It started on your nipples. A burning, stabbing feeling as your baby latched on, and you thought: he's just not on properly. But it didn't ease off. Now it feels deeper, as though the pain sits through your whole breast, still there long after your baby has finished. A lot of mothers describe exactly that path: on the nipples first, then, after a while, a stabbing pain deeper in the breast, as if someone is squeezing it. Sometimes the pain is so sharp it feels like knives or razor blades dragging through the breast.
If you've got pain like that and the word thrush has come up somewhere (from your midwife, on a forum, or in your own head), you're probably sitting with two questions. Is this really thrush? And if it is, why won't it clear up?
This piece gives you the two things you can check yourself, at home and today, before you spend weeks rubbing on one cream after another. One: how to tell from your baby whether it's thrush, with a simple wipe test. Two: why a burning nipple very often isn't thrush at all, and which signs do point that way. And if it does turn out to be thrush, why you and your baby have to be treated together, because otherwise you keep passing it back and forth.
Short answer. Thrush is an infection with a yeast (candida) that can sit on your nipple and in your breast as well as in your baby's mouth. The recognisable picture is burning or stabbing pain in both breasts that carries on between feeds and lingers afterwards, together with a white coating in your baby's mouth that won't wipe off and, often, a stubborn nappy rash. If that sign is missing in your baby, thrush is actually unlikely, and there's usually something else behind your pain, like a shallow latch or a spasm in the tiny blood vessels of your nipple. And if it is thrush, the two of you need treating at the same time, by a GP or a lactation consultant.
How does thrush feel? The pain mothers describe
Thrush hurts in a fairly recognisable way. Burning, stabbing, sometimes a deep throb, and often not on one side but in both breasts. For a lot of mothers it sits on the nipple first and only creeps deeper after a few days, until it's not just the nipples but the whole breast that aches fiercely. The pain can feel as sharp as knives cutting into the nipples.
What's most telling isn't how bad the pain is, but the pattern. Ordinary feeding tenderness flares mainly as your baby latches on and then fades. Thrush pain carries on between feeds and often hangs around for a while after a feed, as if your breast keeps glowing. That carrying on, in both breasts, is one of the things a GP or lactation consultant will ask about.
Worth knowing: it isn't always the case that you and your baby both have it visibly at the same time. One of you feels the pain with nothing to see in the mouth, for the other it's the other way round. Some mothers have a lot of pain themselves while their baby shows no signs at all. That's what makes it tricky, and it's exactly why below we don't look at one single sign but at the whole picture.
Why a burning nipple often isn't thrush
Now the part you won't read on most sites, and that can save you weeks of pain. Over the last few years the line taken by La Leche League, by the NHS and the Breastfeeding Network, and by big clinics has shifted quite a bit. The heart of it: thrush is hardly ever the cause of nipple pain. A shallow or off-centre latch, a spasm in the blood vessels of the nipple (vasospasm, also called Raynaud's), or a skin problem like eczema are far more often to blame. Thrush, if anything, gets pinned on too quickly.
And then something happens that you'll see in almost every forum thread. The mother rubs on cream for weeks, switches products, tries everything, and the pain stays. Six weeks of an antifungal cream for yourself and a gel for your baby is not unusual. If it isn't thrush, a thrush treatment naturally won't work, and meanwhile the real cause, usually the latch or vasospasm, goes untreated. That's how you end up months down the line with nothing better.
So first this: which signs do point towards thrush? There are three that count together.
- Pain in both breasts. Thrush is rarely one-sided. If you only feel it on the left or only on the right, a local cause (a crack, a tender spot, the latch on that side) is more likely.
- Pain that carries on between and after feeds. Not just that sharp sting as your baby latches on, but a burning or throbbing feeling that stays.
- A visible sign in your baby. A white coating in the mouth that won't wipe off, and often a stubborn, angry-red nappy rash. If that baby sign is missing altogether, thrush is a good deal less likely.
