Thrush in breastfeeding is a fungal infection caused by Candida albicans affecting the nipples or breasts, which can cause burning nipple pain and can be passed between mother and baby.
Thrush in the context of breastfeeding is a yeast infection caused by the fungus Candida albicans. The NHS describes it as "a fungal infection in the breasts" that thrives in "warm, dark and moist environments". Candida albicans is normally present on the body and kept in check by beneficial bacteria; when this balance is disrupted, infection can develop. Crucially, La Leche League GB cautions that nipple and breast thrush is "much more likely to be something else" and that antifungal medications have sometimes been used when a different approach would have been more appropriate — making accurate diagnosis important.
What are the symptoms?
According to the NHS, maternal symptoms of breastfeeding thrush include "a burning pain in your nipples, especially after every feed", "itchy nipples that may be sensitive to touch", "flaking and/or shiny skin on the nipple or areola", "white patches/tiny blisters on the nipple or areola", and "a loss of colour in the nipple or areola". In babies, the NHS notes signs may include "creamy white spots or patches on the tongue, gums, roof of the mouth or insides of the cheeks", unsettlement during feeding, "a white film on the lips", and nappy rash that will not clear up. La Leche League GB notes that a white coating on the tongue alone is not a sign of thrush in a baby.
How is it spread?
The NHS states that thrush "is easily spread and if you are breastfeeding, you and your baby can pass it back and forth to each other". Diagnosis may involve a healthcare professional taking swabs from the nipple and the baby's mouth.
How is thrush managed?
The NHS advises that if thrush is confirmed, a healthcare professional may prescribe "an antifungal cream or tablets" for the mother and "an antifungal gel or liquid cream" applied to the baby's mouth. The NHS recommends continuing to breastfeed if possible, and advises: "If you cannot because it's too painful, try expressing your milk instead." La Leche League GB notes that other conditions — including shallow latch, vasospasm, skin conditions, and bacterial infection — can produce similar symptoms to thrush, and that obtaining a confirmed diagnosis before commencing antifungal treatment is important.
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