Candidiasis is the most common fungal (yeast) infection in humans, and Candida Albicans is the mostcommon species. Candida is often found in infants, pregnant women or diabetic patients. It can occurwhen the mother or infant has been treated with antibiotics or can be contracted by the baby at the time ofbirth if the mother has a vaginal yeast infection. Candida in the breastfeeding mother most commonlyoccurs on the nipple and areola. In the infant, candida is often seen in the mouth and on the buttocks.
Sudden onset of sore nipples after any initial soreness has subsided Bright pink or red nipple/areola (may have no visible symptoms) Stabbing needle-like shooting pain radiating through breast White patches on inside of mouth and/or tongue Infant may fussy at breast or refuse to nurse because of oral discomfort Treatment Recommendations
Breastfeeding can and should continue during treatment.
Treat mother’s nipples with anti-fungal medication (see recommended medications).
Treat infant’s mouth and diaper area with anti-fungal medication (see recommended medications).
It is necessary to continue using the medications for mother and infant for as long asrecommended, even if symptoms are no longer apparent.
Wash hands before and after feeds, and after medication application.
Rinse nipples and areola with cool water after feeds and gently pat dry before applying medication.
Reduce moisture retention: keep nipples dry - change nursing pads after each feeding.
Thoroughly wash bras and any other clothing/linen coming in contact with breasts.
Anything that goes into the baby’s mouth, such as teething toys, pacifiers or bottle nipples shouldbe boiled 20 minutes or put through the dishwasher daily. After one week of treatment, discardpacifiers and bottle nipples and get new ones. If a breast pump or breast shells are used, all parts that touch the milk should be boiled 20 minutesor put through the dishwasher daily.
Milk expressed during an outbreak of thrush should not be saved or frozen. Baby could bereinfected later from a bottle of stored milk.
Dietary changes especially reducing sugar intake and yeast-containing foods can reduce thereoccurrence of yeast infections.
Avoid using deodorant soaps as these may decrease normal skin flora allowing overgrowth.
Recommended Medications**
Pediatrician will prescribe infants oral treatment plan
Fluconazole (Diflucan) oral suspension as directed Miconazole cream to diaper area if affected Anti-fungal topical cream to nipples/areola after each feeding for 14-21 days No need to wash off before next feed Miconazole cream (Monistat 7) is first choice (no prescription needed) Fluconazole (Diflucan) orally for persistent or intraductal yeast (requires prescription)Recommended dosage: 200-400 mg STAT, followed by 100-200 mg daily for 14-21 days ** Thomas Hale; Medications and Mothers’ Milk 2004. Thomas Hale; Clinical Therapies in Breastfeeding Mothers, 2002.


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