Breastfeeding can be a rewarding experience, but it can also come with challenges such as sore nipples. Thrush—a yeast infection caused by the fungus Candida albicans—was once thought to be a frequent cause of nipple pain, but recent research suggests it may not be as common as previously believed. This guide outlines potential causes of nipple and breast pain, including thrush, as well as available treatment options. 

Understanding Yeast Infections

Diagnosis is typically based on symptoms and ruling out other causes. Milk cultures have been found to be an unreliable method for testing the presence of Candida in breast milk. Mothers with recent use of antibiotics during pregnancy or postpartum have an increased risk of vaginal yeast infections and other yeast overgrowth. 

Candida naturally lives in moist areas of the skin and in the digestive tract, including in a baby’s mouth. It becomes a medical concern when an imbalance occurs, such as after antibiotic use or in individuals with certain medical conditions, like diabetes, or those with a weakened immune system.

Symptoms of Thrush

For Mom

  • Shiny, flaky, or peeling skin
  • Redness or swelling
  • Itching or burning sensations
  • Intense nipple pain
  • Shooting or deep breast pain

For Baby

  • White patches inside of their mouth that do not wipe away

  • Patches may also appear inside their cheeks, along the gums, or on their tongue

  • Possible fussiness or discomfort when feeding

  • Candida can also appear in the baby's diaper area as a bright red, pimple-like rash, especially in the skin folds

Treatment Considerations

Though uncomfortable and possibly quite painful, it is safe to continue breastfeeding while being treated for thrush.

Over-the-Counter Topical Treatments

Topical antifungal creams such as Miconazole and Ketoconazole can be applied to mother’s nipples and areola 2-4 times daily for 2–7 days..

Prescription Options

Although commonly prescribed to both infants and mothers, the antifungal medication nystatin has been found to be ineffective much of the time. Studies have found that Fluconazole is a more effective treatment for both mother and baby.

Natural Remedies

Gentian Violet was once recommended as an over-the-counter treatment for thrush for both mother and baby. However, because it may increase cancer risk, the World Health Organization now advises against its use.

Practice good hygiene

Wash hands regularly, change breast pads often, and clean breast pump parts well if you are pumping. Routine cleaning is generally sufficient, though experts recommend washing cloth diapers, breast pads, bras, and pump parts in extra-hot soapy water and sterilizing them if thrush is recurring.

Treat Both Mom and Baby

Because the infection can pass between mother and baby through breastfeeding, healthcare providers often recommend treating both at the same time with antifungal medicine, even if only one is showing symptoms of thrush infection.

Recovery Timeframe

With treatment, symptoms often begin to improve within 2-3 days, but the infection can take time to fully resolve so be sure to complete the treatment as prescribed.

What Else Could it Be?

In many cases, nipple pain is linked to a poor latch, bacterial infection, or nipple vasospasms rather than yeast. If you are being treated for thrush and your symptoms are not improving, consult with your healthcare provider to identify the root cause and appropriate treatment.

  • Poor Latch: A poor latch is one of the primary reasons for nipple pain during breastfeeding, leading to injuries such as cracking, bruising, and discomfort. 

  • Bacterial Infections: Staphylococcus aureus (staph) is a bacteria that can cause nipple pain, especially if the skin is broken or injured.

  • Vasospasm or Raynaud's Phenomenon: This condition involves constriction of blood vessels in the nipple—often caused by compression from a shallow latch or an ill-fitting pump flange—leading to pain and color changes.

  • Skin Conditions: Other skin conditions, such as eczema, psoriasis, and dermatitis can cause symptoms similar to Candida.

  • Other Factors: Additional causes of nipple pain can include pump trauma, tongue-tie, and a new pregnancy, among others. 

Get Breastfeeding Help

A lactation consultant can help identify the source of nipple pain and guide appropriate treatment, whether due to breast thrush or another condition. Seek support anytime breastfeeding is painful or if you need guidance during your feeding journey.

Disclaimer: Our classes and accompanying materials are intended for general education purposes and should not replace medical advice. For personalized recommendations, please consult your healthcare provider and/or lactation consultant.