by Elizabeth Pantley, Author of Perfect Parenting and Kid Cooperation

Question
What are the signs of thrush? If we have it, how do we get rid of it?

Learn about it
Thrush (Candida albicans) is a common yeast infection that occurs in a baby’s mouth and diaper area, and on a nursing mother’s nipples. It is almost always harmless, but because it thrives in these warm, moist places, it is extremely stubborn and difficult to eliminate. In addition, it can be very annoying because it is quickly and easily transferred back and forth from mother to baby, until both are totally clear of it.

The signs of thrush in the baby
You baby may have all of these signs, some of them, or even none. If you suspect thrush, review both the signs for a baby and the symptoms that you have. The following are typical signs of thrush in a baby:

• White or gray spots or patches on the inside of your baby’s mouth, gums, or on his tongue. (A milk coating on the tongue wipes off easily; thrush does not.)
• An opalescent shine on your baby’s lips or inside his mouth.
• Red face, particularly on the cheeks.
• Persistent diaper rash that doesn’t respond well to usual remedies.
• Fussiness that appears worse during or after feeding.
• Bleeding of the mouth or gums in severe cases.

Signs of thrush in the mother
The following are typical signs of thrush, but many of these can signal other problems as well. If you review the list for yourself and that for your baby, and suspect thrush is the problem, call your healthcare provider, lactation consultant, or La Leche League leader.

• Pain in the nipples or breasts during or after feedings that may persist between feedings
• Deep pink, red or purple discoloration of the nipple and areola
• A shiny glow on the areola
• Dry, peeling nipples
• Rash or white spots on the nipples
• Itching or soreness that indicates a vaginal yeast infection

Note: You are particularly susceptible to thrush infection following the use of antibiotics, as these medications kill off not just “bad” bacteria, but the “good” types that keep candida under control.

Treating the family
If you suspect a thrush infection, both you and your baby will need treatment simultaneously until all signs of thrush are gone. If you are also nursing an older child, you will have to treat her, too. In some cases, your partner or other members of the family may shows signs of thrush (athlete’s foot, severe dandruff, jock itch, vaginal yeast infection) that will have to be treated to prevent the recurrence of thrush in the family.

Treating the baby
Many babies with thrush show little response to the yeast infection. For others, it is painful and prevents proper nursing. In that case, the infection should be treated promptly and aggressively so that your baby’s growth is not compromised. It’s important that you talk to your baby’s doctor, who may prescribe a topical medication that can be applied directly to your baby’s mouth for pain relief and to clear up the infection. The most common medication is a prescription anti-fungal cream. A homeopathic doctor can talk with you about using a tincture made of usnea lichen, mugwort, rosemary, or unsweetened yogurt with active cultures.

An alternative treatment is 1% gentian violet solution, painted with clean cotton swabs onto affected areas once a day prior to breastfeeding. These areas include your baby’s mouth as well as your nipples and areolae. It’s very messy and will turn your baby’s lips and your nipples purple for a few days, but it is often very effective. (Watch your baby’s mouth carefully for any signs of negative reaction, such as sores, from the treatment. Too much of the solution can burn the skin’s surface. If anything seems amiss, or if no relief occurs within four days, stop treatment and visit your doctor.)

In addition, the following may help your baby feel better, speed up the eradication of the infection, and prevent it from recurring:

• Change diapers immediately when your baby’s wet or soiled.
• Coat baby’s bottom with a diaper ointment between changes.
• Avoid using diaper wipes with ingredients that may cause stinging.
• Let your baby’s bottom dry thoroughly before re-diapering, and allow your baby to be naked for a time during the day.
• Avoid using plastic diaper covers. Instead, use coverings that allow air to circulate, or go cover-less if you’re not expecting a big poop anytime soon.
• Wash cloth diapers, cloth wipes, towels, and washcloths in very hot water to remove all traces of the yeast. A vinegar rinse will complete the disinfecting process.

Treating the mother
Talk with your doctor or lactation consultant about your suspicion of a thrush infection. She will confirm the diagnosis and prescribe a medication to clear up the thrush and any accompanying vaginal yeast infection. As mentioned earlier, if thrush is confirmed in the mother, the baby must be treated also, or the infection may continue to be passed back and forth between you. The following also can be helpful when treating thrush:

• Take an over-the-counter medication, such as acetaminophen (such as Tylenol) or ibuprofen (such as Advil), for breast pain; alternatively, try chamomile, skullcap, or low doses of valerian.
• Place ice packs on the nipples prior to feeding to reduce pain.
• Massage the breasts to stimulate letdown before attaching your baby to the breast.
• Start feeding sessions on the least painful side.
• Take extra care in ensuring a proper latch when nursing.
• Position your baby tummy-to-tummy with you for feeding to create a straight latch position and reduce pulling on the nipple.
• Break the suction with your finger to gently detach baby from your breast.
• Go braless or topless, or keep the flaps down on your nursing bra to allow your nipples to air dry.
• Avoid using breast pads, as these create a warm, moist place for yeast to thrive.

