The Identification and Treatment of Thrush

By Cheryl Taylor, CBE

Thrush is a yeast infection that can present itself in your baby’s mouth or on your nipples. When thrush is in either of these locations, you may also find the yeast deep in the breast tissue, vaginally or on your baby’s diaper area. When the yeast infection presents itself, it may be in all or one of these locations.

Symptoms of thrush may include:

  • Unusually pink or red nipples.
  • Cracked or bleeding nipples
  • Itching or burning nipples
  • A shooting pain deep within the breast
  • Pain that continues throughout a nursing session
  • White patches inside the baby’s mouth. (the inside of his cheeks is a “thrive” zone and an easy to identify location)
  • Yeast infections in other locations (diaper area, vaginal)

If you or your infant contract thrush and present yourself to your Pediatrician, you are likely to be sent home with a prescription for Nystatin. It is the most commonly used medication when dealing with thrush. There is a liquid medication for giving to the baby, and a cream that can be placed on your nipples. Other treatments used are Gentian Violet and Diflucan.

My reservations with beginning with the above medications are that the Nystatin liquid contains sugar to make it palatable enough that baby will swallow it. However, yeast feeds on sugar. This may be the reason why it is often not effective. Gentian Violet is effective, but stains skin purple for several days. I have some lovely photos of my twins with purple faces! Diflucan is very effective, but can cause intestinal distress in mom and/or baby. For these reasons, I prefer to begin with Grapefruit Seed Extract as the first line of defense. I have found that the use of Grapefruit Seed Extract as recommended almost always brings rapid relief and an elimination of the yeast imbalance.

Grapefruit Seed Extract is a broad-spectrum antimicrobial compound synthesized from the seeds and pulp of grapefruit. It is an extremely potent and effective broad-spectrum bactericide, fungicide, antiviral and antiparasitic compound. Tests have shown that GSE is dramatically more effective than Colloidal Silver, Iodine, Tea Tree Oil and Clorox bleach against five common microorganisms. In studies performed by Dr. John Mainarich of Bio-Research Laboratories in Redmond, WA, samples of each of the common antimicrobials or sanitizing agents were evaluated for effectiveness against Candida albicans, Staphylococcus aureus, Salmonella typhi, Streptococcus faecium and E. coli. The other antimicrobials tested were considerably less effective than the GSE.

GSE is extremely effective in the treatment of thrush. I also find it to be the easiest place to start. If used diligently, it typically will clear up thrush within a couple of days.

Treatment of thrush with GSE

  • Make a mixture of 10 drops of Citricidal Grapefruit Seed Extract to one ounce of water. The use of distilled water to make your solution is very important.  The chemicals placed in your local tap water to kill bacteria can reduce the effectiveness of the active ingredients in GSE.
  • IF thrush is not markedly improved by the second day, increase the mixture to 15, or even 20 drops of GSE per one ounce of distilled water.   If after reaching up to at least 20, and a full day of hourly treatment with it, you see no improvement, I would consider using Diflucan.  If you are prescribed Diflucan, continue to treat topically with GSE during the course of treatment.
  • Use this solution with an absorbent swab on mom’s nipples and baby’s mouth once every hour during all waking hours. Swab baby’s mouth priorto nursing and mom’s nipples after nursing.  Applying it to baby’s mouth prior to nursing will help them to  avoid the possibility of baby associating the bitter taste with nursing.
  • If diaper area is affected, put the same strength solution into a spray bottle or swab as above at every diaper change.
  • If the infection is particularly rampant or you are having difficulty getting rid of it, mom may need to take acidophilus or GSE capsules to get rid of it systemically.
  • GSE solution can also be used in laundry or as a surface cleaner to kill yeast hiding and waiting to multiply again.
  • It may be necessary for Mom to eliminate sugar from her diet until the yeast infection is gone.

If treatment with GSE seems to leave your nipple area dry, I suggest applying a light coating of Vitamin E oil in the following manner: First apply the GSE solution, allow that to dry or use a hairdryer to dry it completely, then apply a light coating of Vitamin E oil.  I would suggest doing this 3 to 4 times a day until the dryness is gone.  It should only take a couple of days to show significant improvement.  The Vitamin E oil should absorb into the skin thoroughly prior to the nursing following the application.  I’m a big fan of Lansinoh, but do not use it when dealing with thrush, because it provides a moisture barrier that is counterproductive to getting rid of thrush.

