Thrush is an overgrowth of yeast in a baby's mouth which often transfers onto mom's nipples.  For a breastfeeding mother, this can mean a lot of discomfort and often an end to the breastfeeding relationship if it doesn't get diagnosed or remedied.  It is quite common for providers lacking breastfeeding skills to improperly diagnose thrush and many moms are told to not treat it or that the white in the baby's mouth is from milk.  This is unfortunate as many thrush treatments are available without any harmful side effects that can be utilized in a just-in-case fashion.

Symptoms of Thrush

Keep in mind that some thrush symptoms mimic symptoms of other circumstances like poor latch and tongue tie.  It is usually helpful to have multiple symptoms and sometimes why providers misdiagnose thrush.  If you're not quite sure and your case is mild, start with the mild treatments of thrush immediately to avoid worsening.

• Nipple discomfort like a feeling of irritation, burning or sandpaper while nursing (especially after a period of no breastfeeding discomfort).  Nipples are often more pink or more red than their normal appearance
• Burning and shooting pain within the breasts (ducts) during and between nursing sessions
• Cracked or bleeding nipples (especially after a period of no breastfeeding discomfort)
• White coating or spots inside baby's mouth (especially that don't come off when rubbing with your finger)
• Diaper rash (especially one that is splotchy and very irritated)
• Baby popping on and off the breast when coupled with other symptoms

Causes of Thrush

Thrush is caused when yeast overgrows in the baby's mouth and/or on mom's breast (often these are coinciding even when all symptoms are not present).  Yeast infections are not actually "infections" as yeast is present in all humans - so this "infection" is simply an overgrowth caused from imbalances.

• Gut health and general imbalances of food intake (the real underlying cause of most yeast overgrowth) prenatally and postpartum
• Medications in labor, especially antibiotics for Group B Strep causing yeast overgrowth in mom and baby
• Vaginal yeast infection not treated in pregnancy (also a contributor of early rupture of the membranes)
• Vaginal yeast infection not treated in early postpartum
• Poor latch (position, depth, tongue or lip ties, pacifier or bottle use) causing nipple damage and/or plugged ducts
• Overuse of lanolin or other moisture barrier nipple salve
• Dairy or other food allergens

Treatment of Thrush

In much of western medicine, prescriptions like Nystatin and Diflucan are often used for thrush treatment, but without good or consistent results.  In any thrush or yeast treatment case, focus on gut health to ensure overall body balance is achieved or you're likely to have recurring thrush and yeast overgrowth (including diaper rashes and vaginal yeast infections).  The following treatments are listed with mild treatments at the top and stronger treatments at the bottom.  Most can be combined using multiple methods.

When treating for thrush, treat your nipples and baby's mouth at the same time.  Treat all pacifiers, bottles, and toys that are in baby's mouth at the same time as well by boiling/sterilizing between uses.

Balance Your Lifestyle

Bacterial overgrowth is often a direct result of other imbalances in your life.  No matter the treatment of thrush you select, this must be a part of your thrush protocol.

• Eliminate processed sugar (reduce to the absolute minimum you can handle)
• Eliminate excess of bread, dairy, pasta, crackers, pancakes, muffins, and any processed item similar to these
• Eliminate allergen foods (often dairy, strawberries, citrus - especially undiluted juice)
• Increase dark leafy greens
• Increase all the colors of the rainbow in vegetable and fruit form
• Balance meat and grain intake
• Reduce stress (i.e. schedule overload, work load, family stress, lifestyle stress).  Stress wreaks havoc on bacterial balance due to hormonal and acidic changes within the body, immune system, and sometimes simply decreases your ability to choose healthy foods

Natural Thrush Treatment

• Air & Sunshine - Oxygen and sunlight will kill bacteria.  Go braless to let your nipples breathe and avoid compressing your milk ducts too much which can cause plugged ducts and encourage not only yeast overgrowth, but mastitis as well.
• Raw (or pickled) Garlic - Garlic has great bacterial balancing qualities excellent for any infection.  Cut up garlic cloves into pill-size pieces and swallow 3-10 cloves daily.  You can also just increase your intake of raw garlic in your foods like pesto or guacamole.  Garlic oil can be rubbed on the nipples and a diaper rash.  Some baby's may not like this treatment in their mouth, though some do like the taste of the breastmilk so still receiving the benefits.
• Herbal Infused Oil or Herbal Wash with at least Calendula in the ingredients.  Other herbs beneficial with Calendula are Lavender and St. John's Wort.   This is *not* a pure or diluted essential oil.  While essential oils may be of benefit (like lavender or tea tree in some cases, but not internally for a baby especially), the essential oils of plants are the volatile oils which do not contain all the healing constituents as the whole plant and are not as safe to put in a baby's mouth.  Also, keep in mind, this is not a salve.  While salves can be healing - when it comes to thrush, items like beeswax and lanolin seal off the nipple from oxygen which is needed to kill bacteria and traps moisture which makes bacteria grow.  Salves can be helpful when bacteria overgrowth isn't a problem; however, here you're looking for herbs infused in quality olive oil or coconut oil or a wash made with herbal tinctures and diluted or infused in Apple Cider Vinegar (or other live culture vinegar).
• Probiotic Paste - Probiotic powder mixed in olive or coconut oil to make a paste is great for nipples, diaper rash and eating.  Baby can suck off probiotic powder from your finger (no paste or yogurt needed).  Some moms prefer to use plain yogurt for the same reasons.  Plain is key here.  Keep in mind, though, dairy can contribute to yeast overgrowth - but sugar imbalances - especially processed sugar - is a food that yeast loves.  Plain yogurt can be soothing topically.
• Apple Cider Vinegar - While it doesn't have to be ACV specifically, you want to avoid white or distilled vinegar.  You're looking for a live culture vinegar which has both probiotics and can be taken internally.  Vinegar is helpful for soaking into the skin for ease of application in the diaper region (dry bum usually equals a bum without rashes - no diaper creams needed so be sure to completely dry the entire diaper region and folds before putting on diapers if you're not using EC) or when clothing is a must, but be careful not to overdo it on the nipples.  Adding an herbal infused oil over the ACV gives you both properties without over-drying and cracking or creating a moisture barrier.
• Oil of Oregano - This is the whole oregano herb infused into oil NOT the essential oil of oregano.  Big difference - be mindful.  This infused oil can help topically after a nursing session or on the diaper area, but I would advise against using this in baby's mouth as it is a hot oil that can be very irritating to mucous membranes (whole infused herb included but definitely a no on the essential oil for a baby).  Some moms rub this infused oil or diluted essential oil on the bottom of a baby's feet (and despite what oil professional you may know, this isn't actually the best place for oil application and absorption - but does help keep baby's hands away from it and then rubbing it in their eyes... ouch!).  Not a wide range of positive outcomes with this treatment, but I'm adding it here for information's sake.

