Before discussing the Candida Protocol, it is worth knowing that Candida (“yeast”, “thrush”) does not grow on normal skin. Therefore, if Candida is difficult to treat or returns after treatment, there is an underlying problem which is not being addressed. The underlying problem is usually a poor latch and damage caused to the skin. Even if the damage is not obvious, if there is soreness, there is damage. And why does the baby not latch on well? Because of:
“Technique” of positioning and latching the baby on
More than occasional use of artificial nipples such as bottles and nipple shields
The baby has a tongue-tie. Some tongue-ties are obvious, but many tongue-ties are more subtle and require an evaluation that goes farther than just looking, but includes feeling under the baby’s tongue and testing for upward mobility of the tongue as well and knowing what to feel for. Unfortunately, few health professionals, including some lactation consultants, know how to evaluate whether or not the baby has a tongue-tie. Also, even if the tongue tie was released at one point, tongue ties are far too often only partially released and/or re-attach.
The breastfeeding parent has had a decrease in milk supply. Late onset decreased milk supply and resulting slow flow is common and can also cause late onset sore nipples. Why? When the milk flow slows, the baby tends to slip down on the nipple and/or pulls at the breast or both. For more information on late onset decreased milk supply and what can be done, see the information sheet, “Late Onset Decreased Milk Supply or Flow”, as well as this link. Watch your baby at the breast and watch for drinking – see our video clips.
Whatever the cause of sore nipples in your case, it is important to get the best latch possible. Even if the cause of sore nipples is Candida (yeast, thrush), improving the latch can decrease the pain. With the “ideal” latch, the baby covers more of the areola (brown or darker part of the breast) with his lower lip than the upper lip. Note also that the baby’s nose does not touch the breast. Of course, it is not always easy to change the latch of the baby older than 3 or 4 months, but it is worth a try, and it often does help. Also see our videos showing how to latch on a baby. For a fuller description of how to get the baby to latch on well, see the information sheet “Latching and Feeding Management”.
An infection due to Candida albicans can be difficult to diagnose and mothers should not attempt to do so on their own. The pain due to Candida albicans is often confused with pain due to poor latching and/or pain due to vasospasm/Raynaud’s phenomenon. Furthermore, more than one cause of sore nipples may be the source of your pain. A good practitioner will help you to differentiate between these conditions.
For Nipple Pain: Treatment applied to the nipple(s)
The ointment is applied sparingly after each feeding (except the feeding if/when the breastfeeding parent uses gentian violet). “Sparingly” means that the nipple and areola will shine but you won’t be able to see the ointment. Do not wash or wipe it off, even if the pharmacist asks you to. The APNO can be used for any cause of nipple soreness (“all-purpose nipple ointments”), not just for Candida (yeast, thrush). Use the ointment until you are pain free for a few days and then decrease frequency over a few days until stopped. If you are not having less pain after 3 or 4 days of use, or if you need to be using it for longer than two or three weeks to keep pain free, get good help or advice but do not stop using the APNO.
Gentian violet (see the information sheet “Using Gentian Violet“). Actually, the gentian violet can be used along with the APNO from the very first, but it should not be used alone as it is drying and often does not work when used alone. Use once a day for four to seven days. If pain is gone after four days, stop gentian violet. If better, but not gone after four days, continue for seven days. Stop after 7 days no matter what, not because it’s dangerous, but if the gentian violet hasn’t helped in 7 days, it probably won’t. If not better at all after four days of use, stop the gentian violet, continue with the ointment as above and seek good help. Gentian violet comes as a 1% solution in water. It also usually dissolved in 10% alcohol, as gentian violet is not soluble in pure water. This amount of alcohol is negligible, as the baby will only get a drop of gentian violet at each treatment. Apparently some pharmacists will dissolve it in glycerin instead of alcohol, if you wish. Attention US residents: 2% gentian violet, which seems to be the usual concentration found in the US, should not be used. The pharmacist should dilute it to 1% for you.
If you are not getting better and/or you have pain in the breast as well that is not responding to treatment of the nipples alone:
The information presented here is general and not a substitute for personalized treatment from an International Board Certified Lactation Consultant (IBCLC) or other qualified medical professionals.
This information sheet may be copied and distributed without further permission on the condition that you credit International Breastfeeding Centre it is not used in any context that violates the WHO International Code on the Marketing of Breastmilk Substitutes (1981) and subsequent World Health Assembly resolutions. If you don’t know what this means, please email us to ask!
©IBC, updated July 2009, June 2017
Questions or concerns? Email Dr. Jack Newman (read the page carefully, and answer the listed questions).
Make an appointment at the Newman Breastfeeding Clinic.