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. **************************** 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. ************ 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.