When the Breastfeeding Network thrush leaflet (1) was first written in 1995, there was little available information and the condition seemed rare. Many mothers are now diagnosed and treated for thrush, but identifying it can be far from straightforward and medication may offer an easier option than spending time to help a mother achieve pain-free attachment. However, exposing mother and baby to unnecessary topical or oral treatments is unethical and unfair, delaying resolution of the true cause and necessitating the prescriber to take responsibility for the use of the medicines often outside of their license application.
Research into incidence seems limited to anecdotal reports and small case studies, and some have questioned its existence. (2) However, despite this controversy, practitioners must continue to provide care.
Is it thrush?
Thrush should be a diagnosis of exclusion and positioning and attachment should have been optimised by an experienced breastfeeding worker. It is identified by putting a full clinical picture together (see Boxes 1 and 2). Recognised symptoms include intense pain after a period of pain-free breastfeeding, pain in both nipples or breasts, and pain after feeds or starting toward the end of the feed. It does not produce pyrexia in the mother or inflamed areas on the breast. It is important that symptoms are distinguished from those of inadequate attachment, characterised by pain on attachment, a misshapen nipple after feeds or never achieving pain-free feeds. Thrush often originates from attachment problems, resulting in mastitis antibiotic prescription (see Figure 1).Box 1. Nipple thrush: signs and symptoms Signs and symptoms that could indicate infection (not all need to be present): * Sudden onset of painful feeding after a period of pain-free feeding * Itchy, flaky or shiny nipples but allergy to creams, ointments or breast pads ruled out * Unusually sensitive nipples, such as discomfort due to pressure of clothing * Nipples redder or pinker than usual, or they may lose colour (blanching) * Nipple damage or pain that does not heal despite help with improving positioning and attachment by someone skilled in supporting breastfeeding * Signs of fungal infection in the baby's mouth or in nappy...
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