How to prevent recurring infections

• Clean and sterilize all pacifiers, teethers, and bottle nipples after each use.
• Let nipples dry after breastfeeding before covering them with clothing.
• Avoid letting your baby suck for long periods on a bottle or pacifier.
• Discard breastmilk that was expressed and stored during a thrush infection.
• Maintain diligent hygiene with frequent handwashing after breastfeeding, diapering, and using the toilet. Pay attention to underneath the fingernails, too. Wash your baby’s hands frequently.
• Avoid excess sugar ¾ that applies to you and baby.
• Add plain yogurt to your diet (and to your baby’s diet if she is eating solid food).
• Avoid fermented foods, such as cheese, beer, and wine.
• Wear clothing that allows the skin to breathe, and avoid synthetic fabrics.
• Use regular hand soap instead of antibacterial soap ¾ it kills beneficial bacteria that control yeast growth.
• Disinfect toothbrushes and mouth appliances regularly with a bleach and water solution, or put them in the dishwasher.
• Wash dishes in very hot water.
• Discard solid deodorants used during a thrush infection.
• If the thrush infection isn’t going away, have other family members and even pets checked to see if they are carriers.

Copyright Elizabeth Pantley. (McGraw-Hill, 2003)

About the author:
Elizabeth Pantley is the author of several books, including Gentle Baby Care : No-cry, No-fuss, No-worry — Essential Tips for Raising Your Baby, The No-Cry Sleep Solution: Gentle Ways to Help Your Baby Sleep Through the Night, Kid Cooperation (with an introduction by William Sears, MD), Perfect Parenting, as well as her latest The No-Cry Sleep Solution for Toddlers and Preschoolers and is also president of Better Beginnings, Inc. She is a popular speaker on family issues, and her newsletter, Parent Tips, is seen in schools nationwide. She appears as a regular radio show guest, and has been quoted in Parents, Parenting, Redbook, Good Housekeeping, American Baby, Working Mother, and Woman’s Day magazines. Visit Elizabeth’s web site http://www.pantley.com/elizabeth.

By Elizabeth Pantley, Author of No Cry Sleep Solution

Congratulations on the birth of your new baby. This is a glorious time in your life. Whether this is your first baby or your fifth, you will find this a time of recovery, adjustment, sometimes confusion and frustration, but — most wonderfully — of falling in love.

Babies younger than four months old have very different sleep needs than older babies. This article will help you understand your newborn baby’s developing sleep patterns, and will help you develop reasonable expectations when it comes to your baby and sleep.

Read, Learn, and Beware of Bad Advice
Absolutely everyone has an opinion about how you should handle sleep issues with your new baby. The danger to a new parent is that these tidbits of misguided advice (no matter how well-intentioned) can truly have a negative effect on our parenting skills and, by extension, our babies’ development…if we are not aware of the facts. The more knowledge you have the less likely that other people will make you doubt your parenting decisions.

When you have your facts straight, and when you have a parenting plan, you will be able to respond with confidence to those who are well-meaning but offering contrary or incorrect advice. So, your first step is to get smart! Know what you are doing, and know why you are doing it. Read books and magazines, attend classes or support groups – it all helps.

The Biology of Newborn Sleep
During the early months of your baby’s life, he sleeps when he is tired, it’s really that simple. You can do very little to force a new baby to sleep when he doesn’t want to sleep, and conversely, you can do little to wake him up when he is sleeping soundly.

A very important point to understand about newborn babies is that they have very, very tiny tummies. New babies grow rapidly, their diet is liquid, and it digests quickly. Formula digests quickly and breast milk digests even more rapidly. Although it would be nice to lay your little bundle down at a predetermined bedtime and not hear a peep from him until morning, even the most naïve among us know that this is not a realistic goal for a tiny baby. Newborns need to be fed every two to four hours — and sometimes more.

During those early months, your baby will have tremendous growth spurts that affect not only daytime, but also nighttime feeding as well, sometimes pushing that two- to four-hour schedule to a one- to two-hour schedule around the clock.

Sleeping “through the night”
You have probably heard that babies should start “sleeping through the night” at about two to four months of age. What you must understand is that, for a new baby, a five-hour stretch is a full night. Many (but nowhere near all) babies at this age can sleep uninterrupted from midnight to 5 a.m. (Not that they always do.) A far cry from what you may have thought “sleeping through the night” meant!

What’s more, while the scientific definition of “sleeping through the night” is five hours, most of us wouldn’t consider that anywhere near a full night’s sleep for ourselves. Also, some of these sleep-through-the-nighters will suddenly begin waking more frequently, and it’s often a full year or even two until your little one will settle into a mature, all-night, every night sleep pattern.

