Are There Differences Between Breastfeeding Directly and Bottle-feeding Expressed Milk?

From the breast or from the bottle, fresh or frozen, your milk provides all of the nutrition your baby needs for normal growth and development and much more. The nutritive and health-supportive properties of breastmilk can be bottled, making it the next best alternative when breastfeeding is not possible or feasible. Mothers may need or choose to offer their milk by bottle for a variety of reasons as individual as each mother and baby pair, and as a result of this need, there are many solutions for expressing milk. It is easier than ever before to provide a baby with breastmilk long-term, even when a mother cannot or chooses not to breastfeed directly.  Exclusive expressing and breastmilk-feeding can be necessary and even life-saving, especially for fragile premature babies. In most societies, the value of breastmilk is well-known, but the value of breastfeeding is not. Breastmilk is a wondrous living fluid that cannot be replicated, and breastfeeding is the normal and optimal way to deliver it.

Antibodies are blood proteins produced in response to substances that the body recognizes as alien, such as bacteria and viruses. Close physical contact with your baby helps your body create antibodies to germs in his environment. When you breastfeed directly, your body creates antibodies in response to cues from your baby’s saliva and other secretions. After exposure to new germs, your body can make targeted antibodies available to your baby within the next several hours (Chirco 2008) (Cantini 2008). While a bottle of milk from a previous date will provide your baby with immune factors, it will not contain antibodies to germs he was exposed to today.

Breastfeeding supports the normal development of a baby’s jaw, teeth, facial structure, and speech. The activity of breastfeeding helps exercise the facial muscles and promotes the development of a strong jaw and symmetric facial structure. Breastfeeding also promotes normal speech development and speech clarity. An increased duration of breastfeeding is associated with a decreased risk of the later need for braces or other orthodontic treatment. One study showed that the rate of misaligned teeth (malocclusion) requiring orthodontics could be cut in half if infants were breastfed for one year (Palmer 2008). Bottle-feeding requires a different tongue action than breastfeeding does, and over time may affect the growth and development of oral and facial tissue. Sucking on bottle nipples, pacifiers, and even thumbs and fingers can eventually affect the shape of a baby’s palate, jaw, teeth, and facial structure.  In this presentation, Position and action of the tongue during breastfeeding, dental expert Dr. Brian Palmer shows how breastfeeding promotes normal facial development and provides illustrations showing what happens inside the mouth during bottle- and breast feeding (Warning: Slide 2 of the presentation shows a picture of a cross section of the mouth of a human cadaver for illustrative purposes).

When breastfeeding on cue (as your baby shows signs of hunger), you produce milk in response to your baby’s demand: your body makes milk to replace the milk your baby removes from the breast. When exclusively expressing, you produce milk according to how much milk you are able to remove with the pump and/or your hands. Some mothers find it is more difficult to maintain milk production long term with a pump for a variety of reasons including difficulty scheduling time to express (frequency of milk removal) and the overall effectiveness of the pump at removing milk. Understanding  how long term milk production works can help mothers who are dependent on their pumps for milk-removal maximize both the amount of milk they are able to remove and the length of time they are able to continue producing milk.

Bottle-feeding expressed breastmilk is more time-consuming than breastfeeding directly because you have to spend additional time expressing milk, washing pump and bottle parts,  and shopping for necessary equipment: this time might have been spent enjoying your baby or taking care of yourself. When your breastfed baby is hungry or needs to be comforted, you simply put him to the breast. When bottle-feeding breastmilk, you must first attend to preparing a bottle before you are able to meet your baby’s needs.

Skin-to-skin contact (also known as “kangaroo care”) is important to your baby’s development (Bigelow 2010). Babies held skin-to-skin stay warmer, cry less, and have better-coordinated sucking and swallowing patterns. Mothers who hold their babies skin-to-skin enjoy increased milk production, increased oxytocin release, improved mother-baby bonding, and more confidence in their mothering abilities (Moore, Anderson & Bergman 2009). When you are breastfeeding, you will naturally be in a position to offer skin-to-skin contact to your baby. When you are bottle-feeding, it is important to find additional time each day to hold your baby this way.

Research has shown that breastfeeding directly correlates with a positive mood in mothers. One study examined the effects of breastfeeding and bottle-feeding on maternal mood and stress. After breastfeeding, the mothers in the study were found to have both a reduction in perceived stress and a more positive mood. In contrast, after bottle-feeding, mothers were found to have an increase in negative feelings. The researchers suggested that the higher levels of oxytocin released by breastfeeding may contribute to both reduction in stress and better mood (Mezzacappa & Katkin 2002).

