Treatment Options for Candida Albicans / Yeast
Candida infections of the nipples may occur any time while breast/chest feeding. Candida albicans likes warm,
moist, dark areas. It normally lives on our skin, and 90% of babies are colonized by it within a few hours of birth.
Like many other germs, Candida only becomes a problem under certain circumstances.
Candida albicans is a fungus that may cause an infection of skin and/or mucous membranes in both children
and adults. In small children, this yeast is a frequent cause of white patches in the mouth (thrush), or diaper rash.
When the nursing parent has a Candida infection of the nipple, they may experience severe nipple pain, as well as
deep breast pain.
Candida infections of the skin or mucous membranes are more likely to occur when there is a breakdown in the integrity
of the skin or mucous membrane—one of the reasons why a good latch is very important from the very first day.
Nipple Pain Caused by Candida Albicans
The pain caused by a Candida infection is generally different from the pain caused by poor positioning and/or
ineffective suckling. The pain caused by a Candida infection:
● Is often burning in nature, rather than the sharp, stabbing, or pinching pain associated with other causes of nipple pain.
● Frequently lasts throughout the feeding, and occasionally continues after the feeding has ended. This is in contrast
to the pain due to other causes that usually hurts most when the baby latches on, and gradually improves as the baby sucks.
● Pain may radiate into the armpit or back.
● May cause no change in appearance of the nipples or areolas, though there may be redness, or some scaling. The skin
of the areola may be smooth and shiny, and the nipple may crack.
● Pain may begin after a period of pain free nursing. This characteristic alone is reason enough to try treatment for
Candida. However, milk blisters on the nipple also may cause nipple pain after a period of pain free nursing, as may
eczema or other skin condition.
● May be associated with recent use of antibiotics by the baby or nursing parent.
● May be quite severe, may or may not be itchy.
● May occur in one breast or nipple only.
● May occur only in the breast. This pain is often described as "shooting", or "burning" in nature, and is often worse
after the feeding is over. It is often said to be worse at night. At the same time, the breast appears or feels normal.
This is not mastitis and there is no reason to treat it with antibiotics. Antibiotics may in fact make the problem worse.
● If the baby has oral thrush she/he may be irritable during feeds or pull off the breast due to oral pain.
● May occur as a diaper rash that doesn’t improve with the use of zinc oxide-based diaper creams.
Treatment
Your midwife can give you a prescription for the All-Purpose Nipple Ointment (APNO) as the first approach to
treating these infections. The ointment is applied sparingly after each feeding. Do not wash or wipe it off before
feeding the baby. Use the ointment until you are pain free for a few days and then decrease frequency over a few days
until stopped. If you are not having less pain after 3 or 4 days of use, or if you need to be using it for longer than two
or three weeks to keep pain free, speak to your midwife.
Grapefruit Seed Extract (active ingredient must be “citricidal”) may be used in conjunction with the APNO
(All-Purpose Nipple Ointment). Apply diluted solution directly on the nipples
Using Grapefruit Seed Extract:
● Mix very well 5- 10 drops in 30 ml (1 ounce) of water.
● Use cotton swab to apply on both nipples and areolas after the feeding.
● Let dry a few seconds, and then apply “all-purpose nipple ointment”.
● Use until pain is gone and then wean down slowly over the period of at least a week.
Nystatin
● Treatment with Nystatin requires simultaneous treatment of the lactating parent and baby to prevent cross
or re-infection.
● Babies are treated using an oral drop, as well as a cream for diaper rash if present. The cream is also used for
treating the nursing parent’s nipples.
● Side effects are very rare but could include diarrhea, nausea, vomiting with high oral doses, or local irritation.
● Prescription should be followed according to directions and used until finished.
● Contact your midwife if signs and symptoms of infection are still present following treatment.
Please note that Gentian Violet is NO LONGER recommended for treatment of fungal infections due to safety concerns.