Falling Asleep at the Breast or Bottle
It is very natural for a newborn to fall asleep while sucking at the breast, a bottle, or a pacifier. When a baby always falls asleep this way, he learns to associate sucking with falling asleep; over time, he cannot fall asleep any other way. I have heard a number of sleep experts refer to this as a “negative sleep association.” I certainly disagree, and so would my baby. It is probably the most positive, natural, pleasant sleep association a baby can have. However, a large percentage of parents who are struggling with older babies who cannot fall asleep or stay asleep are fighting this natural and powerful sucking-to-sleep association.

Therefore, if you want your baby to be able to fall asleep without your help, it is essential that you sometimes let your newborn baby suck until he is sleepy, but not totally asleep. When you can, remove the breast, bottle, or pacifier from his mouth and let him finish falling asleep without something in his mouth. When you do this, your baby may resist, root, and fuss to regain the nipple. It’s perfectly okay to give him back the breast, bottle, or pacifier and start over a few minutes later. If you do this often enough, he will eventually learn how to fall asleep without sucking.

Waking for Night Feedings
Many pediatricians recommend that parents shouldn’t let a newborn sleep longer than three or four hours without feeding, and the vast majority of babies wake far more frequently than that. (There are a few exceptional babies who can go longer.) No matter what, your baby will wake up during the night. The key is to learn when you should pick her up for a night feeding and when you can let her go back to sleep on her own.

This is a time when you need to focus your instincts and intuition. This is when you should try very hard to learn how to read your baby’s signals. Here’s a tip that is critically important for you to know. Babies make many sleeping sounds, from grunts to whimpers to outright cries, and these noises don’t always signal awakening. These are what I call sleeping noises, and your baby is nearly or even totally asleep during these episodes. I remember when my first baby, Angela, was a newborn. Her cry awakened me many times, yet she was asleep in my arms before I even made it from cradle to rocking chair. She was making sleeping noises. In my desire to respond to my baby’s every cry, I actually taught her to wake up more often!

You need to listen and watch your baby carefully. Learn to differentiate between these sleeping sounds and awake and hungry sounds. If she is awake and hungry, you’ll want to feed her as quickly as possible. If you respond immediately when she is hungry, she will most likely go back to sleep quickly. But, if you let her cry escalate, she will wake herself up totally, and it will be harder and take longer for her to go back to sleep. Not to mention that you will then be wide awake, too!

Help Your Baby Distinguish Day from Night
A newborn baby sleeps about sixteen to eighteen hours per day, and this sleep is distributed evenly over six to seven brief sleep periods. You can help your baby distinguish between nighttime sleep and daytime sleep, and thus help him sleep longer periods at night.

Begin by having your baby take his daytime naps in a lit room where he can hear the noises of the day, perhaps a bassinet or cradle located in the main area of your home. Make nighttime sleep dark and quiet. You can also help your baby differentiate day naps from night sleep by using a nightly bath and a change into sleeping pajamas to signal the difference between the two.

Watch for Signs of Tiredness
One way to encourage good sleep is to get familiar with your baby’s sleepy signals and put her down to sleep as soon as she seems tired. A baby cannot put herself to sleep, nor can she understand her own sleepy signs. Yet a baby who is encouraged to stay awake when her body is craving sleep is typically an unhappy baby. Over time, this pattern develops into sleep deprivation, which further complicates your baby’s developing sleep maturity. Learn to read your baby’s sleepy signs — such as quieting down, losing interest in people and toys, and fussing — and put her to bed when that window of opportunity presents itself.

Make Yourself Comfortable
I’ve yet to hear a parent tell me that she or he loves getting up throughout the night to tend to a baby’s needs. As much as we adore our little bundles, it’s tough when you’re woken up over and over again, night after night. Since it’s a fact that your baby will be waking you up, you may as well make yourself as comfortable as possible. The first step is to learn to relax about night wakings right now. Being stressed or frustrated about having to get up won’t change a thing. The situation will improve day by day; and before you know it, your little newborn won’t be so little anymore — she’ll be walking and talking and getting into everything in sight…during the day, and sleeping peacefully all night long.

About the Author:
Elizabeth Pantley is the author of several books, including Gentle Baby Care : No-cry, No-fuss, No-worry — Essential Tips for Raising Your Baby, The No-Cry Sleep Solution: Gentle Ways to Help Your Baby Sleep Through the Night, Kid Cooperation (with an introduction by William Sears, MD), Perfect Parenting, as well as her latest The No-Cry Sleep Solution for Toddlers and Preschoolers and is also president of Better Beginnings, Inc. She is a popular speaker on family issues, and her newsletter, Parent Tips, is seen in schools nationwide. She appears as a regular radio show guest, and has been quoted in Parents, Parenting, Redbook, Good Housekeeping, American Baby, Working Mother, and Woman’s Day magazines. Visit Elizabeth’s web site http://www.pantley.com/elizabeth.