Bottle-feeding gives your baby less control over his milk intake. Milk flows easily from a bottle nipple even when the baby is not actively sucking, and the faster flow can cause a baby to continue feeding after he is full.  When bottle-fed, babies may drink more than they need because the care-provider may encourage the baby to finish the bottle rather than waste the milk inside. While breastfeeding, your baby can control the flow of milk by the way he feeds. You are not able to see how much milk your baby consumed, but you can watch for signs that your baby is satisfied, and you will be less likely to coax your baby to continue eating after he is full. Research suggests that infants who are breastfed, rather than bottle-fed breastmilk, are better able to self-determine fullness as children and may have a lower risk of overeating and obesity later in life (Isslemann 2011). Recent research suggests that it is the act of breastfeeding that helps prevent rapid weight gain (Li and Magadia et al 2012).

There are some variations between milk that is obtained directly from the breast (or that has been freshly expressed) and milk that has been stored. For example, freezing has been found to decrease the effectiveness of some of the antibodies and kill some of the living cells in milk (Orlando 2006) (Buckley & Charles 2006). In order for your baby to get the most anti-infective properties from your milk, it is best to offer it fresh whenever possible.

Getting the most of out of breastmilk-feeding

  • Spend time in skin-to-skin contact with your baby to help your baby grow, improve milk production, and promote breastfeeding behaviors.
  • Build and maintain milk production by expressing milk at least as often as your baby would breastfeed and draining your breasts well with “hands on” pumping.
  • Use a paced  bottle-feeding technique that promotes breastfeeding behaviors and respects your baby’s natural suck, swallow, and breathe patterns
  • Beware of marketing claims. There is no such thing as a bottle or nipple that is “just like” the breast. Choose a bottle and nipple that fits your goals and your baby’s individual feeding style.
  • Always hold your baby to feed.  Bottle-propping is a choking and aspiration hazard. Eating is a naturally social experience; propping is isolating.
  • Feed your baby when he shows hunger cues rather than on a schedule and let your baby determine when he is full (applies to healthy, full-term babies that are feeding well)
  • Store breastmilk in smaller quantities to reduce waste
  • Offer freshly-expressed milk whenever possible.
  • If your baby is hospitalized, and you are unable to nurse or hold him, spending time in his environment (including touching equipment and even shaking hands with staff) will help you produce antibodies to germs to which he has been exposed.
  • Baby-wearing and co-sleeping (room sharing) promote bonding, attentiveness to your baby’s hunger cues, and production of antibodies to germs in his environment
  • If you are bottle-feeding due to low milk production, consider the option of using an at-breast supplementer so that your baby can receive supplemental feedings while nursing at the breast.

If you are bottle-feeding your baby exclusively or partly, and you would like to increase his feedings from the breast, or if you need more information about exclusively expressing your milk, an  International Board Certified Lactation Consultant, WIC Peer Counselor, or volunteer breastfeeding support counselor would be able to offer information and support.  The same holds true if you are feeling pressured to provide your milk by bottle even when it is not absolutely necessary; the often-suggested solutions for  daddy- or grandparent- bonding time or feeding in public is “just pump.” Remember, whether by breast or by bottle, every ounce of breastmilk matters! You are doing something very special for your baby, your family, and your community.

More information:

It’s Not Just About Breastfeeding

Weaning from formula supplements

Help-My baby won’t nurse!

It’s Not Really About the Milk

Bottle Vs Breast, A Mother’s Story

Milk Sharing, Good or Bad?

References:

Buckley, K. Charles, G. (2006)  Benefits and challenges of transitioning preterm infants to at-breast feedings International Breastfeeding Journal 1:13

Cantini, A. (2008) Pediatric Allergy, Asthma, and Immunology. Heidelburg, N.Y. Springer.

Chirico, G. et al (2008) Antiinfective Properties of Human Milk  Journal of Nutrition 138, 1801S–1806

Isselmann Disantis, K. (2011) Do infants fed directly from the breast have improved appetite regulation and slower growth during early childhood compared with infants fed from a bottle? The international journal of behavioral nutrition and physical activity 17;8 (1):89

Li R, Magadia J et al (2012) Risk of bottle-feeding for rapid weight gain in the first year of life Arch Pediatr Adolesc Med 166(5):431

Moore ER, Anderson GC, Bergman N. (2009) Early skin-to-skin contact for mothers and their healthy newborn infants Cochrane Summaries

Mezzacappa, E. Katkin. E (2002) Breastfeeding is associated with reduced perceived stress and negative mood in mothers Health Psychology 21(2), 187-193

Orlando, S (2006) The immunologic significance of breast milk. J Obstet Gynecol
Neonatal Nurs 24(7), 678-83

Palmer, B. (2008) The Influence of Breastfeeding on the Development of the Oral Cavity:  A Commentary   Journal of Human Lactation, 14(2), 93-98