Since learning of the powerful antimicrobial that Grapefruit Seed Extract is, I have always kept a bottle in my home for many uses.

For more information on GSE:

For prevention of thrush while taking antibiotics:

There are times over the course of nursing when a nursing mother needs to take antibiotics.  While taking antibiotics, good bacteria are destroyed  along with the bad. The absence of the good bacteria, which usually keep yeast in reasonable balance within the body, is what can leave a nursing dyad with thrush.   There are several options that may help to avoid this imbalance:

  • Take acidophilus/bifidus capsules with doses being as far away from the dose of antibiotics as is possible.  There is dairy free acidophilus available for those needing dairy free products.  Check labels for ones requiring refrigeration.
  • Take Florastor, which can be taken with the antibiotic dose.
  • Eat yogurt with active live cultures.  Make sure you get unsweetened yogurt as you don’t want to feed the yeast with sugar.

All of these probiotics help to reintroduce to the gut the good bacteria that will help to regain control of the yeast overgrowth in the system.

If the infant or child is the one taking the antibiotics, they usually fare better at avoiding thrush while taking antibiotics because breastmilk has a bifidus factor.  It promotes the growth of Lactobacillus, a harmless bacterium, within the gut.  Growth of this bacteria helps to eliminate the overgrowth of yeast.  A toddler or child can also take acidophilus.  The powder itself has a pleasant creamy taste and most are happy to lick it off your finger, take it with spoon or you can mix it into a food.

69 thoughts on “The Identification and Treatment of Thrush”

  1. Help! I've had thrush forever. My oldest is 3.5 years old. I first got thrush when she was about 14 months old and I was nursing her and pregnant with my second baby. I thought the pregnancy was causing my sore nipples and weaned her at 18 months (6 weeks before delivering my 2nd baby). I had thrush the whole time I nursed him but didn't figure it out until he was 10 months old. Most of the time nursing him felt like he was gnawing on me, but by 10 months the pain turned into a liquid fire sensation. My nipples were shiney with white patches and my dr diagnosed the thrush. My baby also had it super bad and self weaned at 11 months and I never got him back on the breast. I took Diflucan for 2 weeks and GSE capsules. The pain went away (I wasn't breastfeeding any more, so thought I was cured). I was pregnant again (got pregnant when he was 10 months old). The moment I nursed my 3rd baby for the first time in the hospital, I knew I still had thrush. My 3rd baby is now 5 months old and we STILL have thrush.

    My dr had me take 4 weeks of Diflucan, but it was only 100 mg daily. I've been taking GSE capsules 3 times a day the whole 5 months. I'm taking a probiotic (4 billion Lactobacillus acidophilus, 3.2 billion Bifidobacterium lactis, and 0.8 billion Bifidobacterium longum)2 times a day. I rinse with a mixture of 1 Tablespoon of distilled white vinegar in 1 cup water after every feeding. I follow by spraying on the dilluted GSE extract of 12 drops to every 1 oz of distilled water. I also have a Rx for Nystatin cream which I apply 4 times a day.

    The pain is way better, almost completely gone, but my baby still has a dot of white in the roof of her mouth (looks like a tiny white bead) and I still have white splotches on my nipples, and my baby still has thrush in her neck folds and a few other skin folds (though way better, she has a Rx for Nystatin cream).

    What am I missing? What do I need to change or add to get rid of this completely? I'm starting to get afraid that all I'm doing to get rid of this thrush may harm my baby. Is it still better to continue breastfeeding (over formula) even though I've been doing this vinegar and GSE for 5 months now? I have read about taking odorless garlic, but am afraid it will change the taste of my milk and she may stop nursing. Also, the bottle says not to take while nursing.

    I know this was long, but I've had a long 3 year battle with thrush. :(

    1. Take a look at what you might have in your diet that feeds the overgrowth of yeast…white flours, sugar, dairy, too much fruit because of the natural sugars. Sometimes the diet has to be altered to eliminate the things that "feed" the yeast.

      I would be surprised if odorless garlic would change the taste of your milk in a negative way. There are enough cultures around the world that have diets heavy in garlic and more breastfeeding in their culture than is typical in the US!

      Hope that helps.

