Jacqueline Kincer 0:03
Welcome back to The Breastfeeding Talk Podcast. I'm your host, Jacqueline Kincer. And in today's episode, I'm going to be talking about a topic that comes up for a lot of breastfeeding moms. And that is thrush. So this episode is the ‘all-about thrush’ episode. I'm going to be talking about what thrush is, I'm going to be busting some myths, and I'm going to be giving you the basic education that you need to know about this particular topic.
It comes up more than you think I will say that, you know, as much as it's great to have Dr. Google and be able to look up information. A lot of the times, unfortunately, were incorrectly self-diagnosing. And when that happens, and you end up going through a treatment protocol that you piece together, and it doesn't work, you sort of convince yourself of a couple of things. One is that something's just wrong with your body, you're special, you're unique. Why is this happening to you?
The other thing is that potentially this is just incorrect, right, that you're maybe going down the wrong path or what have you, I would say most people end up doing the latter. And that's unfortunate because you're very smart, and you're very capable. And you're very wise. And it honestly is just really heartbreaking when parents start to believe some really negative things about themselves and their bodies. And so we want to do really whatever we can to avoid that.
Before I dive into the episode, though, I did just want to thank anybody who is out there subscribing to the show because your subscriptions give me a purpose, and they make me want to keep recording episodes for you. And I've gotten back into doing them weekly. I have an incredible podcast manager who takes care of all of the editing, the show notes, the transcripts. If you guys did not know this, by the way, there are transcripts for all of the new episodes. There are some for the past episodes, and we're working on those. If you are hearing impaired, and you need that kind of assistance, or you're just more of a reader, you can actually access those on our website. So if you go to breastfeedingtalkpodcast.com. And you find a particular episode, there is a link in those show notes there on the website for you to access the transcript. It's got timestamps and everything. So I just wanted to make people aware of that.
Honestly, I used to do all of this stuff myself, I used to edit the show, I used to bring in the intro and the outro and write the show notes and create all of the graphics and all of that, and it just kind of became too much. So now I've got this incredible podcast manager, Jennifer. So I know you're listening. So huge shout out to you. Thank you for making this podcast possible for me to continue.
I will share this review. I love when you guys leave ratings and reviews on the show that actually helps other parents find these episodes and makes it more relevant when they're searching for a particular topic on their favorite podcast app. And so this one was actually left a couple of days ago. It's from one to one Tina, and she says, “Best trustworthy breastfeeding podcast.” Oh man that's a huge compliment. Thank you! She says, “I am obsessed with Jacqueline and everything she creates in does kind of a fan girl here but seriously have got so much out of this podcast even episodes I didn't think I would learn or gain interest in I did I send this podcast Holistic Lactation Instagram to all my mommy friends. And again, not just breastfeeding issues, but all motherhood related support.”
Awe, thank you so much for that incredible review. That means the world to me. And I'm so glad that everything that you're listening to and seeing on Instagram is supportive of your breastfeeding and postpartum journey. So anyway, if you'd love to leave us a review, I think Apple podcasts is the only place to do that. But perhaps other apps have implemented a way to do that now as well, but we would love it.
So let's talk about thrush, though. Hello, Thrush. So there are two possibilities when you think your baby has thrush. There's thrush, which is a Candida albicans overgrowth. It is usually very visually obvious. It's not a mystery as to whether or not you or your baby have this. And so I think what a lot of people will have convinced themselves of and a lot of false information that has even gotten peddled in the IBCLC community.
There's this idea of like ductal thrush or hidden thrush. And I would say there's no evidence to support that. I have not seen that be the case. In clinical practice, there's some other cause. And it's just a matter of finding the right professional to diagnose without other causes and give you the proper solution to treat it.
The other thing that it could be is just because your baby has white on their tongue, or just because you have sore, painful nipples or stabbing pain, your baby could have something called milk tongue, which the formal name for that is pseudo leucoplachia. And that's really a condition that arises when a baby's tongue actually cannot fully elevate to the roof of their mouth while at rest or during swallowing. And so there's this buildup of milk that ends up on the top of your baby's tongue, and it just isn't getting rubbed off. It's not harmful in any way.
