Thrush

THRUSH CARE PLAN
What is thrush? 
 
Thrush is a fungal infection caused by overgrowth of candida (yeast) in baby's mouth, or on mom's nipples. Yeast overgrows in wet, dark, warm places, such as nipples and baby's mouth. Although not all moms and babies develop thrush, moms with injured nipples and babies with oral restrictions (such as tongue-ties) tend to host yeast more commonly. Bottle and breastfed babies have the potential of developing thrush in their mouth and around the diaper areas. If left untreated, thrush will result in painful nursing for both mom and baby (and painful bottle feeding for bottle-fed babies). In breastfeeding, thrush may affect both mom’s nipple and baby’s mouth, although it is possible for only mom to be infected, or for only baby to be infected. 
 
Thrush can make nipple-skin weak and tender, can lead to cracked nipple skin and eventually to a bacterial infection inside the breast. An affected nipple usually hurts/burns, looks scaly, shiny and may appear red or pink. Moms with thrush describe a persistently burning or itching sensation of the nipples while feeding and in between feeds, as opposed to shallow latch-pain which diminishes after a few minutes or seconds.  
 
Good to know: A yeast infection can occur during antibiotic treatment. Some doctors or prescribing midwives will provide patients with a prescription for thrush medication at the same time they prescribe an antibiotic, just in case mom develops a yeast overgrowth from the antibiotics. 
 
If thrush is suspected, take the following steps: 
 
Steps to heal thrush for mom and baby 

• Contact mom’s and baby’s healthcare provider for a diagnosis and proper treatment 
• If prescribed medication, take it as prescribed. Keep in mind that in many cases, thrush has become resistant to the commonly prescribed medication; discussing effectiveness of medication choice is important 
• A commonly prescribed medication prescribed by physicians or prescribing midwives for mom when thrush involves shooting pain inside of breast is Diflucan (Fluconazole), using Dr. Jack Newman's recommended dosing which is about two weeks long (this dose can be easily found online and discussed with your doctor if you are provided a dose any shorter than two weeks) 
• Dr. Jack Newman's "All Purpose Nipple Ointment" can also be prescribed. This ointment is commonly prescribed when thrush appears only to be affecting the nipples, and not the ducts. This medication can usually be called in to compounding pharmacies in the San Antonio area.
• Only use Gentian Violet (an effective over the counter homeopathic solution for thrush) under the care of a physician; dose iinformation is seldom written on labels and too much Gentian Violet given to babiies can cause vomiting and drying out of mom's nipple skin 
• For baby, Nystatin is commonly prescribed by physicians or prescribing midwives whether or not baby shows symptoms, since treatment of baby is important even when mom is the only one showing symptoms.  

 
Tips to eliminate thrush from home environment (to be started very soon after treatment for mom and baby begins): 
 
Environment 

• Disinfect hard items (pump-parts, bottles, pacifiers, etc.) 

• If you have a dishwasher, run these items in the hottest dishwasher setting with regular dishwasher detergent; some moms find that a cupful of apple cider vinegar helps with disinfecting; when possible, use raw/organic apple cider vinegar-a cupful facing up on the top dishwasher shelf so that vinegar gets skimmed off throughout the cycle, instead of being used after first rinse 
• If you do not have a dishwasher, boil washed/clean items for 5 minutes in boiling water; some moms find that adding a 1/2 cup of raw apple cider vinegar to this water also helps 

• Disinfect laundry (bras, burp cloths, blankets, bed sheets, changing pad covers, cloth diapers, etc.) 

• Sterilize by washing items in the hottest washing-machine setting possible, using regular laundry detergent and adding a cup of apple cider vinegar (raw, when possible); drying in a conventional clothes dryer’s hottest setting, or dry outside on a hot sunny day 

Mom 

• Wash hands often and thoroughly with warm soap and water  
• Change breast pads often, or avoid wearing them at all since trapped moisture and the sugar in your milk can cause thrush to grow  
• Change bra as soon as it becomes wet 
• Use common sense during intimacy to avoid passing infection to your partner 
• Avoid eating (or giving baby) starchy/sugary foods, baby cereals breads or pastas 

 
Baby 

• Wipe the inside of baby’s mouth with a wet washcloth after each feeding, and wipe baby’s hands with a wet wash cloth throughout the day 
• If diaper rash develops on baby, ask baby’s pediatrician about which diaper rash cream they recommend; raw/organic coconut oil has anti-bacterial and anti-fungal properties and can be used as diaper rash cream 
• Change baby’s diaper often and keep baby’s genital areas as dry as possible; do not use corn starch or baby powder to thrush in the diaper area: thrush thrives off of starch 
• Do not let baby share cups or spoons with other household members 
• Feed baby expressed milk that was pumped during an infection prior to beginning thrust treatment and disinfecting routine; milk expressed during thrush may contain thrush, but is still useful to your baby; moms who have a lot of expressed milk collected during thrush infection may need to make the difficult decision of discarding their milk