St. Francis Xavier University: Dr. Anne Bigelow. Enhancing Baby’s First Relationship: A Parents’ Guide for Skin-to-Skin Contact with Their Infants

© Jolie Black Bear, IBCLC, Serena Meyer, IBCLC, Teglene Ryan, and Adrienne Uphoff, IBCLC–All Rights Reserved

 

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Breastfeeding: The Gold Standard Conference in New Orleans

bftgsMarch 21, 2012 – March 23, 2012

The 15th Annual Breastfeeding: The Gold Standard Conference
New Orleans, Louisiana
Conference Websitehttp://www.breastfeedingthegoldstandard.org/
Contact Information: Laura Goodwin-Wright LLGWright@aol.com

The Hampton Inn & Suites
1201 Convention Center Boulevard
New Orleans, Louisiana

Sponsored by:
La Leche League of Alabama, Mississippi and Louisiana

The fifteenth annual “Breastfeeding: The Gold Standard” conference is an opportunity to learn about the latest evidence-based practices in the field of lactation to better serve the breastfeeding mothers and babies in your community. This outstanding conference will be held at the Hampton Inn & Suites, 1201 Convention Center Boulevard, New Orleans, Louisiana, and provides 3 days of excellent presentations.

Continuing nursing education hours will be awarded to RN’s who register, miss no more than 10% of class time and complete an evaluation form. Applications have been submitted for CHES, and OT Contact Hours, and CERPs. RDs will be provided the conference certificate and agenda needed to report their CE hours.

In compliance with the WHO Code of Marketing of Breastmilk Substitutes,this program does not receive funding from artificial baby milk companies.

If you look carefully on Thursday and Friday’s line up, our own Jolie Black Bear will be speaking on designing and implementing mother-to-mother support groups! If you would like to meet her in person and discuss how to start breastfeeding support systems in your community or tribal region, please contact us!

 

(c) Native Mothering, 2012. All rights reserved.
Breastfeeding: The Gold Standard Conference information and logo used with permission

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Breastfeeding myths busted: The lowdown on common breastfeeding misconceptions (part 2)

 

myth vs fact

 

Myth: There is no way to tell a baby is getting milk while breastfeeding.
Fact:  Although breasts do not have ounce markers, you can tell your baby is getting milk while breastfeeding in several simple ways. Watch for “pauses in the action of the chin” which indicate the mouth filling with milk, and listen for a “kah” sound which indicates swallowing (see the video below).  After feeding, your baby ideally will act satisfied, and no longer exhibit feeding cues that typically indicate hunger.  Longer term, you can be certain that your baby is taking in enough milk if he has plenty of wet and dirty diapers, and is growing, gaining weight, and meeting milestones. Talk to your health care provider if you are concerned that your baby is not getting enough milk.

If the video does not load, please refresh your page. 

Myth: There is no milk for the first few days after birth.
Fact:  Your breasts begin producing colostrum, your first milk, around 4 and half months of pregnancy. Colostrum is a thick, sticky fluid that is produced in relatively small quantities, yet it is delivered in the perfect volumes for your newborn’s stomach capacity. It contains all the nutrition your baby needs, plus a big boost of anti-infective factors, prebiotics and probiotics that will help protect your baby from illness. Most moms will notice that their milk becomes more plentiful, or “comes in”, about 72 hours after birth. Before then, colostrum is all baby needs except in the rare circumstance that additional nutrition is medically indicated.

Myth: Pain while breastfeeding is normal, especially in the first few weeks.
Fact: Pain is the way our bodies alert us to a problem and let us know something needs to change. Breastfeeding is not supposed to be painful; certainly not like the pain that is so often described in parenting urban legends!

The first days (sometimes even a week or two) after birth, some mothers may experience what lactation experts call “normal tenderness”. It is described as discomfort that lasts through the first few sucks of a feeding, then resolves for the rest of the feeding. Some mothers say the sensation is mildly painful, rather than just uncomfortable.  Normal tenderness is often correlated to stretching of the nipple into the back of baby’s mouth. It has been theorized that general breast tenderness in the first weeks could be related to the normal shift in hormones after the placenta is delivered, or even the initial “stretching” due to filling of the breasts with milk.

Normal tenderness is different from pain that indicates nipple damage is occurring. How can you tell the difference between normal and pain that indicates a problem?  Normal will improve with time (every feeding will be a little better) and will not be severe enough to negatively impact breastfeeding. Just remember this: Pain that negatively impacts breastfeeding is not normal!