A really great way to know the difference is if your baby's tongue has white, and there's not white anywhere else in your baby's mouth, so it's not on their gums, it's not on their lips, it's not on their cheeks, and you don't have any symptoms of thrush. Many babies are misdiagnosed by pediatricians as having thrush when it's milk Tang, and these babies are often prescribed antifungal medications. And it's not yeast. And so that is not great. We don't want to expose our babies unnecessarily to antifungal medications.
And already, the strains of yeast responsible for thrush are resistant to some antifungal medications on the market. And so we don't want to create more resistance to those medications by unnecessarily using them, we want to make sure we're treating yeast now, yeast and thrush in mom are on your breasts on your nipples that tend to be less obvious some of the time because there's more friction against that nipple and aerial or tissue.
Typically, signs of thrush would be bright red skin, and that skin usually has a shiny appearance to it, the skin is often flaky, so it's not cracked. Well, it can be cracked, but it's not just cracked nipples, it's not just crustiness on the nipples crustiness typically indicates something like healing after a wound was created, or something bacterial typically does not indicate something fungal. So bright red shininess to the skin, a burning sensation, can be a stinging sensation, it's very surface level. So it would not be felt deeper inside of the breast. It's present at all times whether or not your baby is nursing.
That discomfort, that stinging, burning sensation, may go away while the baby is nursing because the friction will sort of soothe the irritation if you will. Sometimes white is visible on the nipple or areola, and I want to talk about this as well. If you get a close view of your nipple, it kind of looks like a raspberry, right, there's like kind of these bulbous sections to the tissue and then some deep crevices in between. And you can very often see white in those crevices of the actual nipple tip itself, that's very normal. That does not mean that you have thrush. It could be a normal yeast we have used presently on our skin at all times. It could be a normal beneficial yeast, I don't even know if I'm saying this correctly, but Malassezia is a normal human skin yeast that we have. So it's typically if you do see it, it could be just a thin but viscous white film, Candida albicans.
Thrush is more chunky, for the most part, it's not smooth, it can sometimes look smooth, but for the most part, it isn't. But also, breast milk can end up just stuck in those little folds of your nipples. So a lot of times, it's just milk, it's not thrush. And so, if you're not having those accompanying symptoms, then don't make that assumption. Pretty much every nipple, if we dig deep and look in those crevices, is going to have some amount of whites in there.
So let's talk about the pain of thrush for a mom and on her nipples. Because breastfeeding pain is unfortunately very common. It is not normal, though. So it is a sign of a problem. And the cause of that problem varies. But with thrush, the pain is, again, usually a burning pain, it can create a lot of itchiness can create a stinging sensation. Those are the most commonly described ways that parents will say I feel X, Y, and Z, and they actually do have thrush. So keep that in mind.
Again, it's not going to be something that you're feeling deeper in the breast if you've ever had a vaginal yeast infection basically feels like that but on your nipples and, in fact, most of the time or a lot of the time, moms who have thrush on their nipples also have concurrent vaginal yeast infections. So if you have a vaginal yeast infection going on and all of a sudden things were going fine, and you've got these symptoms of thrush on your nipples, definitely go see your OB to get that taken care of because earlier treatment is better.
The other thing you might notice, too, in your baby is that if they're experiencing thrush and you're experiencing rashing, it truly is thrush, it's very likely that your baby will also have a diaper rash that's very yeasty. Their diaper rash often would look like your nipples were. Right around their anus, it would basically be a bright red, kind of shiny as well. You may see some white chunkiness and white film, of course, it's an area that you wipe frequently. So you may not see actual white, actual buildup of yeast. Sometimes you do though, sometimes you'll actually see it kind of present at the entrance of the anus as well. And so there's little folds around there, you might find that there's kind of white in there. Again, there are some normal skin yeasts. But if you're seeing this diaper rash, that just looks really bad.
The other way to know when thrush is really bad is sometimes when you wipe it off, the skin underneath looks even shinier and more raw. That's typically an indication that you have some yeast going on, if it's just milk. So on the instance of like a baby's tongue, you wipe it off and nothing looks abnormal underneath you just have normal healthy pink tongue tissue. If it's looking raw and exposed and shiny and like it might be painful under there, then it's probably yeast.