Intensive Thrush Treatment

• All Purpose Nipple Ointment (APNO) - Dr. Jack Newman's Candida Protocol is helpful when there is nipple pain and the previous treatments (AND food balance) doesn't work or you've found out you're dealing with thrush when it's an intense case (or really for anyone that just wants a more western medicine approach that actually works).  Like the natural remedies, this can be used from the beginning for any nipple discomfort until latch is managed or if you're not sure if its thrush or not or if it is another type of infection.  Keep in mind, this blend often prescribed by Dr. Jack Newman's International Breastfeeding Centre is really mostly for reducing pain, and may not support healing thrush because the best way to heal thrush is really to fix the latch.  The treatment the clinic uses to really treat thrush specifically, see the next bullet point.  The basics of this treatment are having a compounding pharmacy blend: Mupirocin 2% ointment (15 grams), Betamethasone 0.1% ointment (15 grams), and then add miconazole powder so that the final concentration is 2% miconazole. This combination gives a total volume of just more than 30 grams.  See Dr. Jack Newman's site for more thorough details as needed.
• Medical-Grade Honey - This is NOT raw honey, despite its benefits.  Medical-Grade Honey is a form of manuka honey that has been pasteurized to remove the risks of botulism and other bacterial spores.  This removes the risks of infant botulism that comes along with store-bought and other raw honey forms that should not be fed to an infant less than 1 year of age.  Medical-Grade Honey is the form of treatment Dr. Jack Newman's International Breastfeeding Centre recommends for specific treatment of thrush (despite how much his APNO is used, see previous bullet point).  One brand of Medical-Grade Honey is called MediHoney and can be purchased on Amazon, among other health food stores and OTC pharmacies.  This is great for just about any scrape, cut, or burn so its great to have in your medicine cabinet and diaper bag.  For thrush on the nipples, simply coat between nursing sessions and keep the breasts exposed to air for oxygen flow, or a dry breast pad to avoid the sticky ointment getting on your clothes.  While Medical-Grade Honey provides moist-wound treatment excellent for nipple damage, this ointment is mostly natural and does not create a barrier where bacteria grows, so it is often a better treatment than many of the commercial herbal-based treatments sold in many health food stores.
• Gentian Violet - Let me start this off by saying this is NOT a natural treatment despite what your mommy friends may tell you or what you read on mom blogs.  Gentian Violet is a dye used in surgical treatments among other scientific applications as well as to make black ink - among other things - but has been used for many years as a topical antibiotic.  A dilution of 1% can be painted on the nipples, then nurse, and touch up any uncoated spots after nursing.  Everything will be stained a bright plum purple for the duration of the treatment and a few days after.  This usually washes out of clothes, but not often so keep this in mind.  Coconut or olive oil can be rubbed on the baby's cheeks to prevent some facial staining.  Despite this not being a natural treatment, GV works very well and fast.  Many moms report relief within the same day.  If the pain has stopped after 3-4 days, discontinue use.  If not, continue for no more than a week for two reasons.  Too much GV may cause mouth ulcers (though this is typically from moms using a 2% dilution instead of a 1% dilution).  Also, because if it hasn't worked yet, it probably won't.  It may not be thrush and you could be dealing with a different kind of infection.  Gentian Violet can be found OTC in some pharmacies and, ironically, some health food stores.
• Citricidal Grapefruit Seed Extract (GSE) - Again, this is NOT a natural treatment despite what your mommy friends may tell you or what you read on mom blogs - or even some physician sites.  While some forms of GSE may truly be the extract of grapefruit seed, the real extract of grapefruit seed has been shown not to be effective on its own and there is a lot of controversy surrounding this treatment for breastfeeding and any other bacterial imbalance.  This is also NOT Grape Seed Extract.  Grapefruit Seed Extract sounds like it is an extract from the grapefruit seed - but it is actually a concoction with various processes that has virtually no grapefruit seed extract remaining.  It is, nevertheless, often useful for thrush treatment in the same application manner as gentian violet after diluting 5-10 drops per ounce of distilled water.  GSE can be found OTC in some pharmacies and, ironically, some health food stores.

Remember to get treatment for latch and positioning and any other possible breastfeeding concern while treating for thrush.  Many times there are underlying causes that need addressed so recurring thrush doesn't damage your breastfeeding relationship.  Also keep in mind that other breastfeeding infections exist like mastitis (which is NOT the same thing as plugged ducts, though may be caused from them).  If these treatments don't improve your symptoms within a few days to a week, consider other causes and seek the help of a qualified breastfeeding professional.