Dear Dr. Wong: I am struggling with nursing our two-month-old baby. He developed oral thrush shortly after birth. Within a short time, I had severe pain deep in my breasts. It turns out that I have mastitis due to yeast infection. My doctor prescribed nystatin drops for him.
After several bottles, he is not better, and my pain is worse. We did try putting gentian violet on my nipples and in his mouth, but that didn’t work either. Finally, my doctor gave me a pill for yeast infection. I started feeling better in the last few days, but he continues to have thrush in his mouth. I am worried that I will get the infection again from him. Is there anything else that I can do?
Answer: I am sorry to hear that you have so much trouble nursing your baby. Breastfeeding is usually a pleasant experience for parents. It helps with bonding, although it is tiring; no one else can nurse your baby except you. Unfortunately, you have developed mastitis which is extremely painful.
Oral thrush is a common problem in newborn babies. It is caused by a yeast called candida that is found everywhere in our environment and on our body. Babies pick up candida from their mothers during the birth process. Some babies develop oral thrush, while others have diaper rash or both.
Most of the time, oral thrush is quite benign. It seldom causes discomfort and may not require treatment. However, most doctors prescribe nystatin drops when they see oral thrush. As a result, Candida has developed resistance to nystatin; it is not nearly as effective as before. Diaper rash, on the contrary, is very uncomfortable, and it does require treatment.
Gentian violet is a chemical that was invented by a French chemist more than 150 years ago. It has been used in laboratories to identify bacteria and fungi; this technique is called Gram stain. Before the discovery of antibiotics, gentian violet was used for different infections with some success. It has not been used for many decades until recently, when Candida was found to be less susceptible to nystatin.
Women have found that applying one per cent gentian violet on their nipples and areola (the dark area around the nipples) as well as inside the baby’s mouth once a day for three days can eradicate Candida infection. It is generally safe; there has been no report of serious side effect, although it does stain everything and anything.
However, this treatment is not always successful.
This is where an anti-fungal medicine called fluconazole is useful. It is taken by mouth and it is more effective when the infection is deep in your breasts. A small amount of medicine is secreted through the breast milk. Sometimes, this is enough to eradicate candida in a baby’s mouth. You should watch him over the next one to two weeks while you are taking the medicine. If he continues to have oral thrush, your doctor can prescribe the same medicine for him in the liquid form. It should be effective and safe. You are right, if he continues to have oral thrush, you can get infected again after you finish your medicine.
In the meantime, you should sterilize anything that gets into his mouth with boiling water. The yeast can stay on soothers and nipples (if you give him expressed breast milk with a bottle) for a long time, even when it is dry. When these items are put in his mouth again, he can get re-infected with the Candida. In this case, it is not due to ineffective treatment; instead, it is due to reinfection.
Dr. David Wong is a consultant pediatrician in Summerside and recipient of 2012 Distinguished Community Paediatrician Award of Canadian Paediatric Society. His column will appear in The Guardian on the last Tuesday of every month. If you have a question for Dr. Wong, mail it to Prince County Hospital, 65 Roy Boates Ave., Summerside, P.E.I., C1N 2A9.