If you experience pain that lasts throughout the feeding , or makes you dread feedings and contemplate weaning, talk to an experienced lactation consultant right away. Feeding through pain can compound the issue leading to bruising, cracks, infection or other problems. The sooner you get help, the sooner you will be able to nurse comfortably and truly begin to enjoy your breastfeeding relationship with your baby. The solution for breastfeeding pain is often a very simple one, such as adjusting positioning or latch.  Waiting to seek help can make simple problems much more complicated. Do not wait!

When to ask for help:

  • you experience toe-curling pain that makes you dread feedings
  • you experience pain throughout feedings
  • your nipple(s) looks smashed, misshapen, or discolored after feeding
  • your nipple(s) are cracked, bruised, and/or bleeding
  • your baby nurses “all the time” and never or rarely shows signs of satisfaction
  • your baby has difficulty latching on, or staying latched on to the breast
  • your nipples are sore between feedings
  • you experience nipple pain that radiates into the breast
  • pain is not improving with time, or is getting worse

Build a support network for yourself. Your support network might include friends, family, breastfeeding support groups, lactation consultant, your midwife, or doula. If you seek breastfeeding help from a professional and you still do not get relief, please seek another opinion. You should not have to live in pain or prematurely wean in order to feel better.

Myth: Pumping is a good way to find out how much milk you make.
Fact: If you are breastfeeding your baby, pumping cannot tell you how much milk you are producing. There are many variables that can affect how much milk can be removed with a pump including the efficiency of the pump, how well your body responds to the pump, how long it has been since you last fed your baby, your pumping technique (pumping alone or “hands on”), and perhaps even your breast storage capacity. The best way to know that you are making enough milk is to look at your baby. Is he gaining weight? Growing in length and head circumference? Generally content? Meeting milestones? If so, then rest assured that you are making enough for your baby! If you are having difficulty expressing milk, or if you are concerned about how much milk you are making, talk to your breastfeeding support volunteer or lactation consultant.

Myth: If you breastfeed, you will have to stay at home most of the time and nobody else can help you with the baby.
Fact: Breastfed babies are very portable. There are no bottles, formula, and related items to carry with you (or forget at home!). All you really need for an outing are diapers and wipes. It is easy to breastfeed anywhere, just as it is to bottle-feed anywhere. If you are concerned about feeding in public, consider trying some of these confidence-boosting tips. Your comfort level will increase with time and practice!

There are lots of ways other people can help you care for your baby. Breastfeeding is the only thing that you can do for your baby that no one else can. Your family and friends can help by changing, bathing, rocking, walking, playing with, singing to, or carrying your baby. They can also help by taking care of YOU and important household tasks like laundry, meal preparation, running errands, cleaning, and entertaining older children. Don’t be too shy to ask for help when you need it, even if it is just for 15 minutes to take a shower or take a walk around the block.

Myth: You have to drink milk to make milk.
Fact:  Nutrients and calories are required to produce milk, and nutrition can come from any food source (ideally, a variety of foods in as close to their natural state as possible; “whole foods”). There is no one food that a mother must eat in order to produce milk. In fact, it is not necessary for humans to drink cow’s milk at all, though many people do enjoy drinking it or eating dairy in it’s many forms (such as cheese and yogurt). 

Find more at: Breastfeeding myths busted: The lowdown on common breastfeeding misconceptions (part 1)

References:

Kent, J.C.  et al (2006) Volume and Frequency of Breastfeedings and Fat Content of Breast Milk Throughout the Day Pediatrics, 117(3), 387-395

Mohrbacher, N (2010) Breastfeeding Answers Made Simple: A Guide for Helping Mothers Amarillo, Texas. Hale Publishing, L.P.

Riordan, J. , Wambach, K. (2009) Breastfeeding and Human Lactation Sudbury, MA. Jones and Bartlett Publishers

Wilson-Clay, B., Hoover. K (2005) The Breastfeeding Atlas Manchaca, Texas. LactNews Press

 

Find Breastfeeding Support:

Find an IBCLC (lactation consultant)

Find a Breastfeeding USA Counselor

Find a La Leche League Leader

Women, Infants, and Children (WIC)

(c) Native Mothering–All rights reserved

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Southwest Chicken Soup

Southwest Chicken Soup

With a few inexpensive ingredients, you can make a filling and nutritious meal in no time! This recipe makes enough for 6 hungry adults. You can double it and feed a house full.

