Breastfeeding and Yeast Infections

Breastfeeding and Yeast Infections
Posted by: Dr. Mercola
October 13 2004 | 10,176 views

By Carolyn Dean, M.D., N.D.

The joys of new motherhood are sometimes dampened by the insidious fungus, Candida albicans, for both the breastfeeding mother and her child.

Babies With Yeast Infections

Infants are vulnerable through the birth process itself as follows:

Candida yeast organisms are commonly found in the intestinal tract, vagina and in chronically moist folds of skin, especially in the groin.

Yeast overgrowth in women and infants is commonly caused by antibiotics, which upset the body's natural microbial balance, creating an overgrowth of the fungi.

Newborns most frequently acquire candida infections in the process of birth, either from the vagina itself or from contact with the mother's external genitalia. They can also contract it because of intestinal imbalances aggravated by a course of antibiotics, for any one number of infections that can occur early in life.

An Undetected Case

In one particularly distressing case, a 10 month-old baby, who had been on eight courses of antibiotics, came to see me in my office. Within days of birth he was diagnosed with an ear infection and put on antibiotics.

The mother, a nurse, suspected yeast but the doctors wouldn't listen to her and said there was no such thing as a yeast ear infection. Finally, when she came to see me, there was a child with a "failure-to-thrive," diarrhea, gas, bloating, and a slight yeasty smelling discharge from one ear.

The mother was still breastfeeding so she immediately began a strict anti-candida diet, ate lots of garlic, took nystatin and probiotics. The baby started probiotics and a very small amount of nystatin powder. Within one month, both the baby's and the mother's symptoms had begun to fully subside. Interestingly enough, this young child did not have the usual "thrush" sign of yeast.

Yeast overgrowth usually manifests in the child as thrush, a yeast infection of the mouth and throat. It appears as creamy white, crud-like patches on the tongue, inside the mouth and in the back of the throat.

How Candida Spreads

Candida can also cause or infect diaper rash in infants and worsen the condition, since the candida fungus grows rampantly on irritated, moist skin.

Babies who suck their thumbs can also develop fungal infections around their fingernails, causing redness at the edge of their nails.

Babies in diapers should be changed frequently. Gently wash the irritated skin with mild soap, rinse and pat dry. Do not use plastic pants since they hold the moisture in and prevent air circulation.

It's not necessary to keep an infected child out of child care as long as child care workers are alerted and are vigilant about washing their hands after contact with diapers, nasal, eye and oral secretions to keep the infection from spreading.

Conventional Treatment Options

Yeast overgrowth in babies can be, and often is treated with prescription antifungal medications like nystatin. For the short term, nystatin is effective and relatively safe. Nystatin is not absorbed into the blood stream and treats the overgrowth of yeast in the gastrointestinal tract. The decision to use a strong antifungal like fluconazole (brand name Diflucan) is not to be taken lightly. It is absorbed into the blood stream and does have side effects.

It's important not to lose sight of the fact that we're talking about babies here. I'm a strong proponent of causing the least harm possible -- and prescription drugs should be avoided whenever possible, especially in children.

Natural Treatments Safer and Gentler

I'd prefer to see some gentler ways of addressing the problem for starters. Probiotics, yogurt with live acidophilus cultures, garlic, and coconut oil are the safer antifungals to use.

(However, Dr. Mercola’s favorite source for probiotics now is to locate some raw milk and convert it to kefir. Kefir is very similar to yogurt but it is much easier to make. All you have to do is add the packet to a quart of raw milk and leave it on the counter over night. Without question it is the best value of probiotics as each quart of kefir has more bacteria than many bottles of probiotics.)

For Breastfeeding Women

Almost no illness requires a mother to stop breastfeeding. In fact, there is some evidence that continuing to breastfeed during an infection actually helps protect the baby.

In this same context, almost no illness in the baby requires stopping breastfeeding either.

For nursing mothers, candida infection can cause sore nipples, blocked ducts and mastitis.

Sore Nipples

While sore nipples can be caused by candida overgrowth, the primary cause of sore nipples is a failure of the baby to latch on properly from the day of birth. (For more information on this, go to breastfeedingonline.com.)

Sore nipples caused by failure to latch on usually are worst when the baby first begins to feed and the pain eases as the baby nurses.

According to Dr. Jack Newman, whose articles can be found at Breastfeeding Online, sudden, unexplained nipple pain is a sign of a possible candida infection. "The pain may also come on gradually due to other causes," says Dr. Newman. Yeast infections can also cause cracks around the nipples.

Bacterial infections can also occur in breastfeeding mothers and occasionally in women who are not breastfeeding or pregnant. They have even been known to occur in infants.

