- Nipple or intraductal yeast:
- 200mg loading dose day 1,100 mg a day for 13 days
- Two capsules or tabs. Three times a day.
- Rinse nipples with a solution of 1 T. white vinegar in 1 C. water
- Pat dry and apply antifungal cream
- Apply hydrogel dressing if needed, changing morning and night
- Take six capsules of acidophilus evenly spaced throughout the day.
- Eat a lot of garlic or take odorless garlic capsules. Six tabs of BRI or 4 capsules of Kyolic spaced throughout the day. These garlic products can be found in most drug stores.
- If you have trouble remembering whether you have taken enough of these products you can count them out in a cup in the morning and it is easier to space them out. Remember to keep the acidophilus in the fridge.
- Reduce sugar to a minimum and use NO artificial sweeteners.
- Eliminate dairy products until two weeks after all symptoms are gone. (Dairy products do not include eggs, but products that come from cows milk.)
- After each feeding (or every 3 hours) apply an antifungal solution to mouth (ask your doctor), gently rubbing it around to cheeks and gums. I suggest squeezing the solution into a small cup then dipping your finger into it. Some mothers are reluctant to wake a sleeping baby after the feeding to give the antifungal. It can be given before feeding as well.
- Three times a day, open one capsule and sprinkle about 1/3 of the contents onto a wet finger and spread in baby’s mouth.
- Rinse with each diaper change with vinegar/water solution (1T.vingear/1C. water.)
- Apply antifungal cream.
- Do not use baby wipes. Use clear water for clean-up of bm, then rinse with the vinegar solution.
The following should be continued for two weeks after all symptoms are gone:
- Vinegar rinse for nipples
- Antifungal cream
- Acidophilus for mom and baby
- Vinegar rinse for diaper area
- Nystatin cream for diaper area, or if you run out, Desitin will do.
The routine does get easier as you grow used to it.
And Sunlight is a good treatment for yeast overgrowth.
Sunlight on nipples and baby’s diaper area is helpful, but even a walk in the sun or sitting in a sunny window helps also.
Also Fun. Try to remember what brings you joy, and do it. Laughter or relaxation or things that make you smile will boost your immune system and help your body to return to a state of health.
This is a lot to digest, and some things are more essential than others, and each mother is different in the health of her immune system and her emotional health. But, the “simple” treatment plan is what I consider as minimal for resolution. I’m sure that some mothers recovered without doing all that I recommended, but this is what I give them.
One of the hardest parts for moms to follow (until she has had a recurrence) is that the accompanying treatments MUST BE CONTINUED FOR 2 WEEKS AFTER ALL SYMPTOMS ARE GONE. The balance is tenuous until the bacteria colonization is secure.
From my personal experience, I have adopted the following treatment:
Diflucan–200mg loading dose on day 1
100mg following for the next 13 days
Baby can be treated with Nystatin. It’s not too good, but it is what peds usually use. (Diflucan has been approved in an infant dosage by the AAP.) The prescription usually says every 6 hours, but yeast grows back in 1 1/2 -2 hours. I recommend treating every feeding (or about every 3 hours) with half the amount recommended. Just squirting it in the cheeks doesn’t do much, so I recommend rubbing it around with a finger. This should be continued for two weeks after all symptoms are gone. Often baby needs two bottles before it is resolved.
If the baby has a yeasty diaper area (red around the anus), then a Nystatin cream is good, as is Desitin, which has zinc, an antifungal. Mom should not use “wipes” as they have substances that are favorable to yeast growth. She should have a bowl (or put the solution in a spray bottle, set the sprayer on stream so that that baby won’t inhale it) of 1 C of water with 1 T white vinegar added. She rinses baby’s diaper area with this solution after every diaper change, blots it dry and applies antifungal.
Mother can use a topical antifungal for her nipples. It is thought that a cream made for skin is preferred over one for mucous membrane (the vaginal ones). Nizoral, Nystatin cream, or the OTC Lotrimin AF is a topical treatment that is recommended for nipples by MDs. Some moms are bothered that it says for athlete’s foot, but assure her that it is the same as what a pharmacist would prepare for her and that it has never been on an athlete’s foot. : ) She should rinse her nipples after each feeding with the vinegar/water solution, blot dry and add her antifungal cream. Vinegar doesn’t kill yeast, but it creates an environment that is inhospitable to yeast growth. She does not need to wipe off the cream before feeding. If she wishes she can rinse with clear, warm water before feeding.
Now, Mom can take all of the antifungals that she wants and the yeast will be killed off, but it will return in a few days unless she recolonizes her intestinal tract with proper bacteria. When there is ductal or nipple yeast, there is always systemic yeast overgrowth also.
Acidophilus capsules–It must be the refrigerated kind found in a health food store and kept in the refrigerator at home. I like Natures Way company’s Primadophilus or their Primadopilus and Bifidus combination, but there are other good ones. She takes six a day, continuing for two weeks after all symptoms are gone.
