Breastfeeding can be a rewarding experience, but it can also come with challenges, such as sore nipples. While thrush—a yeast infection caused by the fungus Candida albicans—was once thought to be a frequent cause of nipple pain, recent research suggests it may not be as common as previously believed.¹ This care guide will help you understand the various reasons for sore nipples and breast pain, including thrush, as well as available treatment options. 

Understanding Yeast Infections²

• Symptoms: Common symptoms include shiny and flaky skin, redness, itching, burning of the nipples, and shooting pain in the breast.
• Diagnosis: Diagnosis is typically made by observing symptoms and ruling out other causes. Milk cultures have been found to be an unreliable method for testing the presence of Candida in breast milk.
• Increased Risk: Mothers who have recently taken antibiotics, either during pregnancy or postpartum, are at increased risk of vaginal and other yeast overgrowth. 
• Normal Presence of Yeast: Yeast, particularly Candida, is naturally found in everyone’s gastrointestinal tract and can be present in the mouths of a significant percentage of people, especially babies. It usually becomes problematic only when there is an imbalance, such as after antibiotic use or in individuals with weakened immune systems.

Treatment Considerations³

• Treat Both Mom and Baby: Many healthcare providers recommend treating both mother and baby for yeast, even if only one is showing symptoms.
• Over the Counter Topical Treatments: Topical antifungal creams such as Miconazole and Ketoconazole can be applied to mother’s nipples and areola 2-4 times per day for at least 2 days, and up to 7 days, for treatment.⁴
• Prescription Options: Although commonly prescribed to both infants and mothers, Nystatin has been found to be ineffective much of the time. Studies have found that Fluconazole is a more effective treatment for both mother and baby.⁵
• Natural Remedies: Gentian Violet was once recommended as an over the counter treatment for thrush for both mother and baby. However, because it may increase the risk of cancer, the World Health Organization now advises against its use.⁶

Causes of Nipple Pain that Can be Mistaken for Thrush

What If I Have Questions?

If you are interested in learning more, these Aeroflow classes expand on some of the topics discussed above:

• Ultimate Breastfeeding Prep
• Lactation Q&A

Want More Info?

For a directory of Aeroflow’s other Care Guides offering information on pregnancy, baby care, and more, browse our comprehensive list of titles:

References