Mastitis is not the same problem as blocked milk ducts. Blocked ducts can often be treated with hot compresses. Mastitis usually requires treatment with antibiotics. Anyone who is treated with antibiotics should take probiotics to prevent an imbalance of intestinal microbes that can open the door to candida overgrowth.

Symptoms of a blocked duct include swollen hard masses, redness and pain.

Mastitis is always characterized by hardness, pain, redness and swelling in the breast. There may or may not be flu-like symptoms and fever, but these alone are insufficient for a diagnosis of mastitis.

Abscesses may be signs of complications of mastitis. They must be surgically drained, but again, do not require the mother to stop breastfeeding.

Yeast-Related Breastfeeding Problems

Candida yeast infections in the nipple and milk ducts are not likely to occur unless there is broken skin, a rash or a tear in a mucous membrane. What begins as sore nipples can become a candida infection if oozing serum from a cracked nipple turns candida free from its harmless form to an infection.

Candida infections of the nipples or in milk ducts are difficult to diagnose. There is no definitive test for candida in these cases because either a positive or a negative culture can be incorrect. A woman with a history of vaginitis or other yeast-related problems is more likely to have an infection in her breasts.

Whether or not the baby has a candida infection is also not a positive indicator of the presence of a candida infection in the mother.

Symptoms of candida infections in the nipples or milk ducts:

The infection may occur after antibiotic use by either mother or child.
Nipple pain after a period of pain-free nursing.
Burning nipple pain throughout the feeding.
Shooting pain in the breast that worsens toward the end of the feeding.
Pain may increase after the feeding ends. Pain may also radiate through the arm and shoulder.
Itching sometimes occurs.
Skin around the nipple may be smooth and shiny.
Pain, which improves after the use of gentian violet.
Treating Candida Infections in the Breast

Gentian violet

The first line of attack against candida infections in the breast is gentian violet, an old fashioned remedy that is safe, works quickly and is effective for about 70 percent of women with this problem.

Eight steps on how to use gentian violet:

Mother should be uncovered from the waist up. Baby should be undressed to the diaper. (Note: Gentian violet is messy and it will stain.)
Dip a Q-Tip in the gentian violet.
Put purple end in baby's mouth and let them suck on it or smear it around the inside of cheeks and on their tongue.
Put the baby to the breast. This allows treatment of the breast.
Paint the other nipple with gentian violet, if you are only nursing on one side for this feeding.
Repeat each day for three to four days.
Do not continue if relief has not occurred in four days.
Do not use artificial nipples for feeding. If this is unavoidable, boil them daily and cover them with gentian violet.
Occasionally, a baby will get sores in the mouth from gentian violet treatment. If this occurs, stop treatment and contact a pediatrician.

Nystatin and Diflucan (fluconazole)

If the gentian violet treatment fails, the prescription antifungal medication fluconazole or Diflucan is the recommended treatment. Most doctors doubt that nystatin will work locally if gentian violet did not. It may be worth a try if a mother wants to avoid the stronger and more expensive Diflucan. Using nystatin powder in a paste and taking nystatin by mouth may help resolve the problem.

If Diflucan is used, be aware that this drug stops candida fungi from multiplying, but does not actually kill the yeast, so it may take several days to be effective.

Fluconazole does appear in breast milk, and the baby will definitely get some, which actually can help treat the baby's candida infection at the same time, if there is one. It is said to be harmless if the baby is not infected. However, it is a chemical medication and will require detoxification by the baby's liver.

There have been no reported complications in babies exposed to fluconazole in breast milk, so it is probably safe and advantageous to continue breastfeeding. Some doctors may tell mothers they must stop breastfeeding if they are taking Diflucan. According to breastfeeding expert, Dr. Jack Newman, that is not the case. The benefits of breastfeeding probably outweigh any negative side effects.

Some candida strains are becoming resistant to Diflucan, so the operative dosage is a 200-mg. first dose followed by two full weeks of 100 mg. a day to ensure effectiveness.

Most doctors want to see the mother symptom-free for a week before medication is stopped to prevent recurrence.

Other Treatment Options

The standard anti-candida diet will be very helpful in treating breastfeeding mothers with candida infections and must be an ongoing process. This essentially involves eliminating all sugar, processed, fermented foods and foods containing yeast for at least three weeks.

In addition, eating organic yogurt daily and taking a good quality probiotic will help re-colonize the digestive tract with healthy micro-organisms and bolster the immune system to fight off the infection in other parts of the body.

For more information about the anti-candida diet, yeast problems in general, other natural ways to approach yeast overgrowth and for the highest quality supplements for women with yeast problems, go to: The Yeast Connection.

Carolyn Dean, M.D., N.D., is medical advisor to Woman's Health Connection at The Yeast Connection and is featured on the website's "Ask A Pro" page. Her latest books are The Miracle of Magnesium and Natural Prescriptions for Common Ailments.