Nipple pain can occur in a breastfeeding mum for many reasons. Obtaining a correct diagnosis is critically important for a successful continued breastfeeding realtionship. Breastfeeding is recommended exclusively for your baby’s first six months and then in combination with food right up until two years of age or beyond. This article does not serve to prove the benefits of breastfeeding – it is universally accepted as the best source of nutrition for your baby and has many benefits for mum too. No doubt I’ll write all about that at some other stage – today I am more focused on identifying those mums who are struggling with pain during feeding and would like to highlight thrush as a potential cause. From experience I have found it is important to know the appropriate treatment when attending the doctors so that you can discuss the best treatment options available to you.
Nipple pain can be caused by several factors which include an incorrect latch, inappropriate breast pump use or manual expression techniques, tongue tie, and bacterial or fungal infections. Candida (fungal) infections tend to occur after antibiotic use or if a mother has vaginal thrush or their baby is suffering from oral thrush.
Symptoms of a thrush infection of the nipples can include:
- Cracked sore nipples which may or may not bleed.
- Shiny skin around the nipple area which may have the presence of red spots around the nipple area.
- Persistant pain during feeding – either in the early weeks or even in a well established breastfeeding relationship when pain was not previously an issue. I highly recommend seeing a lactation consultant if you suspect latch is an issue – these fabulous consultants are highly skilled at correcting latch and identifying issues such as poor positioning, tongue tie and more! Saved me on more than one occassion!
- Pain which lasts during and after feeds. Often worst at the start of a feed.
- Pain which shoots through the breast can indicate ductal infection.
Treatment of thrush infections of the nipples and ducts should be led by your GP and should include treatment for both mum and baby! There is no point treating mum alone if a baby has oral thrush as every time they have a feed the thrush can be passed back and forth. Treatment should include the use of medicines such as mycostatin (on prescription only) as drops for your baby and daktarin cream or canesten cream for local application on the nipples. Daktarin oral gel can also be used for babies older than four months (it’s too thick for younger babies). Your GP may prescribe oral fluconazole at a dose of 200-400mg to be taken straight away and followed at 100-200mg daily for a minimum for two to three weeks. As this dosing is unusual and quite specific for ductal thrush it is a good idea to discuss it with your GP as the licensed doses which are advised by the manufacturer are significantly less. The following information from ‘Drugs in Pregnancy and Lactation by Gerald G Briggs and Roger K Freeman’ may be useful for your GP:
‘The safety of fluconazole during breastfeeding cannot be completely extrapolated from these cases, but the dose administered to these infants far exceeds the amount they would have received via breast milk. Since no drug-induced toxicity was encountered in the infants, fluconazole is probably safe to use during breast feeding. The American Academy of Pediatrics classifies fluconazole as compatible with breastfeeding’ I would also highlight the references I have mentioned below if further information is required about the dosing schedule.
I’d recommend mums to change breast pads frequently and use a hot wash on nursing bras. If your nipples are cracked and sore multimam compresses are great – especially if stored in the fridge before use.
Mums should continue to feed as normal during thrush infections. Unfortunately symptoms can be slow to resolve but with the correct treatment it will go! In the meanwhile mums should rest as much as possible – I’m a big fan of the ‘any excuse’ opportunity!! Should I write on here that men should do all of the housework and take sole care of any other children in the family….. well I could…but I’m not sure I can find the evidence to back it up – hmmmmm I’ll use personal experience on this occasion!!
I hope you find this helpful and if you have any questions at all please don’t hesitate to contact me by sending a private message to the WonderBaba facebook page (www.facebook.com/wonderbabacare) or by calling me (Sheena) at Milltown totalhealth Pharmacy in Dublin 6 on 012600262. I’m always happy to help!
Drugs in Pregnancy and Lactation by Gerald G Briggs and Roger K Freeman