It’s Thrush. Or Is it?

Beware of Ducks

Beware of Ducks! Photo credit: "Kicki" on Flickr Creative Commons

If it looks like a duck and walks like a duck, it must be a duck right? Not necessarily if that “duck” is thrush in a breastfeeding mom. Thrush (a yeast infection most commonly caused by the fungus Candida albicans) is a common diagnosis whenever a mother presents herself to a doctor with nipple or breast pain. Unfortunately, thrush is not as common as many health care providers seem to think, and many women suffer needlessly due to misdiagnosis. There are countless stories of mothers being treated repeatedly for “recurrent thrush”. These women struggle, sometimes for weeks or even months, with painful breastfeeding. They usually try numerous different treatments but never find complete relief from the discomfort.

Here’s a common scenario: Your nipples are sore and cracked and you have shooting pain through your breast while nursing . You go to the doctor and he diagnoses thrush, gives you a prescription for Nystatin (an antifungal) and sends you on your way. After a week, the Nystatin doesn’t seem to be helping so you try Gentian violet on the advice of a friend, and things seem to improve. Two weeks later however, the pain is back, so you go back to the doctor and he prescribes Diflucan (fluconazole), assuring you that this will get rid of the yeast. There’s minimal change after a week, and you find yourself on and off Diflucan for weeks, diagnosed with “resistant thrush” and desperately looking for answers. What’s going on and why can’t you get rid of the pain?

The symptoms attributed to thrush include burning nipple pain, itching, shiny, flaky skin on the nipples/areola, and deep or shooting pain in the breast. The problem with these symptoms, is that there are many other possibilities besides thrush. These include (but are not limited to):

  • poor latch
  • sucking issues in baby
  • tongue tie
  • vasospasm
  • Reynaud’s phenomenon
  • eczema on the nipple
  • allergic dermatitis
  • psoriasis on the nipple
  • damage from pumping
  • bacterial infection

By far, the most common cause of nipple and deep breast pain is poor latch. Any time a mom has nipple or breast pain, the first thing that needs to be looked at is baby’s latch and sucking ability. This needs to be done by someone skilled at breastfeeding assessment. Sometimes a baby’s latch can look “perfect” from the outside, but something is going on inside their mouth that is causing problems. If your nipple looks compressed or pinched when it comes out of your baby’s mouth (like a new tube of lipstick), then something is not right and it needs to be addressed (no matter how “good” it looks from the outside!).

Issues such as tongue-ties and sucking issues caused by birth interventions (such as vacuum, forceps, or C-section), or even muscle tightness due to your baby’s birth or position in the womb, can also cause a lot of pain. Issues such as these are unfortunately often missed however because most health care providers are not trained to look for, or properly assess them. Because of this, finding skilled help is important. If you have been told that your baby’s latch is “fine” but you are in pain and your instincts are telling you that something isn’t right, then keep looking until you find someone with the experience to help you.

If your baby’s latch and suck truly are not the problem, then current research tells us that bacterial infection is a more likely cause of breast/nipple pain then thrush. It had been believed that deep breast pain was caused by yeast within the ducts of the breast (ductal yeast). Current research however calls into question the existence of “ductal yeast” and tells us that bacterial infection (usually Staphylococcus aureus) is actually a far more common cause of nipple and/or deep breast pain. Despite all the fear that exists over using antibiotics because they might cause thrush, some cases of “resistant thrush” actually need antibiotics!

I’m not suggesting that thrush doesn’t exist, certainly it does. However, it is no where near as common as it would seem from the number of women who are diagnosed as having it. The most important point here is this: If it looks and walks like a duck but doesn’t quack or behave like a duck, then it’s time to start looking at who’s pretending to be a duck. In other words: If appropriate thrush treatments don’t solve the problem in a timely manner, it most likely isn’t thrush, and it’s time to look at what else could be causing the pain!

Fleur Bickford is a nurse, lactation consultant, and mother of two. She’s passionate about helping families discover the joys of breastfeeding, birth and parenting, and providing parents with evidence based information. She is a private practice lactation consultant in Ottawa Ontario. You can find more information about Fleur on her website,

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8 Comments | Last revised on 07/28/2011

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