  2. My 3 month old granddaughter has a persistent diaper rash which we have been combatting with every conceivable idea since she was 2 weeks old. We’re convinced it’s yeast even though my breast-feeding daughter has no symptoms at all in her breasts. We ‘ve gone through 2 tubes of nystatin, vinegar water with tea tree oil rinse at every diaper change, lots of air time, probiotics, (the baby had a course of antibiotics which no doubt made the problem worse) and the rash continues. There is no sign of thrush in her mouth. Should we ask the pediatrician for Diflucan to eradicate the problem or will it go away on its own? Should her mother be treated as well? I’m aftraid it’s being passed back and forth from my daughter to the baby even though my daughter has no symptoms…can the yeast problem cause long term harm to the baby? Auto-immune problems? She is also EXTREMELY gassy so that in itself is painful. Any advice you can offer would be very very much appreciated. Oh, another thing… My daughter has gone back to work and has frozen a lot of milk…can it be used?

    1. Are you sure that the rash is yeast and not food allergy related eczema or rash? Yeast can have a nasty looking red rash and also produce a lot of gas, but it's possible that it's something else as well. If it is yeast a topical treatment wouldn't touch a systemic problem and could continue to produce the yeast rash.

      Information on using expressed breastmilk while battling thrush: http://www.kellymom.com/bf/concerns/thrush/thrush

  3. Hi Dr. Gordon,

    I am reaching out to you as my daughter and I are combating thrush and can't seem to shake it.

    My daughter was born on March 11th, 2010 and was bottle feed for the first week. We had some latching issues of which were corrected when she was a week old after a visit to a lactation specialist. She has since been 95% breastfed with a pumped bottle on the very rare occasion. At approximately 3 weeks old she was confirmed to have thrush and I a nipple infection. We were both prescribed Nystatin – her 1 ml four times daily for 7 days and a medicated diaper rash cream applied twice daily to treat the rash she had developed due to thrush and I the cream twice daily and to be removed prior to feeding. The cream seemed kind of pointless to me as she was eating every 1 1/2 – 2 hours at the time, so I figured it would have been ineffective when only on for a short period of time. Nonetheless, we continued this for over a week. Sometime around 4 weeks I was also given diflucan 400 mg first dose, 100 mg twice daily for two weeks with a repeat. I was also taking antibiotics for the first week of the diflucan.

    Unfortunately, the diaper rash was not getting better and was turning into welts. At her 4-week doctor appointment I was given the APNO and my daughter a repeat of the Nystatin for another 14 days. We were also given a different diaper rash cream, which was to be more effective and a little stronger. I also repeated the diflucan for another 2 weeks. The diaper rash seemed to be disappearing and the thrush improving. After 14+ days, we stopped the Nystatin, I continued with the APNO anyways and a day or two later the diaper rash was returning as well as the thrush in her mouth, so we started the Nystatin again. In the meantime, I decided to get more information about Gentian Violet and the "Newman treatment method".

    I finally decided that the Nystatin was not working and that we would try the Gentian Violet. I was able to pick up a 15 ml bottle of 1% Gentian Violet of which the pharmacists suggested I dilute it with 50% water. So I prepared a mixture of 5 ml sterilized water and 5 ml of Gentian violet. I would dip a cotton swab in it and paint her mouth and my nipples and continued to use the APNO at all feedings except the one with the Gentian Violet. I also picked up a bottle of Acidophilus and was taking 3 capsules (Swiss brand maximum dosage on the bottle – 2 billion active cells per capsule) per day and for 3 days dipped my finger in a broken capsule and placed in my daughters mouth. In addition, I have been taking GSE capsules at the maximum dosage per day on the bottle of 3 pills (375 mg – Inno-Vite brand). Within 1 day the diaper rash was drastically improved and by day two completely gone. I continued for 7 days until her mouth looked clear of the thrush. Within a day of stopping the Gentian Violet, the diaper rash started to return and by the second day her mouth was white and my nipples were starting to get a little itchy and raw again.

    At my daughters 2 month appointment, my doctor stated to redo the Gentian Violet treatment again for 10 – 14 days and to still dilute the Gentian Violet. She wasn't overly concerned by it as my daughter is consistently gaining weight and its just more of a nuisance then anything else.

    I repeated the cycle again, and finished on May 28th. The diaper rash is mostly gone, she gets red dots now and the next morning they will be gone after using the Rx diaper rash cream. However, her mouth is still a little white (on tongue only) and didn't seem to go away during this treatment. I am at a lost of what we should do.