I don't even know how we got to this place either. There are so many myths about thrush, there's this idea, and I don't even remember which way it goes. But if you can wipe it off, then it's not thrush, one or the other, thrush or milk tounge, both can be wiped off. There's no like extra stickiness that either one of those things particularly has, it's just a matter of what the tissue look like underneath once you've wiped it off. So keep that in mind.
Most of the time, with babies, it's not going to just be on their tongue and kind of a symmetrical central pattern on the tongue, it again will be on their palate, their gums, their cheeks, their lips, other places as well. So it's pretty obvious most of the time unless you've just happened to catch it early on.
The other thing I'd point out is that, for the most part, I don't see thrush and people that are immediately postpartum. So if you're experiencing nipple pain, it probably isn't thrush, it's probably the latch. So that's something to get assessed and checked out. Of course, you know, we want to make sure we're ruling out something like thrush as well, but it usually creeps up later on in the journey.
You can be actually more susceptible to things like thrush or mastitis if you've had antibiotics during your labor during pregnancy because that's knocked out a lot of your really good beneficial microbiome that keeps things in check. And then birth and pregnancy in general, very stressful on the body, especially birth, and then postpartum, and all of that. And so stress can lower our immune system, it can create opportunities for overgrowth of pathogenic antigens, like yeast-like bacteria. And so you just want to keep that in mind, if that's part of your medical history, that maybe you're more susceptible to that, maybe you're more prone to that. So taking a breastfeeding specific probiotic can be really helpful for something like that, or just trying to get your yeast back into balanced as well, can also be really helpful. So if you're having nipple pain, and there's no itching, and there's no burning sensation that's constant all the time, it's probably not thrush.
Let's talk about perceived thrush though a little bit more because again, I mentioned early on about the milk tongue and the pseudo leukoplakia. And a baby will see this pattern very often with tongue ties. And the reason for that is, is that the tongue tie at a very minimum is keeping the baby's mid tongue from elevating, which is the most important motion they need to make for breastfeeding. Because it's what generates suction in the mouth, it's what allows nursing to happen pain-free, it's what allows milk to flow freely from the breast and not be cutting off the flow or pushing milk back into the milk ducts, something like that. So it's very, very important. And that would be with a posterior tongue tie.
If the baby also has an anterior tongue tie, the forward front portion of the baby's tongue also cannot elevate. And so you've got a whole host of problems there. So no matter what type of tongue tie your baby has, though, because that central part of the tongue cannot elevate up to the roof of the mouth, then that milk builds up, and it settles on that place in the tongue. And again, it's not harmful, it doesn't do anything. It doesn't cause any pain or discomfort or anything, but it's a sign, and so if you're seeing that your baby's tongue has a white coating on it, and perhaps it's very thick. If it's mild, I would say there's somewhat of a range of normal of this, but if it's a thick white coating, it's very visually obvious like you take photos of your baby and their tongue is just got this white coating on it, then it's probably a good idea to have your baby assessed for a tongue tie.
Now it may or may not be causing you pain at the breast and you may not even be nursing on the breast, you might just be pumping but if you are nursing at the breast and you're also experiencing pain while seeing that your baby has a tongue with a white coating on it. Again, it may not be thrush, it could be, but you can be experiencing nipple pain from friction, you can be experiencing the bolt damage, which can cause changes to that nipple and areola tissue that can sometimes mimic thrush. But again, it really won't be a shiny appearance, there might be red, there might be a pain, and there might be itching as the tissue heals. But now it's moving on to a healing stage, you might have granulation tissue.
Granulation tissue is white, it is sort of the precursor to a scab. And so whenever we have tissue that is wet and moist, that will create granulation tissue during healing. And it's just sort of a soft kind of fills in for where the scab is going to go later on when your lactating milk is flowing from your nipples very often. And so yes, you can get some actual hard crusty brown scabs, but it's going to begin as granulation tissue and a lot of people mistake that as thrush, they will, unfortunately, do some treatments that are very damaging to that nipple tissue and delay healing and can actually create scarring and can block milk ducts and things like that. So you don't want to just put anything on your nipples unless you know what's going on.
I think this is one of those biggest the biggest take home messages is that there are treatments out there for thrush that people can do at home. Absolutely. Some of these are dangerous. I will talk just a moment about Gentian Violet, this is kind of one of those, you know old-time remedies. Midwives still recommend this. Hopefully, there are no IBCLCs out there recommending this Gentian Violet is going to turn everything purple.