Additional resources:
https://ibconline.ca/information-sheets/candida-protocol
Candida infections of the nipples may occur any time while breast/chest feeding. Candida albicans likes warm,
moist, dark areas. It normally lives on our skin, and 90% of babies are colonized by it within a few hours of birth.
Like many other germs, Candida only becomes a problem under certain circumstances.
Candida albicans is a fungus that may cause an infection of skin and/or mucous membranes in both children
and adults. In small children, this yeast is a frequent cause of white patches in the mouth (thrush), or diaper rash.
When the nursing parent has a Candida infection of the nipple, they may experience severe nipple pain, as well as
deep breast pain.
Candida infections of the skin or mucous membranes are more likely to occur when there is a breakdown in the integrity
of the skin or mucous membrane—one of the reasons why a good latch is very important from the very first day.
Nipple Pain Caused by Candida Albicans
The pain caused by a Candida infection is generally different from the pain caused by poor positioning and/or
ineffective suckling. The pain caused by a Candida infection:
● Is often burning in nature, rather than the sharp, stabbing, or pinching pain associated with other causes of nipple pain.
● Frequently lasts throughout the feeding, and occasionally continues after the feeding has ended. This is in contrast
to the pain due to other causes that usually hurts most when the baby latches on, and gradually improves as the baby sucks.
● Pain may radiate into the armpit or back.
● May cause no change in appearance of the nipples or areolas, though there may be redness, or some scaling. The skin
of the areola may be smooth and shiny, and the nipple may crack.
● Pain may begin after a period of pain free nursing. This characteristic alone is reason enough to try treatment for
Candida. However, milk blisters on the nipple also may cause nipple pain after a period of pain free nursing, as may
eczema or other skin condition.
● May be associated with recent use of antibiotics by the baby or nursing parent.
● May be quite severe, may or may not be itchy.
● May occur in one breast or nipple only.
● May occur only in the breast. This pain is often described as "shooting", or "burning" in nature, and is often worse
after the feeding is over. It is often said to be worse at night. At the same time, the breast appears or feels normal.
This is not mastitis and there is no reason to treat it with antibiotics. Antibiotics may in fact make the problem worse.
● If the baby has oral thrush she/he may be irritable during feeds or pull off the breast due to oral pain.
● May occur as a diaper rash that doesn’t improve with the use of zinc oxide-based diaper creams.
Treatment
Your midwife can give you a prescription for the All-Purpose Nipple Ointment (APNO) as the first approach to
treating these infections. The ointment is applied sparingly after each feeding. Do not wash or wipe it off before
feeding the baby. Use the ointment until you are pain free for a few days and then decrease frequency over a few days
until stopped. If you are not having less pain after 3 or 4 days of use, or if you need to be using it for longer than two
or three weeks to keep pain free, speak to your midwife.
Grapefruit Seed Extract (active ingredient must be “citricidal”) may be used in conjunction with the APNO
(All-Purpose Nipple Ointment). Apply diluted solution directly on the nipples
Using Grapefruit Seed Extract:
● Mix very well 5- 10 drops in 30 ml (1 ounce) of water.
● Use cotton swab to apply on both nipples and areolas after the feeding.
● Let dry a few seconds, and then apply “all-purpose nipple ointment”.
● Use until pain is gone and then wean down slowly over the period of at least a week.
Nystatin
● Treatment with Nystatin requires simultaneous treatment of the lactating parent and baby to prevent cross
or re-infection.
● Babies are treated using an oral drop, as well as a cream for diaper rash if present. The cream is also used for
treating the nursing parent’s nipples.
● Side effects are very rare but could include diarrhea, nausea, vomiting with high oral doses, or local irritation.
● Prescription should be followed according to directions and used until finished.
● Contact your midwife if signs and symptoms of infection are still present following treatment.
Please note that Gentian Violet is NO LONGER recommended for treatment of fungal infections due to safety concerns.
Additional resources:
https://ibconline.ca/information-sheets/candida-protocol
