Hi Anne,

Interesting case re the persistent thrush in the mother and nursing
children.  For persistent oral thrush, I have found painting nystatin oral
suspension on the oral mucosa and tongue with a fat Q tip after every
nursing works better than 1 ml qid.  If this fails, I resort to ketoconazole
suspension painted on twice a day for five days followed by some nystatin.

Have you tried a combination topical steroid mixed with the antifungal or
even a topical steroid alone for the mother's nipples?  Perhaps the yeast is
an incidental finding and the real culprit causing the mother's pain is a
contact dermatitis or an eczema?

Finally, what about the HIV status of this family?

Let us know how this turns out.

Shirley Gross M.D.,C.M., C.C.F.P.
Edmonton Breastfeeding Clinic