Number one, I don't think that's a great course of treatment. It's sort of like, you know, the toilet water in airplanes, how it's blue, and like really blue dye. This reminds me of the National Lampoon movie Vegas Vacation. He's trying to join the Mile High Club with his wife on the airplane. And they end up getting their, I think it's like his hand or something, and something else in the toilet water. And they’re dyed blue. And then afterwards, he says that his pen exploded, and that's why he's covered in blue.
Anyway, Gentian Violet basically does that, but it's purple. It is actually made from coal tar. Gentian violet is in coal tar and is a known carcinogen. This is information that you can easily find online. I believe there's even like a CDC or FDA, something about this. And so I'll make sure to link up some information in the show notes about this. But carcinogenic, it does not belong anywhere in a baby's mouth, and it certainly does not belong on your lactating breast. So please, please, I would absolutely say without a doubt, this is not an appropriate treatment, you should be trying some natural things, if that's appropriate, and your IBCLC can direct you as to what those are.
Some health care providers beyond lactation might know this as well. But you can certainly do an antifungal medication. And that's a whole other discussion as well, because again, there are some antifungal medications that yeast is now resistant to, and so you want to make sure you're using the correct one. And so that's really important as well.
If you are experiencing actual thrush, you do need to treat yourself and your baby simultaneously. And so what this means is is that the pediatrician treats your baby your OB or midwife or general practitioner or what have you treats you, so you're going to need to get two different prescriptions, one for your baby, one for you, if you're going that route for treating thrush. Okay, you're going to want to treat yourselves simultaneously.
The other thing you're going to want to do that you may not have considered as anything that could possibly come into contact with thrush needs to be sanitized. So this means washing and boiling or sterilizing pump parts, pacifiers, bottle nipples, teething toys, clothing, rags, or anything your baby might be drooling on. Getting saliva on any of that all needs to be sanitized. So put that on the sanitize cycle and your washing machine. If you can dry these things on high heat, what have you. And then, for your nursing pads, I would suggest using disposable ones if you normally use reusable ones during this time. In fact, I would probably just say throw out your reusable ones and just buy a brand new set. If you're going that route, yes, you can sanitize those but I just like to be super safe.
So definitely use disposable ones if you're leaky or you're applying some treatments to your bras during this time, change some very frequently and then also your nursing bra or if you're not wearing one, any shirt, any clothing that's coming into contact your bedsheets things like that. Underwear as well if you're experiencing some vaginal yeast infection symptoms, so please please make sure that you are taking care of all of those things and that you're doing all of those things until symptoms are gone for 24 hours like a complete resolution of thrush. If you want to be even safer about it, I would say 48 hours. You don't want to keep reinfect you're passing back and forth if you only treat your baby, but your baby truly has thrush in their mouth every time they go to the breast they're gonna give it back to you.
If you're not treating yourself at the same time, you're just creating some antifungal resistance. And then, of course, you know, not allowing any of the treatments to work, and so on and so forth. Again, there are natural ways to do this. But it really just depends on how severe things are and what your particular situation is. And so you would want to work with an IBCLC, who's skilled with that we can definitely help you, you know, on a virtual appointment or what have you, if that is something that you're trying to avoid some pharmaceuticals, great, there are some very safe options out there. But that would be medical advice. And I can't just give you directions on how to do that on the podcast because it is individual circumstances. You're going to be different depending on what's going on without mom and baby and their individual symptoms. Same with antifungals. So you want to make sure you getting the right medication in the right form, all of that. So there's topical, there's oral, there are various options, and that's going to be up to your healthcare providers to determine which course is best.
Here's the other thing about nipple pain when it's not thrush. So baby with a tongue tie. Okay, if they're not nursing effectively, they can get that milk buildup on their tongue, right? So there, yes, there may be nursing, but their tongue is not elevating properly, so they get that buildup of milk. Well, what's happening for you, potentially, this is causing you some nipple pain. And it can cause some redness again, it can cause that granulation tissue, right?
A lot of these things to the untrained eye can appear like thrush, so it's easy to see why it's over-diagnosed. I would say thrush is exceedingly uncommon. Like actual truth rash is exceedingly uncommon in clinical practice. I would say that I could probably count on both hands, the number of times I've actually really had a client with it. Maybe they had it before they got to me, I don't want to say they never had it at all, that, but they may have gotten treatment and then they decided to come see me or something. So there's that.
