Treatments for Breastfeeding Washington DC

by Jack Newman, MD, FRCPC

Fluconazole (Diflucan.) is a synthetic antifungal agent that can be used for the treatment of a variety of Candida albicans and other fungal infections. For the breastfeeding mother in particular, it can be used to treat recurrent Candida infections of the nipples, and, if such a thing exists, as I believe it does, Candida infections of the milk ducts.

Candida (yeast) infections of the nipple and ducts

Candida infections of the nipples may occur any time while the mother is breastfeeding. Candida albicans likes warm, moist, dark areas. It normally lives on our skin and other areas, and 90% of babies are colonized by it within a few hours of birth. It, like many other germs that live on us normally, only becomes a problem under certain circumstances.

Candida infections of the skin or mucous membranes are more likely to occur when there is a breakdown in the integrity of the skin or mucous membrane-another reason why a good latch is very important from the very first day. Many Candida infections would, perhaps, not have occurred if the mother had not had sore nipples and a breakdown of the skin of the nipples and areola. The oozing of liquid that occurs often in cracked nipples encourages Candida albicans to change from its harmless form to a disease causing form.

The widespread use of antibiotics also encourages the overgrowth of Candida albicans. Many pregnant women, women in labor, and new mothers, as well as their babies receive antibiotics, sometimes with very little justification.

Diagnosis of Candida infections of the nipples and/or ducts

There is no good test which helps makes the diagnosis. A positive culture from the nipple(s) does not prove your pain is due to Candida. Neither does a negative culture mean your pain is not due to Candida. The best way to make a diagnosis is by history.

The presence or absence of a Candida infection in the baby is not helpful. A baby may have thrush all over his mouth, but the mother may have no pain. A mother may have the classic symptoms of a Candida infection of the nipples, and the baby may have no thrush or diaper rash.

The typical symptoms of a Candida infection of the nipples are:

• Nipple pain that begins after a period of pain free nursing. Though there are a few other causes of nipple pain that begin later, Candida infection is definitely the most common. The nipple pain of Candida may begin without an interval of pain free nursing, however.

• Burning nipple pain that continues throughout the feeding, sometimes continuing after the feeding is over.

• Pain in the breast that is "shooting" or "burning" in nature and which goes through to the mother's back and shoulder. This pain is usually worse toward the end of the feeding, and worsens still more after the feeding is over. It also tends to be much worse at night. This pain may occur without any nipple pain.

• Pain, as above, which is made much better with the use of gentian violet, though unfortunately, gentian violet does not seem to work as well as it used to.