I am a new IBCLC working with a mother with very sore nipples.  Her newborn has a white tongue.  Could her nipple pain be caused by a yeast infection?

            MC, Florida, USA

A white tongue does not automatically indicate oral thrush.  Candida (“yeast”) infections spread rapidly in the mouth.  Within a day or two, white patches will appear on the palate, the inside of the cheeks, and the lips. If a white coating appears only on the tongue, it is probably not an indication of a fungal infection.  White tongue can be caused by various viral illnesses, but if the baby is not sick, a white tongue by itself is considered to be benign and does not require any treatment.

Mothers researching sore nipples often encounter information about yeast infections. If their infant has a white tongue, they may begin to self-treat their nipples with medications, essential oils, or caustic substances such as grapefruit juice that can cause allergic reactions. It is always best to get a medical diagnosis before recommending any “yeast” treatments, which may do more harm than good.

In the early postpartum, nipple pain that fails to improve within a few days is more likely to be the result of trauma related to a poor latch, or to a bacterial infection.  It can also result from ill-fitting pump flange or excessive pumping pressure.  It is important for the LC to start with suggestions to improve positioning, and to observe the mother’s pumping equipment and technique. Gentle cleansing (rinsing) of the nipples and application of expressed milk or purified lanolin generally speed healing.  If the pain gets worse or the nipples appear red or infected, the LC should refer the woman to a doctor for evaluation.  

The pictures below from The Breastfeeding Atlas may help your understanding.  The infant with the white tongue was born with a tooth.  His mother had very sore nipples and was concerned about a yeast infection.  However, there was no sign of any spread to the rest of the oral cavity. In this case, the mother’s nipple pain was related to trauma from the tooth. The second picture shows an infant with a diagnosed case of oral thrush.

Barbara Wilson-Clay, BSEd, IBCLC, FILCA

Infant a white tongue and a natal tooth

Oral Thrush