Let's talk more about the pain, right? So you can experience pain at the nipple if your baby has a tongue tie and is not nursing as effectively or functionally as they could be. But that can also create pain for you deeper in your breast. So this is where the idea of ductal thrush comes from. Now, you could have a clogged duct or mastitis or subclinical mastitis, something else that is causing pain in your breast. This is really why it's important to work with an IBCLC, who understands this, and who can go through that process of differential diagnosis? Who can properly assess you to figure out what's going on? Do you have thrush? Do you have mastitis? Do you have vasospasm?
So what's vasospasm? Well, vaso, right. So that kind of has to do with our blood vessels spasm, that's a contraction. That's essentially what can happen inside of our breasts. So if your baby is compressing the milk ducts and compressing the capillaries and the vessels and things in your breasts are very, very sensitive. And if they're doing this throughout the course of an entire feeding, unbeknownst to you, you may experience a little bit of pain at the beginning launch or none at all. And then things feel okay.
It's after your baby unlatches that you suddenly start experiencing some pain, and it can feel like a burning or stinging pain, your nipple can change colors, it can turn white from blanching, and then it can turn kind of red color and then kind of a purple color. And so that can happen. But you often get shooting pains in your breast as well.
Now, there are some ways that you can treat these symptoms. But ultimately, we want to treat the root cause because this type of response to nursing is not normal, it's a sign that something is not going functionally well in your baby's mouth and at the breast. And so you want to address that. So the stops happening because this type of pain is really unpleasant.
The way that it happens, I try to explain this, whenever I work with people one on one, let's say you cross your legs right now, okay, and you're cutting off some circulation to one of your limbs, your foot or you know, your lower leg and nothing feels weird, nothing feels out of the ordinary. And then in fact, a little while later, you know, it actually starts to go numb. It's not until you release your foot or your leg from that position that the blood flow returns. And now you get this pins and needles feeling. All of a sudden, your nerves are like, oh my goodness, I can receive signals again. And then they're firing like crazy. They're firing all around, and they're just, you know, kind of going haywire. Right? So that happens. And eventually, that subsides. That's essentially what's happening when you're experiencing vasospasm in your breast. So it may feel just as intense as that, especially because our breasts are very sensitive to touch a lot of the time and to sensation. So keep that in mind. That's essentially what vasospasm is.
Here's another topic that the episode wasn't necessarily about, but most people just experienced basal spasms, it does not mean that they have Raynaud's phenomenon. So a lot of people, I'll even see this on Instagram, people say oh, I have or Naud’s disease or have an odds phenomenon or you know Raynaud's. Unless you've actually been diagnosed for Raynaud's by a healthcare provider, you don't have Raynaud's. Just because you have vasospasms. And I've even seen IBCLCs say this.
So Raynaud's is a systemic vascular condition that affects your entire body, not just your nipples, your breasts. And if you think that you might have Raynaud's, you want to go to your general practitioner and get assessed and possibly diagnosed for that. But just because you experience vasospasm, or pain at the breast, or your nipple changes color when your baby latches or you're done pumping does not mean you have Raynaud's. So please stop using that out of context because that is an actual medical condition. And I feel like it takes away from the validity of that medical condition. When that word is just thrown around like, oh, you just have the syndrome now? Well, maybe you don't, right. So maybe there's actually a problem that's localized. And this is not something you experience anywhere else on your body. So correct terminology I find, obviously in health care, but just in general, I think is really, really important. I would just say we need to be really intentional with our words, because our words do matter. That could be something that you experience. And so it's really great.
If you're not sure why you're experiencing breastfeeding pain. If you have thrush, you think you have thrush or you think your baby might have it? You know, I would say it's not that you don't want to trust your baby's pediatrician. But they're not trained in breastfeeding medicine, they're not trained to treat you. They're not trained to go as deep as I did in this podcast episode about a topic like this. And so your best bet if you're really unsure, and you think something else might be going on, is to really work with a skilled IBCLC, wee do virtual appointments.