1-2 lbs chicken–breast, whole cut up, legs, thighs, or quarters
1 can whole kernal corn (16 oz)  [may sub 1 lb frozen corn, or the kernals from 4 ears of corn]
1 can light red kidney beans (16 oz) [may sub 1/2 lb dried beans, cooked or 16 oz can of pinto or black beans]
1 28 oz can crushed tomatoes with garlic and onion [may sub 28 oz can spaghetti sauce, 4 oz can tomato paste, 28 ounce can whole tomatoes]
Seasonings to taste–your choice of salt, pepper, garlic, onion, chili powder, taco seasoning, southwest seasoning powder, red pepper, jalapeno powder, chipotle sauce, cumin, oregano, parsley

Remove skin from chicken (if applicable), cover with water, season with salt, pepper, and any other seasonings you like. Bring to boil. Cook until chicken is done in center and tender,(about 25 minutes for chicken leg quarters). Remove chicken from pot. Allow stock to cool. Using a large spoon, skim any fat floating on the surface. Discard. Return stock to heat. Meanwhile, remove chicken from bones (if applicable) and put it back into the hot stock. Add tomatoes, beans, and corn. Add seasonings. Taste. Adjust seasonings. Add a little water if the tomatoes are too strong. Bring mixture to a boil. Reduce heat medium low, then simmer for at least 15 minutes to enhance flavor. The longer it simmers, the better the flavor.

Can be served alone, or with cornbread, frybread, tortilla chips, or crackers. Can be topped with avocado, cheese, and/or sour cream.

 

 

 

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I’m Breastfeeding and I Think I Have Thrush!

Oral Thrush. Photo by James Heilmen, MD.

What is thrush?

Thrush can be defined as a parasitic overgrowth of organisms that are considered normal body flora, such as Candida albicans. The most common cause of thrush is C. albicans, but other yeasts in the genus Candidas may also contribute to the symptoms of thrush. The normal body locations that harbor yeast tend to be places that are moist and sheltered enough to prevent sun exposure. Candida is found in the vagina, in the oral cavity and in the intestinal tract in great numbers, it may also occur on the skin of the body in folds or creases. Unfortunately it may also like to live in cloth diapers, bedding, or in material that touches an infected area of skin.

In most cases a person’s relationship with their normal flora is benign (harmless), during administration of antibiotics or systemic corticosteriods an overgrowth of yeast may be seen. The normal bacteria and flora of the body work together to keep harmful bacteria and yeasts from taking hold in the tissues of the body. They do this by preventing any uncolonized space for intruders to grow on.

Thrush is common after a course of antibiotics (the resulting inhibition of both good/bad bacteria allows the yeast organisms such as candida to grow unimpeded). The balance that is typically struck between helpful bacteria and Candida is disrupted during antibiotic use, where the unusual absence of bacteria leaves room for more development by the flora. As a preventitive measure, a mother might consult her health care provider about the use of a probiotic supplement in her diet in conjunction with her prescribed antibiotic. In some adults the long term use of corticosteriods for inflammation or asthma may suppress the immune system enough to prevent an adequate response to candida overgrowth. Mothers who are diabetic or HIV positive may also be at greater risk for thrush.

Serious cases of thrush may require antifungal medications for both the baby and the mother at the same time (so no cross transference happens).  Treating just the baby or just the mother for symptoms of thrush fails to account for the close and repeated contact between the nursing baby’s mouth and the mother’s breast. In situations when the mother is having repeated thrush infections, a consultation with her health care provider is recommended so they can review her iron levels, immune status, diet, and a culture of her nipple may be done to ascertain what type fungal infection she carrying. In some cases C. albicans may develop a resistance to particular antifungals and other methods or medications must be tried. In the last few years it appears that thrush is more resistant to Diflucan ( a medication used to treat thrush) and I see more and more women needing two full courses of the medication.

If a mother has been under a lot stress, her immune system function may be low and it is possible to see thrush occurring in a population of women without prior use of antibiotics or medical issues. Lack of sleep, worries about infant health or other stress inducing parenting behaviors can all contribute to a weakened immune system. Higher levels of the stress hormone cortisol can produce a mother who is more vulnerable to illness or candida overgrowth.

If a mother has a baby who is teething, or who has recently bitten an area on the nipple, or maybe she is just getting started and she has cracked nipples- the mother may have a break in the skin that becomes either infected with bacteria or C. albicans. With acute symtoms of fever and pain, a visit to her health care provider will help rule out mastitis, which presents with a high fever and pain in the breast. Thrush typically does not produce a fever, but if it effects specific places in the body it can result in a fever. For oral and breast thrush, a fever is not usually present.

If the mother has a compromised immune system due to HIV status, other medical issues, or medicines, she should consult her health care provider about appropriate measures and medications to treat thrush.

What are some of the maternal symptoms of thrush?

