Diagnosing and treating Thrush in baby and you

Discussion in 'Parenting' started by Maggie Sugar, Jun 12, 2006.

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  1. Maggie Sugar

    Maggie Sugar Senior Member

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    Here's the Stickey y'all wanted. Good luck.
    Yeastie Beasties,

    or everything you always needed to know about thrush.


    Thrush sucks. Ask anyone who has had it. Mamas hate it babies hate it, LCs hate it cuz either someone has it and we can't get it treated or someone doesn't have it and insisits that they do.

    Symptoms:

    Mama: Burning nipples, itching nipples, scaling and peeling, feeling described as "broken glass" going into the nipple.

    With ductal thrush: Deep breast pain after a bout with nipple thrush, shooting pain into breast and often into armpit.

    Usually a lack of fever or the malaise that accompanies bacterial mastitis.

    Baby:White "plaque"in baby's mouth. Looks like milk that can't be rubbed away. If plaque is able to be removed, some blood may appear.

    A "Pearly Membrane" inside of mouth that is slightly whitish and translucent.

    A red raised edge diaper rash with red bumps.

    Gas and fussiness. Some babies whose mouths are in great pain may refuse to nurse or fuss at the breast.

    Many babies have NO symptoms at all! They can still give the trush back to you, though!

    What to do about it:

    The best person to diagnose you is a La Leche League Leader or a Board Certified Lactation Consultant. Not all sore nipples are thrush and you need to make sure of what you have.

    Sugar's Words of Wisdom:

    Both you and the baby need to be treated, even if only one of you has symptoms.

    The first line of treatment is Nystatin for the baby and an antifungal cream for your nipples. (Usually Monistat, Clotrimizole or something similar.)

    Put the dosage amount (plus a few extra drops for abosrption) of Nystatitn in a paper cup and soak it up with a Q-tip. Rub this all over the baby's gums, tongue, roof and bottom of mouth. Ask the prescribing doc how often you can use it, keeping in mind yeast can proliferate in only and hour or two. We often dose every 2 hours for severe infections. You may be given and antifungal for the baby's butt if she has diaper rash yeast.(Mycolog or something similar.) Use this as prescribed. Any med left in the cup can be fed to baby to drink. This will help to kill any yeast in her GI tract. Just give it to her out of the cup, with her sitting up on your lap.

    Use the cream prescribed for your nipples as directed.

    This should continue for at least 10 days, even if you feel better after just a few. If you don't kill all the yeast, it will come back after you stop the meds and the next infection will have developed resistance to the meds and you may need something stronger.

    I did that and I still have it!

    Yeah, that happens a lot. About 50% of the yeast strains common in North America are resistant to Nystatin.

    What to do next OR what to do if your doctor "doesn't believe in thrush."

    There are still HCPs who don't treat for thrush. Breastfed babies have much milder symptoms than FF kids and some docs don't know what to look for. Also, many don't believe that mamas can get the thrush from babies and won't treat you. Here's what to do:

    1) Get a new doctor. It's my opinion that if your doc is this ignorant about thrush and breastfeeding, what else is he ignorant about? I wouldn't want him in a dire emergency. I would also want someone caring for my baby and I who listens to me and believes me.

    2)You can do Gentian Violet.

    Gentian is an OTC med that you can use to treat thrush if you have no other option. It is messy, it doesn't always work and you have to be careful with it, but some mamas have no other choice. It's cheap, you don't need a prescription and you can do it yourself.

    Use only Gentian Violet .5% (that's point five per cent) any stronger can cause burns. If you can only get the 1% dilute it 1:1 with sterile, distilled water, only as much as you will use in a day.

    Use twice a day for no more than 3 days.

    Put about a 1/2 tsp in a disposable paper cup.

    Using a disposable swab (Q-tip) soak up the Gentian and paint your nipples and the baby's whole mouth with the stuff like the Nystatin directions above. Repeat 2 X a day for 3 days. Use a separate swab for each dosing and a separate swab for you and the baby.

    Wear really raggy clothes and put old clothes on the baby. This stuff stains like crazy. It may take a few days to wear off.

    What to do if you still have it or you start getting pains in your breasts.

    First of all, see your lactation specialist to make sure it is thrush. These cures will not work for a bacterial infection, poor latch on or other causes of sore nipples.

    If you are sure it is thrush, you've tried the Nystatin or Gentian, OR you have shooting breast pain, which may mean the yeast has invaded the duct and nothing you put on your skin will effect it.

    Talk to your Doc or Midwife about Diflucan. It is a systemic antifungal which works from the inside. Nystatin, Gentian, Clotrimizole are all contact substances that have to touch every yeast bud to irradicate the infection.
    Diflucan is different, you take the tablet and it works systemically. It is compatible with breastfeeding and can be used in babies over 1 day of age.


