Breast and nipple pain in breastfeeding women is sometimes caused by a thrush (candida) infection in the breast. Breastfed babies can also develop thrush in their mouths.  

Thrush infections sometimes happen when your nipples become cracked or damaged. This means the candida fungus that causes thrush can get into your nipple or breast. 

Thrush infections can also happen after you or your baby has had a course of antibiotics. Antibiotics may reduce the number of helpful bacteria in the body and allow the candida fungus that causes thrush to flourish.

You may have a thrush infection in your breasts if:

• you start to feel pain in both nipples or breasts after feeds, having previously had no pain after feeding
• the pain can range from sore to severe and lasts for up to an hour after every feed

It's not likely to be thrush if:

• you have always experienced pain while breastfeeding
• the pain only affects 1 nipple or breast
• you have a fever
• there is a warm, red patch on 1 of your breasts

Signs to look for include:

• creamy white spots or patches on the tongue, gums, roof of the mouth or insides of the cheeks – if you gently wipe these patches with a clean cloth, they won't come off
• your baby being unsettled when feeding
• a white film on the lips
• in some babies, nappy rash that won't clear up

If you suspect you or your baby has a thrush infection, see your health visitor or GP. They can arrange for swabs to be taken from your nipples and your baby's mouth to see if thrush is present. It's important other causes of breast pain are ruled out before you start treatment for thrush. 

If no thrush is present, the pain may be caused by something else, such as poor positioning and attachment. It's important for your midwife, health visitor or a breastfeeding specialist to watch you do a full breastfeed and give advice if needed.

Read more about other possible causes of breast pain.

If either you or your baby does have thrush, you'll need to be treated at the same time as the infection can easily spread between you. It can also spread to other members of the family. 

Washing your hands carefully after nappy changes and using separate towels will help prevent the infection spreading. You'll also need to wash and sterilise any dummies, teats or toys your baby puts in their mouth.

You'll need to wash any breastfeeding bras at a high temperature and change your breast pads frequently while you're both being treated.

If you express any breast milk while you have thrush, you'll need to give the milk to your baby while you're still having treatment. Do not freeze it and use it at a later date, as this could cause the thrush to come back.

You can carry on breastfeeding while you and your baby are treated for thrush. 

Oral thrush in babies is usually treated with an antifungal gel or liquid. This is safe for your baby to have. It's important to wash your hands carefully after treating your baby. 

See more about treating oral thrush in babies.

Thrush in breastfeeding women is usually treated with a cream that you sparingly spread on and around your nipples after feeds. You'll need to wash your hands thoroughly after treating yourself. Some women may need to take antifungal tablets to clear the infection. 

Once you and your baby start treatment, your symptoms should improve within 2 to 3 days. It will take a little longer for the infection to clear completely. 

If you don't see any improvement within 5 days, speak to your health visitor or GP.