Breastfeeding - Nipple Pain & Yeast

No matter what causes sore nipples, it is important to address the basics of latch and ensure that the latch is correct. Even if the cause of sore nipples is Candida (yeast, thrush), improving the latch can decrease the pain. Yeast pain is usually a burning sensation that lasts throughout the feeding session.\n\nFor nipple pain/Treatment applied to the nipple(s):\n1. Jack Newman's APNO (All Purpose Nipple Ointment) - compounded ointment with Mupirocin 2%, Betamethasone 0.1%, Miconazole powder to 2% concentration. Apply sparingly after each feed without wiping before next feeding. If no improvement after 3-4 days or if more than 2 weeks needed, seek re-evaluation.\n\n2. Gentian Violet 1% - Use once daily for 4-7 days. Causes staining. Apply with cotton swab to nipple/areola, allow to air dry, then nurse. May cause mouth sores in baby occasionally.\n\n3. Grapefruit Seed Extract (GSE) - Apply diluted solution (5-10 drops in 30ml water) directly on nipples. Use with APNO. Can increase concentration if needed.\n\nIf experiencing breast pain in addition to nipple pain:\n- Oral GSE: 250mg (2 tablets of 125mg) 3-4x daily\n- Probiotics: 10-20 billion cells 2-3x daily for mom (1 hour apart from GSE). Baby can be treated 2x daily x 7 days\n- Oral Fluconazole: 400mg by mouth x1 day, then 100mg twice daily x at least 13 days. Do not discontinue until pain free for at least 1 week. If no improvement after 10 days, discontinue.\n\nDiet modification: Reduce sugar intake to minimum. Avoid refined carbohydrates.