    Diflucan is given one 125 mg tablet, once a day for 2 weeks OR one 125 mg. tablet, once a day for 3 days, one week off then one 125 mg. tablet, once a day for 3 more days. This newer prescribing method is gaining popularity. It depends on your doc which one he or she wants to try.

    Other Stuff to Help Kill the Beasties

    1)Try to clean up your diet. Don't go nuts and stop eating fruit and bread and live like a fasting monk, (research doesn't support the theory that you can cure yeast with food changes) but your immune system will function better without a lot of sugar and junk in your diet.

    2)Take acidophilus. An enteric coated one is best. That way you don't have to take it on an empty stomach. (Primadophilus by Nature's Way is a good one.) This probiotic will recolonize you with good bacteria so the yeast won't be able to gain a foothold again. This stuff make more sense than eating tons of yogurt. You's have to eat 20 tubs of yogurt to get the bacterial load in a single capsule of Acidopilus. Plus, if you beleive the diet theories, dairy products (and that includes even yogurt) increases your suseptability to yeast.

    3)Treat your partner if need be. Often sex partners are notorious for giving you the yeast back. Male partners will need to get either a vaginal yeast cream or Lotrimin AF and rub it on their penis several times a day for a few weeks, other men may need Diflcan also.

    Some guys get the yeast on their balls and thighs, too. Put the cream there if need be. It looks red with a raised edge, and he may be really itchy. Make him use the stuff on his penis if you keep getting the thrush back after you've had some relief, as he may be asymptomatic and giving it back to you anyway.

    If you have a female partner, she can start with an OTC vaginal yeast cream and may only need to go to Diflucan if that doesn't work or she gives it back to you again.

    4) Keep everything that touches your breasts and the baby's mouth really clean!!!! This neccesitates boiling toys, breast shells, pacis, bottle and artificial nipples (if used) every day!!!! Some womyn even boil their bras. You can also bleach the bra (1 cup to a laundry load) as bleach kills yeast on inanimate objects well. (Medela, the breast pump company, has :sterilization bags which you use to steam sterilize in the microwave. You can use any HARD object in these, shells, bottle nipples, Nukkies, cups ect. You can call 1800TELLYOU to find someone to sell you some. These are great and save a LOT of time.)

    5) Use disposable nursing pads while you are being treated. It's one less thing to wash and worry about.

    6) Wash your hands after going potty or scratching yourself and before nursing the baby. (Did I really have to say that?)

    7) Boil your baby's diapers or consider a diaper service if you can afford it. It's important to kill all the yeast and home machines just don't get the water hot enough. You can also bleach your diapers, if you want, and just rinse them an extra time or two. (I'm assuming you are using cloth, here, don't boil your Huggies.)

    8) Some mamas get relief from an analgesic (like Motrin or Tylenol) until the meds start to work. Some mamas are in so much pain that the doc will give you some codiene or Vicodin. If you are in severe pain, don't be afraid to ask.

    Thrush can be treated and it is not a reason to wean. Educate yourself, find a good LC LLLleader and HCP and you will get through this.

    Peace and health,

    Maggie Sugar , IBCLC



    This page is for informational purposes only, it is not intended to diagnose, treat or cure any disease or condition or take the place of your Health Care Provider.
     
  2. Maggie Sugar

    Maggie Sugar Senior Member

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    Overactive Ejection Reflex (Letdown) and

    Foremilk Hindmilk Imbalance

    By Maggie, IBCLC
    LLL Leader, AAPL,



    Diana thought there might be something wrong with her milk. Her 4 week old baby often choked and sputtered when her milk let down, her baby had frequent large stools that often squirted out with force making loud almost comical noises. They were sometimes green and had curds of undigested milk in them. The baby seems to often be “gassy” in pain after nursing and was starting to cry and pull away when put to the breast. Diana herself found that her letdown (or ejection reflex) was sometimes painful and if the baby came off the breast during it her milk would spray forcefully. She had also experienced a few painful episodes of plugged ducts.

    She was told that her baby must be lactose intolerant, or she was eating something the baby was “allergic” to, or must be allergic to her milk. Diana sought help from her lactation specialist and learned that she was experiencing Over active Ejection Reflex (or OER) and that there were management techniques that could help both her and the baby and allow them to continue nursing and benefiting from the breastfeeding relationship.



    Human milk contains a large quantity of lactose. Lactose is a milk sugar that not only is the perfect food for a growing baby’s brain, but also helps the baby absorb other nutrients in her mama’s milk. It is almost unheard of for a human infant under the age of two years to be truly lactose intolerant. Most cases of perceived lactose intolerance in a baby this age are really OER or Foremilk/Hindmilk Imbalance.



    Foremilk is the watery milk produced at the beginning of a feeding to quench a baby’s thirst. It is high in lactose to be sweet and keep the baby interested in continuing the feeding while waiting for the hindmilk. Hindmilk is the milk that is produced at the later part of a feeding. It is high in fat and helps a baby to feel full and satisfied.