    I was hoping you could give me some advise on this resistant case of Thrush.

    My daughter was born 9 lbs 11 oz and at her 2 month appointment she was 13 lbs 6 oz so clearly the thrush isn't bothering her. As our doctor said, its more of a nuisance then anything else. Our case was never a sever one as I was conscience of Thrush from the beginning and at first signs I sought help. She never had major white patches, only a white coating on her tongue and a little fussiness in the beginning prior to treatment when eating. She never had patches on her checks or roof of her mouth. As for me, my nipples were bright red, a little itchy, a little raw feeling and on one nipple some pain when she was latching on not caused by a poor latch and on the same breast the occasional shooting pain. I no longer have the shooting pain or raw nipples and the color seems to have returned to what I think was the color before breast feeding of a pinkish/red. However, there is a little bit of itchiness returning.

    Should I repeat the Gentian Violet and not dilute? Should I repeat the Acidophilus in her mouth? Should I exceed the dosages of GSE & Acidophilus. Based on this information, please advise what you would suggest as the next course of action in treating thrush.

    I'm sorry for the long winded e-mail but thought it would be best to give all the details. I look forward to your response.

    Thank you in advance.

    Regards,

    1. Instead of focusing on the treatments, let's shift some focus to what you could be eating that is feeding the yeast overgrowth. Do you have white flour in your diet…white pasta or white bread? Sugar? Dairy? With as many ways as you have tried to treat the thrush to get rid of it I would say that it's time to make some drastic changes in your diet that will eliminate any of the items that we know can feed yeast easily.

      As for treatments, it's hard to know exactly what worked and worked the best because of the variables and combinations. The sugar in Nystatin can actually feed the yeast as often as it gets rid of it. So it's possible that it exacerbated the situation and hard to know which.

      1. I don’t eat an over abundance of “White Flour”; however, I do have a moderate amount a day. I drink mostly water and 2 coffees a day (two tsp of sugar in each) but I don’t drink cola or fruit juices. I am not a huge fruit lover and usually have some sort of bagel or toast for breakfast and a sandwhich usually for lunch. Dinner is mostly a protien, veggie and sometimes a startch. My dairy is also very limited as my daughter was very gassy in the early weeks and cut out foods that generally made her gassy.

        I was looking at the candida diet and just can’t see how that would fit into my lifestyle. To start, there is very limited options as literally everything is cut out except meat, certain veggies, wild rice and water. To live like this for a minimum of 3 weeks doesn’t seem possible. I imagine that there is some sort of happy medium that I can do.
        I could start by removing most of the carbs from my diet but I cannot live on eggs for breakfast alone, so would have to substitute with low carb options ie. whole grain cereal… but then I am introducing a bit of dairy back into my diet, which is fine as my daughter is older and handling the gas better. I can cut the sugar down and eventually out of my coffee, but to cut coffee out all at once would be difficult. I guess I am at a loss and I am not sure if these little changes will do anything to improve the situation. I guess my last option would be to stop breastfeeding and treat again with diflucan for myself… but this is really not the route I would like to take. In the meantime, I have started the Gentian violet again on my daughter and I, we are on day 4 and I still notice a little bit of bumps on her bum… perhaps the thrush is becoming resistant to this method.

        1. You should absolutely keep breastfeeding. Instead of jumping to a candida diet, I would recommend cutting out all white flours and sugar. Use whole grains for your bread or pasta, and continue to drink coffee just don’t put sugar in it. Have you tried the liquid stevia? It’s extremely sweet and a plant source, but one drop in a cup of coffee will make it really sweet. Reduce the natural sugars so you aren’t eating too much fruit and you’re already not drinking juices. It can be an adjustment to eliminate dairy but certainly possible. I have a daughter that is 10 that doesn’t have any dairy, so we’re very used to it here.

          Are you taking GSE capsules as well as treating topically? I’ve worked with nursing dyads before that have had systemic yeast that they were struggling to keep away the outbreaks of thrush and we have great success with the diet adjustments and GSE internally for mom and topically for both. When you were treated with Diflucan were you both treated at the same time?

          1. Cutting out sugar and white grains won't be such an issue. I h ave never tried liquid stevia, is this something I would purchase at a health food store?

            I have been taking up until today (just finished the bottle) GSE capsules with Oregeno in it. I am taking 375mg daily all in one dosage as recommended on the bottle. Should I up the dosage beyond what the bottle suggests? Also, I didn't use the GSE liquid on my nipples, should I be doing that also? What should my daughter be getting if not the Gentian Violet?