Do you recognise yourself more in a short, fierce pain soon after a feed, where your nipple blanches white first and then changes colour, and it's worse in the cold? That fits vasospasm better than thrush. If your main doubt is about the nipple itself, cracks, tenderness or the latch, it helps to first go through what to check first with nipple pain, because nine times out of ten that's where the answer sits.
The wipe test: how to tell from your baby whether it's thrush
This is the one thing you can do at home today, and it clears up the biggest uncertainty straight away. Because a white tongue very often isn't thrush at all. Milk residue on the tongue is perfectly normal in a breastfed baby, and a lot of mothers get an unnecessary fright from it. That's exactly the doubt you hear so often: thrush has supposedly been diagnosed, when there are no real white patches, only a white film on the tongue.
Here's how to do the wipe test. Wash your hands and gently wipe a clean finger, or a clean, damp piece of gauze, over the white patch in your baby's mouth.
- Does it wipe away, with normal pink tongue underneath? Then it's almost certainly just milk residue. Harmless, and no cause for worry.
- Does it stay put and leave a red, irritated patch behind (that sometimes bleeds a little) if you do manage to lift it? Then that fits thrush. A thrush coating sits not only on the tongue but also on the inside of the cheeks, on the gums or against the roof of the mouth, as white, soft patches.
For one baby the stuck-on white patches in the mouth are obvious, alongside a white film on the tongue. For another the doubt lingers precisely because all you can see is that stubborn white tongue. The difference between those two is exactly what the wipe test settles for you.
Check one more thing while you're at it: the nappy area. Candida loves warm and damp, so a thrush infection often goes hand in hand with a stubborn, angry-red nappy rash, sometimes with small red spots around the edge, that won't shift for ordinary nappy cream. If you can see the wipe-proof white patches and a nappy rash like that, the odds of thrush are higher.
Why it won't clear up: the reinfection loop
Say it is thrush. Then comes the hardest part, and the very reason it drags on for weeks in so many mothers. Candida travels back and forth between your breast and your baby's mouth. Treat only yourself, and your baby hands it back to you at the next feed, and the other way round. It's a kind of fungus that you keep passing between you.
That's also where the doubt you read so often comes from, whether you're both actually being treated properly: treating only yourself, and your baby with a home remedy like coconut oil, often doesn't feel like enough. That instinct is right. You and your baby need treating at the same time, even if only one of you has symptoms. If you don't, the ball keeps bouncing back and forth between you and it looks as though nothing helps, when the real problem is that one side keeps being left untreated.
That's why rubbing on cream for weeks without a diagnosis is so often why it lasts so long. Not because you're doing anything wrong, but because a fungus ping-ponging between two people only stops when you tackle both sides together, with the right treatment, and that goes through a GP or lactation consultant.
When to ring your GP or lactation consultant
Thrush doesn't belong in the try-it-yourself category, for two reasons. First, you need the right treatment for both of you at once, and that comes from a doctor. Second, some more serious things look like thrush at the start, and you don't want to miss those. So contact your GP or a lactation consultant, and don't sit and wait, if you notice one or more of these:
- Persistent, burning nipple pain that doesn't improve within a few days or keeps coming back. Even if you're not sure yet whether it's thrush, this is the point to have it assessed rather than reach for another product.
- Broken, cracked or bleeding nipples. They're painful in their own right and a way in for bacteria, and they should be looked at.
- A fever, or a red, warm, painful patch in your breast with a fluey, shivery feeling. That doesn't fit thrush but a breast infection, and that's more urgent. Read how to recognise a breast infection and when to call. If instead you feel a clearly defined hard, painful spot with no feeling of illness, look at recognising a blocked milk duct.
- Your baby feeds poorly, is unsettled at the breast, or has noticeably fewer wet nappies. A sore mouth can put a baby off feeding, and then you want someone to take a look.