    Both Fore and Hind milk are needed for a balanced feeding yet sometimes either the mother’s body or improper breastfeeding management can cause problems with this balance.



    In OER the mama may have a very strong letdown, accompanied by discomfort and spraying. Some mamas say they can hear very loud gulping in the baby and sometimes even hear the milk hitting the baby’s stomach.



    Symptoms in Mom:

    · Strong painful letdown

    · Often frequent plugged ducts

    · Lots of leaking

    · Spraying of milk, some mama’s can spray several feet during ejection



    Symptoms in baby:

    · Gasping, choking, gulping or trouble “keeping up” with letdown

    · Green frequent stools

    · Pain and “gassiness”

    · Loud “tummy” noises

    · Sometimes a rejection of the breast

    · Rapid weight gain, conversely babies who get only foremilk and then are taken off the breast too early in the feeding may have low weight gain

    · Spitting up large quantities of milk

    · Lack of comfort nursing

    · Some babies may appear to want to wean in the late first or early second year because of discomfort and lack of comfort nursing





    The goal is to “tame” the letdown and allow the baby to ingest a better balance of hindmilk in each feeding.



    You may use a technique where the baby feeds as often as she likes, but only offer one side for a three to four hour period. The baby may nurse 2 or 6 times or more, but she is only given the breast for all the nursings in the time period. Also, the baby is taken off of the breast during the first letdown (or ejection) in each nursing. The milk can be allowed to flow into a clean cloth diaper or burp rag. After the letdown has subsided (usually around 20 to 50 seconds) the baby is put back on the breast and allowed to remain there as long as she likes. There should be no timing or scheduling of feeds.



    These instructions are not written in stone. A mama with engorged breasts may choose to relieve the engorgement by switching to the other side sooner than the prescribed time. Switching when very uncomfortable can help avoid plugged ducts. If mama feels discomfort she should do what she needs to to relieve the pain. The baby should be observed to make sure she is wetting at least 6 wet diaper in every 24 hour period. A baby over a month old may actually start to stool less frequently than before. This is normal and fine. The stools will probably be larger if less frequent. The green color should no longer occur if the balance is working.



    Some mamas find nursing “uphill” to be helpful. The mama can lie or sit reclined propped up with pillows or a bed sitting pillow (the author found this type of pillow to be the easiest way to use this position.) The baby lies on top of her and can then push away easily if the flow of milk becomes too forceful. Gravity is also believed to help stem the flow in this position.



    These techniques should help to promote a gentler letdown and also allow the baby to gain the advantage of receiving all the hindmilk she needs in each feeding. Some mamas can abandon the 4 hour per breast prescription after the problem seems resolved,(usually at least 2 weeks) some may need to continue it for a longer period of time or even use it for the entire months or years of nursing.



    This should only be practiced after a mama’s milk supply is established when the baby is at least 3 weeks old. If mama has these problems in a younger baby nursing longer on each side and not being obsessive about using each breast at every feeding will help. She can always take the baby off the breast during letdown to reduce the lactose load and forceful filling of the newborn’s stomach. One breast per feeding is fine if the baby is wetting at least 6 wet diapers and having at least 3 stools in 24 hours and seems happy and satisfied.



    Foremilk Hindmilk Imbalance





    Foremilk Hindmilk Imbalance is a very similar problem, but instead of the condition being caused by the mother’s unique physiology, it is often caused by improper breastfeeding management. Timing feeds, scheduling feeds and switching sides too frequently can all cause a baby to not ingest enough Hindmilk. One may be so religious about trying to use each breast in each feeding and/or so tied to a set amount of time when one feels the feeding must end that the feeding is ended before the baby has had a chance to get to the hindmilk. The baby then only gets foremilk, gets a lactose overload leading to tummy aches, green stools and often very frequent hunger. This may happen because the feeding was ended before the baby got to the fat containing hindmilk, leaving the baby hungry and frustrated.



    The symptoms are very similar to OER in the baby, but usually the mother herself does not have the symptoms listed above and may have a history of rigid feeding patterns or be following a “baby training” type program.



    The best piece of advice in this situation is to let the baby finish the first breast first. Be in no hurry to switch to the other breast or end the feeding. Some newborn babies may take 20 minutes to even get to the hind milk. The information that “the baby gets all the milk in the breast in 10 minutes” is a complete fallacy! Most babies need a good deal more time than that at most feedings.



    The baby will let you know when to take her off the breast. Most babies will fall into a satisfied sleep and detach from the breast naturally or show the “drunken sailor” look when they are done.



    Keeping records of wet and stooled diapers and adequate weight gain (average is 4 to 7 oz a week during the first 4 months) will ensure that the baby is getting enough milk. (See the tear off sheet number00 Is My Baby Getting Enough Milk?) Following the above suggestions can help keep both mother and baby comfortable and satisfied.





    See also Overactive Letdown:It’s Symptoms and Consequences and Finish the First Breast First, both published in Leaven October/November 1995

     
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