Do you have shooting pains in your breast? Are your nipples pink and sore? Does baby have a white coating on their tongue? If the answer is yes and you go to the GP, chances are that you will leave with a prescription of thrush mediation for you both.

Over the years I have met many women being treated for nipple thrush and their babies for oral thrush – but I can only be certain of seeing it once. Thrush is one of those things that appears to be over-diagnosed at the moment and many breastfeeding mothers and babies are being treated unnecessarily.  In this article we will talk about thrush signs and symptoms, and why they are often mixed up by well-meaning health professionals who do not have time to watch a feed.

Sore nipples can make a mother utterly miserable. If you are struggling with sore nipples especially if breastfeeding has never been pain free, please get some proper support from a lactation consultant or at a breastfeeding drop in.  In nine out of ten cases a professional watching a whole feed can offer guidance unique to you and your little one that reduces the pain or even removes it all together. If your baby has a shallow latch onto the end of your nipple, especially if your nipple comes out looking pinched or white at the tip, it is probably compression that is causing the nipple pain and the shooting pain sensation as the blood rushes back afterwards.  A more severe version of this is called vasospasm and you can read more about both here https://kellymom.com/bf/concerns/mother/nipple-blanching/.  For more information on achieving a comfortable breastfeed, please see the other articles and videos on this site.

Rarely a mother will know that she suffers from Raynaud’s Syndrome, that causes vasospasm in the nipples as well as other extremities. This can be very painful. Mothers are advised to keeping the nipples warm, some find expressing less painful than direct breastfeeding, and some need pain relief or other medication. There is more information on diagnosis and treatment options here https://breastfeeding.support/nipple-vasospasm-breastfeeding/.

So when is the pain caused by thrush? Thrush is a fungal infection of the nipple that can also affect your baby’s mouth. Women often describe an itchy, scratchy, broken glass kind of pain in their nipples and shooting pains deep in their breasts for up to an hour after every feed.  A baby with thrush will have irregular white patches in its mouth, extending across the tongue, cheeks and gums and sometimes lips. The patches do not rub off.  Sometimes the tongue and lips have a white sheen. As thrush passes between you, it almost always happens on both breasts at once.  Thrush is really uncommon in mothers and babies within the first two weeks, even if the mother has been given antibiotics in labour or after the birth.  Early onset nipple pain, especially if breastfeeding has never been pain free, is unlikely to be thrush.

This photograph from the nhs website shows oral thrush in a baby.

What is that white coating on my baby’s tongue then? Babies can often have a white coat on their tongue, and it is sometimes quite thick.  It is often referred to as “milk tongue” but it isn’t really milk. Babies whose tongues are a little restricted in their mouth, and often babies that are tongue-tied, cannot raise their tongue well and rub the top if it during feeds so they often have a consistent coating. The image below is milk tongue. You can see that baby’s tongue is held down towards the floor of the mouth. If it is not hurting you or them, and baby is happy and gaining weight, please don’t worry about it.

If you also have nipple pain or baby is not gaining weight well it might be the tongue restriction that is causing the problem. As a starting point, please get help from a professional in achieving a good deep comfortable latch. It might be necessary to treat your baby’s tongue, and you can find help with this through your medical professionals or the Association of Tongue-tie Practitioners (www.tongue-tie.org.uk).

If you can see a clear restriction under your baby’s tongue, especially if the tongue makes a v-shape or notch when baby tries to lift it, this is tongue-tie not thrush.  Here is a picture of tongue-tie.

What if it really is thrush? Then please see your GP and get a swab to confirm this.  If it is thrush then treatment will be prescribed for both your nipples and your baby’s mouth.  It might take a couple of weeks to go away.  The evidence-based treatments are listed in this excellent article https://www.breastfeedingnetwork.org.uk/thrush-detailed/

I would be very interested to hear more from mothers who have been diagnosed with thrush (by swab) and the treatment options they have used.  Please don’t hesitate to get in touch if you have questions about anything you have read in this article.  Best wishes with your breastfeeding journey.