Nipple thrush

What is nipple thrush?

Nipple thrush is a fungal infection that you can get when you’re breastfeeding.

Thrush is a common yeast infection. It can affect different parts of your body, such as your vagina or nipples, when you are breastfeeding.

If you’re breastfeeding, nipple thrush can affect your breasts or nipples, or your baby’s mouth or bottom.

Thrush is contagious. It can be easily passed from you to your baby. Or from your baby to you.

What are the symptoms of nipple thrush?

The most common symptom of nipple thrush is pain.

This is often described as nipple pain or discomfort that is:

• burning
• itching
• stinging

The pain may range from mild to severe. Your nipples may be tender to touch. Even clothing on top of your breasts may cause pain. The nipple pain can last for up to an hour after every feed.

Other signs of nipple thrush are:

• your nipples may be bright pink
• your areolas (the round areas of skin around your nipple) may be dry or flaky
• your nipples may have sores (for example, a crack), which are slow to heal
• you may have a fine white rash around your nipples

However, there are often no obvious signs of nipple thrush.

You are unlikely to have nipple thrush if you always have pain when breastfeeding. Speak to a lactation consultant, midwife or child health nurse for advice and support.

If you have nipple thrush, your baby may also have thrush. This is because thrush is very contagious.

What are the signs of thrush in my baby?

Your baby may get thrush:

• in their mouth (oral thrush)
• on their bottom (nappy rash)
• both in their mouth and on their bottom

Oral thrush looks like:

• a thick white coating on the tongue
• white spots on the inside of the cheeks, gums or roof of the mouth

Your baby may also be unsettled when you feed them if they have oral thrush.

Thrush on your baby’s bottom may appear as a bright red rash with spots around it. The rash only gets better with antifungal treatment.

If either you or your baby have thrush, you will both need to be treated at the same time.

What causes nipple thrush?

Nipple thrush is a fungal infection caused by the yeast candida albicans. This can be linked to:

• recent vaginal thrush infection
• nipple damage
• recent use of antibiotics by you or your baby

You can also get thrush infections in other places in your body.

When should I see my doctor?

See your doctor or lactation consultant if you have nipple pain that doesn’t go away even when you change your baby’s positioning when feeding.

Sore or cracked nipples that take a long time to heal are also a sign that you should see your doctor. This can be a sign of infection, and you might need medicine to treat it.

You should also see your doctor if you notice signs of thrush in your baby. This includes a thick white coating on the tongue or white spots on the inside of the cheeks, gums or roof of the mouth, or a bright red rash with spots on your baby’s bottom.

How is nipple thrush diagnosed?

Your doctor will ask about your symptoms and may want to examine your breasts and your baby.

How is nipple thrush treated?

If you have been diagnosed with nipple thrush, both you and your baby will need to be treated. This will stop you passing the infection back and forth when breastfeeding.

Antifungal treatment, in the form of a cream or gel, is the most common treatment for nipple thrush. You can put this cream or gel on your nipple after a feed.

Your doctor may also prescribe antifungal tablets for you. These medicines are safe to use while you’re breastfeeding.

Your symptoms should improve within 2 to 3 days. If you haven’t seen any improvement in 5 days, you should see your doctor again.

Always tell your doctor that you are breastfeeding before they prescribe any medicines. You can also check with your pharmacist that the medicine is OK to take while breastfeeding.

Self-care treatments

To stop the spread of thrush, always wash your hands after nappy changes.

Wash your towels, bras and cloth nursing pads in hot soapy water. Dry your washing outside if possible.

Can I still breastfeed if I have nipple thrush?

It’s safe to breastfeed while you have nipple thrush.

You can also feed your baby any recently expressed breastmilk while you are being treated for thrush. But do not freeze the milk and use it later, since this can cause the thrush to return.

Can nipple thrush be prevented?

There are some things you can do that may help you avoid getting nipple thrush.

Wash your hands well, especially after every nappy change.

Thrush thrives in moist, warm environments, so keep your nipples dry. Wash your bras in hot water and change your breast pads often.

Make sure that every family member uses a separate towel and wash the towels often.

Wash and sterilise anything that your baby puts in their mouth. This includes:

• dummies and comforters
• bottle teats
• toys

You may find that taking a probiotic helps to control thrush, especially after taking a course of antibiotics.

There is little evidence to show that reducing the levels of sugar or yeast in your diet is effective at stopping thrush.

Complications of nipple thrush

If not treated, the pain from nipple thrush can lead people to stop breastfeeding earlier than they would like.

It’s important to treat both you and your baby for thrush. Otherwise, the infection can continue to pass between you both.

Resources and support

If you need help or support with breastfeeding, talk to your doctor, midwife or lactation consultant. They will be able to watch your baby feeding and give you advice on attaching your baby for feeds.

You can also get breastfeeding support by calling the National Breastfeeding Helpline on 1800 686 268 (1800 mum2mum).

The Australian Breastfeeding Association provides information and videos on positioning your baby to breastfeed.

You can read more about medicines that you can use while breastfeeding.