Some LCs love the challenge of thrush.  I am one of those who has to fight
the desire to put my hands over my ears and run away.  I find thrush so
frustrating.  It seems that everyone has their own favored thrush protocol.
I remember fiery Lactnet discussions from long ago on the wisdom or danger
of eliminating foods that contain yeast, baking soda rinses for nipples, and
other folk and traditional remedies (even treating fungal infections with
urine). I think that when we see so many varied approaches, it is a clue
that no one treatment is effective for all cases.

If you go to the web site
http://www.geocities.com/breastfeedinglinks/#Breast%20Infections
and look under Thrush/Yeast, you will find links to some of the current
often-used resources and treatments:

Thrush/Yeast
Could we have Thrush?
Fluconazole (Diflucan) for Thrush/Yeast
Identifying and Treating Thrush - Using Grapefruit Seed Extract for
thrush/yeast by Cheryl Taylor White at Ask Dr. Jay Gordon.com
Information Sheet and Care Plan for Yeast (Candida) by Anne Smith, IBCLC
Oil of Oregano for Thrush?
Pat Gima's Yeast Treatment Plan - Breastfeedingonline.com
Preventing and Removing Gentian Violet Stains
Treating & Preventing Thrush - from Mothering Magazine, covers herbal &
pharmaceutical remedies and  great household routine info to help.
Using Gentian Violet for Thrush/Yeast - Dr. Jack Newman's handout
Yeast Infections and the Breastfeeding Family: Helping mothers find relief
for symptoms and treatment for the infection preserves the breastfeeding
relationship- from Leaven (LLLI)

There is also some basic thrush information at the LLLI web site at
http://www.lalecheleague.org/FAQ/thrush.html


Kay Hoover has an excellent handout that shows in photographs as well as in
text just how to use both gentian violet and nystatin, hang the wash outside
in the sunshine, etc.  I find mothers frequently use the nystatin dropper in
the bottle to squirt it directly into the baby's mouth.  Since nystatin is
in a sugary solution, is it possible that the yeast from the baby's mouth
could contaminate and even grow in the bottle of medicine when used that
way? No research has been done on that as far as I know.  We do hear reports
that nystatin doesn't seem to work as effectively as it did in earlier
years.  Having the photographs about proper way to use the nystatin and
gentian violet is very helpful in teaching mothers and reinforces the
information when they are at home.

Physicians I respect differ in whether they believe it is necessary to treat
the baby if only the mother has symptoms.

As far as research goes, ILCA has often had as a speaker Jimi
Francis-Morrill, PhD, IBCLC.  Her doctoral research was on yeast and
breastfeeding.  If you have access to the ILCA Conference Syllabus from July
14-18, 2004, her talk and bib are on pages 661 - 664.  My frustration when I
first heard her speak at ILCA some years ago was that her research threw
many of my prior beliefs out the window.  For example, we had been telling
mothers to boil bottle nipples, pacifiers, etc. for 20 minutes to kill
thrush, but Jimi's research showed that boiling caused the yeast spores to
form a tough, protective shell.  I believe she said you'd have to boil for 4
hours to counter this.

Lisa Amir, Kay Hoover and Chris Mulford wrote a Lactation Consultant Series
monograph titled "Candidiasis and Breastfeeding" which has 102 references,
for those who want to look at more studies.

I work a lot with mothers of multiples.  I see a lot of these mothers with
thrush problems.  I think one reason is that many have C-section births and
may have been given IV antibiotics that they aren't even aware of.  They are
more tired and stressed, and therefore more vulnerable to overgrowth of
yeast that may always be present in our environment.  And they are passing
it among mother and 2 or 3 babies, so it gets to be a circular pattern.  I
try to offer suggestions that don't throw these mothers completely over the
edge.  They are busy enough as it is. There are some things that are not too
hard to do that may help, like switching from antibacterial soaps for
handwashing (which kill off the good bacteria in the environment that keep
yeast in check, as well as the bad) to just plain soaps, emphasizing good
handwashing for everyone, getting towels in the bathroom thoroughly dry,
having the mother take acidophilus to restore the normal flora in her gut
that has been wiped out by antibiotics, etc.  As well, of course, as helping
her understand the use of whatever medications her physician prescribes.

Another issue for me is the mothers who are given one diflucan tablet as a
treatment for thrush.  Tom Hale's book, "Medications and Mothers Milk," 2004
edition, has a good discussion of the proper dosage to treat ductal yeast.
(pages326-330) It is helpful to give this to mothers to share with their
physicians, or to the physicians directly.


Thoroughly frustrated, still,

Anne Altshuler, RN, MS, IBCLC and LLL leader in Madison, WI

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