For yeast (thrush) in the baby's mouth, your doctor will probably prescribe oral nystatin drops. After each nursing session (or however often your doctor suggests) rinse the baby's mouth with water, offer him a drink of water from a cup, or wipe the inside of his mouth with a damp washcloth. Milk that remains in the baby's mouth can be a source of food for yeast. Then apply the medication according to directions. Usually, the directions say to use 2cc in each cheek four times a day. Since yeast multiplies so quickly (as often as every hour), you may want to ask the doctor if you can use 1cc for the whole mouth 8 times a day. Put the medicine in a spoon or paper cup and use a Q-tip to swab it in the baby's mouth. Don't put the dropper directly in his mouth and then back in the bottle, to avoid contaminating the medication. Once there are no visible signs of yeast in his mouth, ask your doctor about cutting back to a lower dose. A complete course of treatment usually takes several weeks. If there is no improvement in a few days, ask your doctor about using a Â½ percent solution of gentian violet for a few days.
Boil any object that goes in the baby's mouth (such as pump parts, bottles, nipples toys, and pacifiers) for 20 minutes each day. Add some vinegar to the boiling water. Continue using the medication for at least 2 weeks after symptoms are gone. If nystatin and gentian violet do not seem to be clearing up the thrush in the baby's mouth, ask your doctor about pediatric Diflucan suspension. As of November 1995, it has been approved for pediatric use in treating babies six months or older, and has an FDA Safety Profile for newborns one day and older. The clinical cure rate for oropharyngeal candidiasis in pediatric patients is reported at 86% with Diflucan (2-3 mg/kg/day) as opposed to 46% of patients treated with nystatin.
In certain cases, yeast infection on the mother's nipples does not respond to topical treatments. In these cases, pain is severe and unrelieved. Pain may begin as burning or stinging on the surface of the nipples, primarily during breastfeeding, and progress to deep stabbing internal pain inside the milk ducts. This type of deep, sharp pain continues throughout the day and may be worse at night, interfering with the mother's sleep. Pain may radiate into the armpit or back. If topical treatments are ineffective, you may need to talk to your doctor about the possibility of using a systemic treatment which is taken orally, and is available only by prescription. You may want to ask him to prescribe a prescription painkiller as well. The systemic treatment which seems to be most effective is Diflucan (fluconazole). Discuss the following treatment plan with your doctor, as this is strong medication and should be used only when topical treatment has failed to prove effective, or when the yeast has spread into the milk ducts.
Diflucan is often used to treat vaginal yeast. For treatment of a vaginal yeast infection, 150 mg in a single dose is the current FDA recommendation. Unfortunately, this therapy is not sufficient for ductal candidiasis in lactating women. For the treatment of systemic (ductal) yeast, 400 mg STAT (loading dose on the first day) followed by 150-200 mg daily for periods of up to four weeks is generally recommended by many clinicians.
Of antifungal medications, Diflucan is well tolerated. Adverse effects (such as vomiting, diarrhea, stomach cramps, and rashes) have only been reported in 5-30% of patients, and only 1-2% of patients had side effects severe enough to require them to discontinue the medication. In rare cases, adverse hepatic (liver) effects have been reported, but usually in connection with high doses of the medicine over long periods of time in severely ill patients with immune-compromising diseases such as cancer or AIDS. I don't know of any cases of liver problems in healthy nursing mothers at the doses recommended in this article.
Diflucan is very effective, but also very expensive (over $10.00 per tablet). Check with your insurance carrier for coverage information.