  • Pain that occurs during nursing, and continues after the feeding
  • Sharp stabbing pain in the breast, a feeling of “broken glass”
  • Burning and itching of the nipple and areola
  • A rash that appears with small raised bumps on the nipple
  • A glassy or shiny look to the nipple, it may appear iridescent like mother of pearl
  • The nipple may appear red or pink, the skin may be flaky
  • Mom may have a concurrent vaginal yeast infection, or thrush under the breast
  • The pain may radiate deep in the mother’s breast
  • Sore or cracked nipples that do not resolve with effective latch and positioning
  • Recurrent breast infections and plugged ducts

What are the infant symptoms of oral thrush?

  • A thick white cottage cheese like coating may appear on a baby’s tongue, and he may have white patches in his mouth that won’t wipe away. (View the photo on the top of this article.) If the tongue is scraped and the white patches uncover to show inflamed red skin it’s time to contact your HCP! Regular milk tongue can be wiped off, thrush cannot.
  • Baby may have some trouble with nursing, feel uncomfortable nursing, or the baby may refuse the breast or act fussy during/after nursing
  • Baby may have a red bumpy diaper rash with/without pustules, or scalded red looking buttocks
  • The baby may have no sign of thrush inside the mouth or on the body, but this does not rule out thrush if the mother is diagnosed with it; the baby may be asymptomatic. Careful assessment by a qualified healthcare provider will ascertain whether treatment is advisable

How do I get rid of  thrush?

