Introduction********
My name is Marie Davis. I am an RN who is a UCLA Certified LC. I work in both
private and hospital based practice. My private practice deals with difficult
cases. I am currently employed as a LC at Kaiser Permanente Riverside, CA. My
partner and I see approx. 500 nursing mothers and babies per month. Our
program provides prenatal classes, hospital rounds and  clinical follow-up
after discharge. We are physician mentored by Dr. Christopher Wade. I am also
a clinical instructor for the UCLA Extention LC training program.
I have particular interest in Overactive let-down (or Overfeeding syndrome)
phenomenon that manifest most often as colic. We are currently gathering a
data base of signs and symptoms and treatments.*************
Below are the instructions I use at our clinic for nipple and oral thrush. We
have great success with this protocol. Because yeast is an opportunist, we
feel that the body has been thrown out of balance. The focus in on regaining
balance. Both medication and self care changes are made.  Our mothers who
follow this for 14 days do not ususally require a second treatment.
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SELF CARE INSTRUCTIONS FOR THRUSH
Thrush is caused by a yeast-like organism that is present in the air and on
your skin.

1. Bathe nipples and areola with a weak vinegar solution after each nursing.
Make the solution with 1 teaspoon vinegar added 1 cup of water. Make a clean
solution every day.  The solution can be applied by moistening a cotton ball
and  squeezing it over your breast.  Do not touch your breast with the cotton
ball.  Use a fresh cotton ball for each breast.
2. Apply Nystatin cream to your nipples and areola as directed every
  ___6____   hours for a minimum of 14 days.  Continue to use the medication
for 14 days even if your nipples are no longer tender.
3. Use the oral  Nystantin (liquid) medication for your baby every ___6____
hours for a minimum of 14 days.  Place half of the dose inside the baby's
cheek.  Coat the baby's oral surfaces with the medication by using a cotton
swab, clean finger tip or gauze square.  Allow baby to rest briefly.  Then
apply the second half of the dose in the opposite cheek and coat the surfaces
again.  Use the medication for a minimum of 14 days  even if you no longer
see white patches in the baby's mouth.
4. Watch baby's diaper area for a rash.  Contact the clinic or your pediatric
provider if a rash appears in the baby's diaper area. The rash may also be
caused by yeast.
5. Use a clean towel for each bath or shower.  Wash all towels in hot water
after each use.  Do not allow damp towels to hang in bathrooms.
6. Wear a clean, washed, cotton bra daily.
7. Use disposible bra pads, if needed.  Avoid bra pads with occlusive liners.
If you are using washable bra pads, boil in water with a little vinegar added
for 20 minutes at a full boil after laundering.
8. Keep your nipples and areola dry.
9. Expose your nipples and areola to air as much as possible.
10. Boil infant's rubber nipples and/or pacifiers in water with a little
vinegar added for 20 minutes once a day.  Replace all rubber nipples after 10
days of treatment. Clean baby's toys with vinegar and water to prevent
reinfection.
11. Wash your hands frequently.  Keep nails clean and short.  Use a nail
brush to scrub under your fingernails.
12. Yeast may cause you to crave sugary foods, cheese, bread or alcohol.
Avoid adding these items to your diet until treatment is completed.
13. Add live culture, unsweetened yogut to your diet once or twice a day.
Acidophilus (live or viable units) may also help.
14. If you are using a breastpump, boil all parts that come in contact with
your breasts and breastmilk in water with a little vinegar added for 20
minutes at a full boil after each use.
15. Use breast shells with large holes to keep bra from sticking to nipples
and assist with air circulation.  Boil shells in water and vinegar for 20
minutes every day.  Replace the shells, if needed, after 10 days of the
treatment.
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It seems like a lot of vinegar but it works. Vinegar apparently can break
down the cell wall of the yeast preventing reproduction. The instructions
also target areas of potential re-infection.