What is the treatment for a breastfeeding mother when her baby has thrush?

Treatment for a Breastfeeding Mother When Her Baby Has Thrush

When a baby has oral thrush, both the mother and baby should be treated simultaneously with antifungal medication to prevent reinfection, even if the mother is asymptomatic. 1

Treatment Options for the Mother

First-line Treatment

• Topical antifungal treatment should be applied to the nipples/areola after each feeding:
  • Nystatin cream 1
  • Clotrimazole gel 2
  • Miconazole cream 3

For Persistent or Severe Cases

• Oral fluconazole is recommended for mothers with persistent symptoms or severe cases that don't respond to topical treatment 1, 4:
  • Loading dose: 200 mg on first day
  • Maintenance: 100-200 mg daily for 14-30 days (duration depends on symptom resolution) 4

Important Considerations for Fluconazole Use

• Fluconazole is present in breast milk at approximately 13% of the maternal dose, but this is considered safe for the infant 5
• Breastfeeding can continue during fluconazole treatment 5
• Other azole antifungals (besides fluconazole) are not recommended during breastfeeding 3

Signs and Symptoms of Candidal Mastitis in the Mother

• Burning, stinging pain that radiates from nipples into the breast 4
• Pain that persists throughout and after feedings 4
• Cracked nipples that don't heal despite proper latch 4
• Absence of classic mastitis symptoms (fever, redness) 3
• Symptoms may fluctuate between topical (surface) and ductal (deeper) infection 6

Treatment for the Baby

• Oral nystatin suspension (100,000 units/mL): 1 mL four times daily for 7-14 days 3, 1
• Alternative: Fluconazole oral suspension 3 mg/kg once daily for 7 days (shown to be more effective than nystatin in infants) 7

Important Clinical Pearls

• Treat both mother and baby simultaneously, even if one appears asymptomatic, to prevent reinfection 6, 2
• Continue treatment for at least 7-14 days, even if symptoms resolve earlier 3
• Persistent cases may require longer treatment courses (up to 6 weeks in some cases) 4
• Pain management may be necessary for the mother to continue breastfeeding during treatment 4
• Keep the affected areas dry between feedings 3
• Sanitize pacifiers, bottle nipples, and toys that go in baby's mouth 1

Common Pitfalls

• Treating only the baby and not the mother can lead to persistent reinfection 2
• Discontinuing treatment too early when symptoms begin to improve 4
• Failing to recognize candidal infection when white plaques aren't visible in the infant's mouth (some cases present without visible plaques) 6
• Inadequate duration of treatment leading to recurrence 1
• Not considering candidiasis in mothers with persistent nipple pain, especially following antibiotic treatment 4

By treating both mother and baby simultaneously with appropriate antifungal medications for an adequate duration, the candidal infection can be effectively resolved, allowing for continued successful breastfeeding.