  • Seek medical treatment and use all of your prescribed medication to avoid breeding an organism that is more tolerant of the medication. Consider treatment for both your baby and yourself, to avoid passing the infection back and forth between baby and mom.
  • Nystatin is commonly prescribed for thrush despite evidence that oral diflucan in a pediatric dose may be more successful at treating it, (Groins et al., 2002) showed evidence that nystatin was not as effective as Fluconazole. According to a study in 2011 Nystatin and Fluconazole were both effective antifungals, but fluconazole was more effective for treating invasive fungal infections. If the mother is treating a thrush infection for the first time around with Nystatin, it may still be effective, but if a second round of antifungals are needed, it may be a good choice to investigate another drug option.
  • Always talk to your health care provider and/or IBCLC before using any over the counter medication or home remedy for thrush.
  • Some strains of Candida are developing resistance to treatment and if symptoms continue without getting better after 2-3 days of treatment, a mother would be well advised to seek reevaluation by a skilled healthcare provider. *Many mothers report that their symptoms worsen during the first 1-2 days after treatment before getting better.
  • Many mothers find that taking probiotics while being treated for thrush supports the use of medication and possibly speeds the elimination of thrush infection. I’ve noted that there is a specific type (humorously named Raw Vaginal Probiotic) that is particularly helpful in restoring correct flora in the body.
  • Some mothers find that virgin coconut oil feels soothing on the nipples. It naturally contains caprylic acid, which has antifungal properties, however the empiric treatment for nipples is APNO cream (all purpose nipple ointment) that is compounded by a local pharmacist. You will need a prescription for it. Some Doctors will give you a way to make it over the counter yourself, but please ask for directions to do that. The medications in the ointment are compatable with breastfeeding providing you use as directed. Typically you put on about a 1/2 pea sized amount after each feed. You will usually feel better within about 6 hours.
  • Thrush enjoys moist areas of the body, and can be spread through casual contact with infected areas or sexual contact between partners. If thrush is reoccurring despite the treatment of a mother and baby pair, the mother’s sexual partner should be encouraged to be evaluated as a carrier of infection.
  • If you are using cloth diapers, you can use a combination of soap and antifungals to get rid of the yeast. Sunlight is very good at killing C. albicans, so consider line drying your cloth diapers if you can. Some research has been done on the effectiveness of natural antimicrobials like tea tree oil in the treatment of fungal infections. Most commonly, it is suggested to use the citrus derived grapefruit seed extract as it has been found to help eliminate Candida. Consult your diaper manufacturer to see if it would be safe to wash your diapers with a few drops of either of these essential oils.
  • Dedicate the same time you spend on cloth diapers to your nursing bras. They should be changed daily and washed in hot water, preferably dried in the sun. Consider going without a bra as much as possible, allowing the skin to “breathe”. Change nursing pads frequently, and keep your nipples as dry as possible. Specific care of clothes and everything that touches your breasts, your baby’s mouth, or even your baby’s bottom will help prevent colonization of Candida.
  • Boil all bottle nipples, pacifiers, and nipple shields for 20 minutes after each exposure to the baby’s mouth to reduce the colonization of Candida. If possible, replace these weekly until the infection is resolved. You could also use a steam sterilizer bag to reduce the time of the plastic being hot.
  • Eat well, including a variety of nutritious foods in your diet. Vitamin and mineral deficiencies can contribute to predisposing people to Candida infections.
  • Use good hygiene, including washing hands with non-antibacterial soaps after changing a diaper, using the restroom, or touching the breast.  Use disposable towels to dry hands, or thoroughly sanitize hand and bath towels after use. Shower or bathe daily.
  • Consider rinsing the nipples after feeding or expressing. You can use plain water, or talk to your health care provider or IBCLC about using a rinse made of 1 part vinegar to 4 parts water (1:4).It can help change the pH (acid level) of the skin, making it a less friendly environment for yeast to grow.
  • Wear cotton underwear, and avoid non-breathable clothes. Your skin will stay dryer with natural fibers.
  • Kill yeast spores on any washable materials in your home. Yeast Infections and the Breastfeeding Family by Karen Zeretzke, IBCLC offers a comprehensive list of practical ways mothers can reduce Candida in the home and prevent reinfection, as well as a variety of comfort measures for mom and baby. *Please note that this is an older resource, and some of the information about how Candida infection affect mothers, and how it should be treated, has been updated or changed due to new evidence. The practical suggestions offered are still invaluable.
  • If all that fails to treat the Thrush you can consider the use of gentian violet. It is a common mistake to assume that the dye is a more natural way to address thrush. It’s not. Please make sure to dilute the dye if it is at 2% strength.
  • Regarding Gentian Violet according to Dr. Jack Newman:“We believe that gentian violet (combined with “all purpose nipple ointment”, see the information sheet Candida Protocol) is a good treatment of nipple soreness due to Candida albicans for the breastfeeding mother. This is because it often works even when used alone (though we don’t recommend this, see first paragraph), and relief is rapid. It is messy, and will stain clothing (actually, it will usually wash out eventually or may be removed from clothing with rubbing alcohol), but not skin. The baby’s lips will turn purple, but the purple will disappear after a few days. Gentian violet is available without prescription but is not available at all pharmacies. Call around before going out to get it. If you are in the US: gentian violet seems to be sold commonly as a 2% solution rather than a 1% solution. This is too strong a concentration and probably accounts for the mouth ulcers that some babies get after being treated with it. The pharmacist should dilute it for you. It’s easy to do on your own: just add an equal amount of water to the gentian violet 2% and you have gentian violet 1%.
    1. About 10 ml (two teaspoons) of gentian violet is more than enough for an entire treatment.
    2. Many mothers prefer doing the treatment just before bed so that they can keep their nipples exposed and not worry about staining their clothing. The baby should be undressed to his diaper, and the mother should be uncovered from the waist up. Gentian violet is messy.
    3. Your baby will be less purple if, before you apply gentian violet, you rub some olive oil into the baby’s cheeks and around his mouth.
    4. Dip a clean ear swab (Q-tip) into the gentian violet.
    5. Paint one of your nipples and the areola and let dry for a few seconds.
    6. Put the baby to the breast. In this way, both the baby’s mouth and your nipple are treated.
    7. When baby is finished on that side, touch up the gentian violet on the nipple if necessary, place a breast pad over top, and cover up that side.
    8. Repeat for the other side
    9. If, at the end of the feeding, you have a baby with a purple mouth, and two purple nipples, there is nothing more to do. If only one nipple is purple, paint the other one with the ear swab and the gentian violet. In this way, the treatment is finished in one go.
    10. A cotton pad can then be used to wipe the excess gentian violet from baby’s face
    11. 11. Repeat the treatment each day for at least three or four days t see if it is working and then continue for the rest of the week if it is seen to be working (see the Candida Protocol information sheet for how long to use gentian violet).
    12. There is often some relief within hours of the first treatment, and the pain is usually gone or virtually gone by the third day. If it is not, it is unlikely that Candida was the problem, though it seems Candida albicans is starting to show some resistance to gentian violet, as it already has to other antifungal agents. Of course, there may be more than one cause of nipple pain, but after three days the contribution to your pain caused by Candida albicans should be gone. However, if your pain is virtually gone after three or four days, but not completely, you can use gentian violet a few more days if necessary.”

Is it thrush or something else?

A few other conditions can result in breast pain, such as a poor latch, vasospasms, dermititis, or bacterial infection. A study on breast pain (Thomassen 1998) spoke on deep breast pain being more likely the result of bacterial infection- best treated with antibiotic medication. Occasionally the symptoms of breast infection, mimic the symptoms of thrush. Making matters more complex, a mother may have both a staphylococcal infection (the most common bacterial infection found on the nipple) as well as a thrush infection.

Topical infections of the nipple, called comorbid infections (bacterial and fungal combined) have been identified. If a mother has early tissue break down from nursing trauma or fungal infection, bacteria and/or fungus may find entry through cracked or damaged skin. Seeking medical treatment and consulting an IBCLC will help a mother find the right tools to heal her first line of defense: her skin. Maintaining healthy intact skin is always the very best way to avoid disease or infection.