Thrush is something really easy to treat online, or if it's tongue tie and assessing for that and treating that or if it's assessing for vasospasm or clogged ducts or mastitis, these are all things that we can do. And, you know, we want to make sure you get appropriate treatment. So while we can't prescribe antibiotics, or antifungals, or certain things like that, we can at least tell you what you want to go to your other provider who can possibly prescribe things, if that is needed for you, the information that you need to have to get the right treatment. I always love to work collaboratively with other providers on your healthcare team because that's what it's all about. We don't assume we can do everything. And we hope your doctor doesn't either, although sometimes they do.
So anyway, I hope this help episode was helpful for you on the topic of thrush and just nipple pain in general and trying to figure out, you know, is this thrush? Or is this something else, and oftentimes it is something else? Sometimes it's thrush. So I don't want to deny anyone's experience, I will just share this story.
We had a client, I want to say it was earlier this year. And she had a really just a really hard go of things, things ultimately did get better. But she was convinced that she had thrush and had it for like a really long time.
So here's kind of the last point about thrushes, it is possible for you to have thrush for a long time if it goes untreated, or there's this passing back and forth because you're only treating one of you, you were your baby. But in general, it gets resolved in a couple of weeks, and then you know, or, or a shorter timeframe. And then that's it, you're done. You could have a recurrence, but it's not going to be constant and chronic for months, most of the time. If it was like your thrush would be so bad that you would have like given up breastfeeding. I mean, it's just not like it would have overgrown to the point that you would have gone to the doctor and gotten a treatment.
So anyway, she was very much convinced that she had thrush, and initially, there was an initial topic and conversation about it like well, okay, you know, possibly this is thrush, she seems to want treatment for thrush, you know, he recommended some gentle out home remedies, which of course, didn't help in terms of the pain and everything she was experiencing. And we didn't think it would because we didn't think she had thrush. So this was me and another lactation consultant on my team. And she was going through a lot like we don't want to just say, Hey, you're wrong, you know, we want to validate her experience and her symptoms and everything she's experiencing. And we're like, Well, hey, look either way, like we need to work on, you know, certain things with breastfeeding. And then we can introduce kind of some gentle things for thrush and what have you, anyway, got the ties, treated, got the latch stuff fixed and worked out.
And lo and behold, all of the thrush symptoms went away getting ties treated does not cure thrush. So just want to be really clear about that. And so it actually took her several weeks, maybe even months, to come to terms with and kind of come back to me and say, you know, I finally realized that I probably didn't have thrush for all of those months. And she was like, it's because, you know, I saw the improvement that the other things made and how those symptoms disappeared once those improvements were made, and yeah, I think I was wrong. It wasn't Thrash. And it definitely was not a moment where I was like I told you, so you know, but it was just I always want to honor people's experiences. I don't want to say you're wrong and you don't know your body because I don't believe that. But I did just want to tease out like, hey, what's actually going to improve this person's symptoms? She thinks it's thrush, I would say on a clinical level, I disagree. But let's assume that's true. If it is, we still want to do all of these other things.
This is why I would say if you are experiencing some signs and symptoms of thrush, and it's not 100% definitive that you or your baby have thrush. Work with someone like a skilled IBCLC like me and my team so that we can tease that out for you. Because I would sure hate for you to go through this process of using a treatment that you think is going to work and then never getting results with it. And so you have nothing to show for at the end of the day, and you're like, man, I've tried it all, and it's still painful, or I'm still experiencing this, or this is still happening with my baby. So sometimes it's just a matter of, well, we made the wrong assumption, to begin with, and maybe there's something else going on.
So anyway, I hope this episode was helpful. I would be so curious to hear your thoughts. Have you ever had thrush? Take a screenshot of this episode, share it on your stories on Instagram, tag us.
Let me know your thoughts. I always love to hear from people. Send me a DM over on Instagram. Or if you thought you had thrush and it turned out it wasn't, or you already knew it wasn't thrush and you should get your baby checked for a tongue tie. You got it treatment turned out great. Like I would just love to hear your story and your experience with this particular topic. So please, please share and make sure you're following me over on Instagram at Holistic Lactation, and I'm also on Tik Tok at Holistic Lactation. But truth be told, I just repost my Instagram reels over there. So but if you're on that platform, definitely follow me over there as well. And I look forward to chatting to you on the next episode.