My baby has oral thrush - can it affect me if I'm breastfeeding?

Oral thrush is a fungal infection in your mouth.

Healthy babies under two years old often get oral thrush. It's most common in babies around four weeks' old.

If your baby has oral thrush and you're breastfeeding, it's possible for your baby to pass a thrush infection to you. The infection can affect your nipples or breasts. It's commonly called nipple thrush (mammary candidosis or mammary candidiasis).

What are the symptoms of nipple thrush?
What else could it be?
Positioning your baby correctly
Will I need treatment?
Getting help

What are the symptoms of nipple thrush?

The symptoms of nipple thrush may include:

• pain while you're feeding your baby, which may continue after the feed is finished - this can start to happen after feeding has been going smoothly,
• cracked, flaky or sensitive nipples and areola (the darker area around your nipple),
• areola that is red or shiny, or
• a shooting pain, burning or itching sensations in one or both of your breasts, which may continue between feeds.

It's also possible that you may have no symptoms of infection.

Symptoms of nipple thrush do not include fever or redness of your breasts. However, these can be symptoms of mastitis (inflammation of the breast) - see 'getting help' below.

It's more likely that your baby can pass a thrush infection to you if you have had:

• cracked nipples before because your baby was not positioned correctly when feeding, or
• other thrush infections.

It may also be more likely if you've been taking antibiotics. This can reduce your level of healthy bacteria, allowing the fungus that causes thrush to increase.

What else could it be?

A nipple thrush infection is difficult to diagnose, because:

• you may have no symptoms, even if it's confirmed that your baby has oral thrush, and
• any symptoms you do have may also be found in other conditions.

For example, pain in your nipples could also be caused by a bacterial infection.

However, if your nipples are sore, painful or cracked, the most likely cause is that your baby is not attached to your breast correctly when it's feeding.

Positioning your baby correctly

There are several ways you can check that your baby is positioned correctly on your breast. For example, it's important that your baby open its mouth wide when it's 'latching on' to your breast.

If you have sore nipples or pain in them, learning how to reposition your baby may solve the problem. For more information, see breastfeeding in ' further information' below.

If the pain in your nipples continues once your baby is positioned correctly, you should seek further advice from your midwife or doctor.

Will I need treatment?

If you have no symptoms, you're unlikely to need treatment, even if it's confirmed that your baby has oral thrush.

If you do have symptoms, or if the infection is causing problems with feeding, your doctor may prescribe an antifungal cream, such as miconazole. You should apply the cream to your nipples after every feed, and remove any that's left before you feed your baby again.

If your infection is more severe, your doctor may recommend a course of antifungal tablets, such as nystatin. For example, if the infection has gone deeper into your breasts and spread to your milk ducts.

If your doctor prescribes antifungal cream or tablets for you, your baby will probably be treated at the same time, to prevent re-infection. If your baby is prescribed miconazole gel, the dosage will vary depending on your baby's age. Your doctor will be able to recommend the correct dosage for your baby and advise you about how long the treatment is needed.

If the infection does not clear up after a few days, or if feeding problems continue, you should visit your doctor again.

Getting help

If you think you have nipple thrush or mastitis, you should seek advice from your midwife or doctor.

A breastfeeding counselor may be able to provide specialist advice about feeding problems. You can also ask your midwife or doctor for advice about feeding your baby.