Storing milk during thrush outbreak

Milk expressed during a thrush infection can be fed to your baby immediately while you are both being treated. It is best not to freeze or store this milk for later use but new evidence says that the likelihood of reinfection from stored milk is very low. Please see milk storage and handling guidelines for more information.

 Sources:

Dugdale D. III, Vyas J. Zieve D. “Thrush“. A.D.A.M. Medical Encyclopedia. Division of General Medicine, Department of Medicine, University of Washington School of Medicine; and , Harvard Medical School, Division of Infectious Disease, Department of Medicine, Massachusetts General Hospital. Also reviewed A.D.A.M., Inc. (Aug 2011)

Aydemir C et al., “Randomised controlled trial of prophylactic fluconazole versus nystatinfor the prevention of fungal colonisation and invasive fungal infection in very low birth weight infants.”  Arch Dis Child Fetal Neonatal Ed. 2011 May;96(3):F164-8. Epub 2010 Jul 21.  U. Neonatal Intensive Care Unit, Zekai Tahir Burak Maternity Hospital, Samanpazari, Ankara, Turkey.

Niimi M, Firth NA, Cannon RD. “Antifungal drug resistance of oral fungi.” Odontology. 2010 Feb;98(1):15-25. Epub 2010 Feb 16.  Department of Oral Sciences, School of Dentistry, University of Otago, New Zealand.

Goins RA, Ascher D, Waecker N, Arnold J, Moorefield E. “Comparison of fluconazole and nystatin oral suspensions for treatment of oral candidiasis in infants.”  Pediatr Infect Disease Journal. (Decemeber, 2002) 21(12):1165-7. Wilford Hall USAF Medical Center, San Antonio, TX, USA.

Thomassen P, Johansson VA, Wassberg C, Petrini B. “Breast-feeding, pain and infection.” Gynecol Obstet Invest. (August 1998) 46(2):73-4.  Department of Obstetrics and Gynecology, Stockholm Söder Hospital, Karolinska Institutet, Stockholm, Sweden.

Ignacio C, Thai D. “Comparative analysis of antifungal activity of natural remedies versus miconazole nitrate salt against candida albicans.” Biological Sciences Dept, College of Science and Mathematics, California Polytechnic State University, San Luis Obispo. (2005)

Heggers, J. P. et al., “The Effectiveness of Processed Grapefruit-Seed Extract as an Antibacterial Agent: II. Mechanism of Action and In Vitro Toxicity.” Journal of Alternative and Complementary Medicine, (2002) Vol. 8: No. 3, 333-340

O’Sullivan, G.C. “Probiotics”. British Journal of Surgery (2001) 88, 161-162. Department of Surgery, Mercy Hospital, and Department of Surgery and Cork Cancer Research Centre, University College Cork, National University of Ireland, Cork, Ireland

Wilson-Clay B, Hoover K. The Breastfeeding Atlas. 4th edition. Manchaca, Texas: LactNews Press, 2008.

Riordan J, Wambach K. Breastfeeding and Human Lactation. 4th edition. Sudbury, Massachusetts: Jones and Barlett Publishers. 2010.

(c) 2015 Serena Meyer RN, IBCLC. All Rights Reserved
Updated 3/2017

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Asian-style chicken and broccoli

Here’s a quick, inexpensive, and healthful meal that is both simple and delicious. Use what you have in your pantry to make a simple marinade and sauce that will bring your family running to the table.

1 lbs chicken breast meat (cut up)
1 lb fresh or frozen broccoli
1 c white or brown rice (optional)
your choice of seasonings

Cut up chicken. Place in medium sized bowl. Make a simple marinade from ingredients you have in your cabinet. I used soy sauce, chopped garlic, red pepper flakes, and garlic ginger Asian salad dressing. The longer you leave it sitting, the more flavorful the chicken.  You can make it ahead and leave it in your refrigerator overnight, or let it rest for just 15 minutes before you begin cooking.

If you’re using frozen broccoli, put it on the counter to begin thawing.

Next, begin cooking rice by package instructions. There are some great rice cooking tips here. If you’re limiting carbohydrates, feel free to omit the rice. Chicken and broccoli stand well on their own.

Heat a large skillet and coat with either cooking spray or a Tbs or so of cooking oil.  Add chicken (leave marinade in bowl for now). Cook chicken on both sides until slightly browned. Pour marinade over the chicken and allow it to come up to boil. Add thawed frozen or fresh broccoli to the skillet. Stir occasionally until broccoli is bright green and fork tender.

To plate: Start with a serving of rice, top with chicken, broccoli, and sauce. Finish with your favorite seasonings. Enjoy!

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