using dark towels, and sleeping on dark sheets. On the upside: gentian violet resolves thrush within 2 or 3 days, and you'll have lots of opportunities to teach your baby about the color purple.

Another option for your baby is a relatively new drug called Diflucan, an oral medication that is mixed with water and given to the baby twice a day for 2 weeks. It's a lot easier than swabbing the baby's mouth, and you see results in 48 hours. A pill form of the same medication is an option for adults. One caution about Diflucan: It can damage your liver. Don't take it lightly.

Until the thrush is gone, it's extremely important to sterilize everything that touches the baby's mouth or your nipples. That means boiling all bottle nipples, pacifiers, breast pump parts, and toys. Wash all clothing-yours and the baby's-in hot water. Thrush, as you've learned, is highly contagious.

Don't despair: Thrush can be treated, and you can prevent its return by monitoring your diet and making sure you use breathable, not moisture-proof, nursing pads in your bra. The initial pain should subside within 72 hours.