A practical word on where to go. In the UK your GP is who you ring for anything that needs a prescription, like thrush. In the early weeks your midwife can think it through with you, and after that your health visitor and your local NHS infant feeding team are there for feeding support. A lactation consultant (IBCLC) is worth her weight in gold for going through the latch and the cause of your pain with you; you can find one through the Lactation Consultants of Great Britain (LCGB) directory, and the National Breastfeeding Helpline (0300 100 0212) is there for the everyday questions. Your health visitor and the baby clinic are lovely for support, but an infection that needs a prescription belongs with a doctor. Not sure it's worth a phone call? It is. There's no breast complaint too small to ask about.
What you can do while you wait for your appointment
While you wait for your appointment or your result, you're not left empty-handed. These things make the stretch more bearable and help stop a fungus spreading easily. They don't replace treatment, but they do support it.
- Wash your hands often, and certainly before and after a feed and after a nappy change. Candida spreads on hands.
- Keep it dry. A yeast thrives in a warm, damp place. Let your nipples air-dry after a feed before you do your bra back up, and don't sit for long in a clammy breast pad.
- Wash things hot. If you use fabric breast pads, bras and muslins, wash them on a hot cycle and dry them well, so you don't keep the fungus in the wash.
- Keep feeding as a rule. With thrush you can usually carry on feeding. Talk to your GP or lactation consultant about the most comfortable way to do that, especially if feeding hurts.
Gentle support through a painful stretch
In days like these there's one thing you can do without: a bra that presses, rubs or stays clammy against a nipple that's already burning. Soft, dry support helps you through the stretch, even though it's your doctor and not your bra that clears the thrush.
Our nursing bra is wireless and knitted from a soft, giving fabric that holds your breast in place without pressing hard against anything, with a clip that opens one-handed so you can feed quickly and without a fuss. It's made from an OEKO-TEX Class I certified fabric (certificate number 11-36224), the strictest category for textiles that come against a baby's skin, and the absorbent layer catches up to 30 ml per cup so your shirt stays dry if you do leak a little. It doesn't heal or prevent thrush, that's down to the right treatment and your doctor, but it is comfortable to wear through exactly this sensitive stretch. If you'd rather have everything on milk supply and breast problems together first, go to the overview of milk supply and breast problems. And you can see the bra itself here: see the nursing bra.
Frequently asked questions about spotting thrush
How do I know if it's thrush or just a poor latch?
Look at three things together. Thrush usually sits in both breasts, the pain carries on between and after feeds, and there's a visible sign in your baby (wipe-proof white coating, often an angry-red nappy rash). If the pain is on one side only or mainly as your baby latches on, and you can see nothing in your baby, a latch problem or something else is more likely than thrush.
Can my baby have thrush without me being in pain, or the other way round?
Yes. It isn't always visible in both of you at once: sometimes you feel the pain with nothing to see in the mouth, sometimes it's the other way round. That makes it hard to spot. The important thing is that if thrush is diagnosed in one of you, the two of you are treated at the same time, because otherwise you reinfect each other.
Why won't my thrush clear up after weeks of creams?
Usually for one of two reasons. Either it isn't thrush but, say, a latch problem or vasospasm, so a thrush treatment doesn't work. Or it is thrush, but only one of you is being treated, so you keep reinfecting each other. In both cases carrying on rubbing cream yourself doesn't help, and you need a GP or lactation consultant for the right diagnosis.
Is a white tongue in my baby always thrush?
No. Milk residue on the tongue is perfectly normal in a breastfed baby and it looks white too. You tell the difference with the wipe test: gently wipe with a clean finger or piece of gauze. Does it wipe away with pink tongue underneath, it's milk. Does it stay put and leave a red patch, that fits thrush.
Can I keep feeding if I have thrush?
With thrush you can usually carry on feeding and don't have to stop. It can hurt, though, so have your latch and your pain looked at together with a lactation consultant, because a better position often makes a big difference. Talk to your doctor about treating you and your baby at the same time, so the infection doesn't keep going back and forth.
Read on in this guide
- Recognise a breast infection and know when to call
- Recognising and clearing a blocked milk duct
- What to check first with nipple pain
- Fabric choice and skin comfort for sensitive nipples
- Everything on milk supply and breast problems (the overview)