            I read also to put a few drops of the GSE liquid in with my laundry… I have just been washing with hot water.

            When I was taking the Diflucan, my daughter was prescribed Nystatin.

            I have always been prone to Vaginal Candida, so perhaps this is why we are having such a difficult time getting rid of the thrush. As I will be going back to work by the time my daughter is 7 months old, I will only be BF for another 3 months, so I guess I am looking for a solution to remedy the problem now and prevent further outbreaks when we are not taking medications as seems to be the case.

            Thanks!

            1. It's hard to identify in a nursing dyad who is carrying and who is perpetuating! If you have not tried both of you on Diflucan at the same time it would be something to consider. If you have always been prone to yeast overgrowth then it really would be worth seeing if the diet changes make a difference for you. I would definitely recommend considering continuing to nurse after you return to work. It is very possible to even exclusively nurse and use expressed breastmilk when working. Getting a good double electric pump for work is important. With pumping at work and nursing in the evenings and on days off it's very possible to keep supply up enough for expressing and nursing. The immunity provided and the optimal support of health and development is very worth the effort to pump while at work. We have many articles in our Breastfeeding section about nursing and working.

              1. Thank you so much for the encouragement and information.

                I think the yeast overgrowth was previously caused by the estrogen in the birth control pill I was taking as during pregnancy I didn't have one outbreak.

                I had started taking Fenugreek to increase my supply so I could start pumping to freeze for later use; however, I was under the impression that milk that was expressed during a candida outbreak could not be used at a later date as the cadida cells do not die off during the freezing process and could cause another outbreak when the expressed milk is used. Is this not the case?

                I guess my other question would be regarding the GSE… before I see a doctor about a dosage of Diflucan for both of us, I thought using the GSE liquid on both and capsules would be worth the try first? Do you have a page with exact dosages and instructions for baby and mom for GSE liquid and capsules? OR should I skip altogether and go for the Diflucan?

                1. http://www.kellymom.com/bf/concerns/thrush/thrush

                  It is certainly worth the effort to try the GSE while making the diet changes, and if it doesn't begin to show improvement within 2-3 days you can always go on to getting Diflucan for both of you and treating at the same time. The solution instructions are in our article on Thrush: http://drjaygordon.com/breastfeeding/thrush.html As for adult dosage on the capsules I would go with Nutribiotics recommendation on the bottle.

  4. Hi,

    My baby is now 7 weeks old and since i've started nursing i've been having problems with pain in my nipples and breasts. Some weeks its not so bad and others i have alot of pain. This 7th week i noticed my nipples were getting more and more white spots on them and the pain was increasing plus my baby was screaming and fussing lots at feeds especially in the evening. I did look in my baby's mouth and saw that he had white spots on both sides of his upper gums so i knew right away we had thrush. So i made an appointment with the health nurse and she recommended the Gentian Violet 1%. But i refused to give that to my baby because i don't know what he would be getting into his system. So i figured i'd go the natural treatment. I've been putting the GSE and all purpose nipple ointment on my nipples after every feed for 3 days now. Plus i'm taking Acidophilis capsules 2 a day. And i also give my baby powder Acidophilis 2 times a day for 2 days and still there's so change. He's still screaming and fussing and i still see the white spots. Can i continue giving my baby the powder Acidophilis? What should i do next? Or is it too early yet, after 3 days, to notice a difference? Give me answers please, i can't stand the pain anymore plus knowing my baby is in pain and the medication doesn't seem to help yet.

    Thanks!!!!

    1. If you are in a lot of pain from the thrush, and it sounds like baby is too, it may be time for you to discuss with your doctor the option of putting you both on Diflucan at the same time and kicking it quickly. Proper dosage for thrush in a nursing mom is detailed here: http://www.drjacknewman.com/pdfs/Fluconazole-2008… GSE both in capsules for mom and topically for baby and mom CAN be very effective, but it often isn't as quick as Diflucan is and there are times when TIME is of the essence for a nursing dyad when they are both in pain. Thrush can cause gas and GI pain for baby, and can be excruciatingly painful for mom. Continuing on acidophilus for you is a good plan. You can take 2 capsules with each meal for a few days while combatting this big time and back it off to 2 a day when you have the yeast under control.

      Hope this helps.

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