Baby needs to recolonize his intestines too. Mom can open one capsule of acidophilus and sprinkle about 1/3 of the contents onto a wet finger and spread in baby’s mouth. Or she can buy a separate Bifidus for him. The combination is good for this use. (Bifidus is the major “good” bacteria that is in a breastfeeding infant’s gut.)
I sometimes recommend Echinacea as an immune system booster unless mom’s eyes are glazed over with all of this strange stuff. I use the tincture, which is more concentrated and recommend three droppers full a day. But if acidophilus is new to her I, usually leave off the Echinacea and just rely on garlic and sunlight.
Whole grains are better than processed when working with yeast overgrowth, but again, I evaluate the mom’s capacity to adapt. Sometimes I add a B complex (yeast free) to the plan.
Some people feel that city water that has chlorine in it kills off some of the good bacteria that we are trying to colonize. Mom can either drink bottled water, or she can let a pitcher of water sit out overnight, and the chlorine dissipates.
Garlic is antifungal and an immune system booster. Most Americans don’t eat much garlic, so I recommend a good odorless capsule. Either Kwai or Kiolic brands that can be found in any pharmacy. She will take six tabs of Kwai or 4 capsules of Kyolic a day. And this is also continued for 2 weeks after all symptoms are gone.
Moms often tell me that they can’t remember how many they have taken, so I suggest that they put the desired number of acidophilus and garlic tabs in a bowl in the fridge (acidoph. must be kept refrigerated) and then they can be sure that they take enough. They should be spaced throughout the day.
If the mom uses breast pads, she should use disposable ones and change at each feeding.
A product that I am finding good for very sore or damaged nipples is hydrogel dressing. It is located in the pharmacy in the first aid section near bandaids. One common brand is Second Skin. It is a thin plastic rectangle that has a gelatinous watery substance on one side. Mom cuts it to fit just a bit beyond her nipples, places it on with the watery side toward the nipple. Then she holds it in place with a breast pad. It is very soothing and keeps any anti-fungal cream from being rubbed off on a breast pad or bra. She can use it for several feedings before changing it. The Second Skin comes with 4 packs and the mothers I have used it with cutting them in half. So your client would want to buy several packs.
Mom will need to take this yeast seriously, and if you explain that it is systemic, she will be motivated to treat her whole body. Here is the plan laid out more simply:
I had a lot of requests for my yeast treatment plan. I’ll admit that it can be overwhelming. I have developed it over about 5 five years while I became the “yeast queen” of Wisconsin, but I don’t know what I would have thought if someone had handed it to me all at once. So don’t go screaming and throw it in the fire yet.
We always have yeast in our bodies. It lives in harmony with the bacteria throughout our system. When our immune systems are compromised or when we take an antibiotic, the bacteria is killed off, and the yeast grows excessively. This is a “yeast infection” or yeast overgrowth. The goal is not to get rid of the yeast permanently but to restore the healthy balance. Any yeast infection–nipples, feet, mouth, vagina–is always systemic and is out of balance in our GI tract, so topical treatments must be accompanied by oral treatments. This explanation makes it easier to follow all of these instructions.
Patricia Gima, IBCLC
Some clarification questions Ann had:
Have you seen persistent yeast where you need to go over the two weeks with more Diflucan?
Yes. If mom goes to the MDs who treat it until it is resolved, she may have to have a repeat prescription.
Have you had to go to a much higher dose of Diflucan because the 100mg daily/13 days, the mother is still feeling pain?
I h aven’t recommended a higher dosage, just extended prescription. Dr. Jack, though, said that in tough cases he does give 200mg for the entire period.
What about all the boiling and washing with chlorine that so many other suggest?
I mention it, but have’t stressed it as much as some do. Mom is so overwhelmed by all of the treatment, that I offer these measures as suggestions. If there is pacifier use I always stress the boiling. And I recommend disposable breast pads. I believe that if a mother works on boosting her immune system, reducing the yeast overgrowth, recolonizes her digestive tract with good bacteria, improves her diet to decrease the yeast-loving environment, then she won’t have to do much “cleaning” work. The overgrowth in her and her baby’s body is the area of focus.
I forgot to mention that I recommend that anti-bacterial soaps be avoided.
Also, if mom is agreeable, I recommend eliminating grocery store meats that probably contain antibiotics. But I know that with some moms, if I tell them to change their diets too drastically, they will just stop breastfeeding, thinking that the problem will then go away.
I do believe that there is an emotional component to yeast overgrowth–overwhelmed, feeling victim, helpless, when will it by “my” turn? etc. So I try to tailor the treatment plan to what I think the mom can handle and feel empowered by.
What I want to see is PREVENTION. Not so many broad-spectrum antibiotics, and if they are used, use of acidophilus and garlic, etc. from delivery. Also, women getting more help in the post-partum period so that they get more rest and are less burdened by all of the responsibility of their new role.