Dip an ear swab (Q-tip) into the gentian violet.
Put the purple end of the ear swab into the baby's mouth and let him suck on the swab
for a few seconds. The gentian violet usually spreads around the mouth quickly. If it does
not, paint the inside of the mouth to cover as much of the inside of the cheeks and tongue
as possible.
Put the baby to the breast. In this way, both the baby's mouth and your nipple are
treated.
If, at the end of the feeding, you have a baby with a purple mouth, and two purple
nipples, there is nothing more to do. If only one nipple is purple, paint the other one
with the ear swab and the gentian violet. In this way, the treatment is finished in one
go.
Repeat the treatment each day for three or four days.
There is often some relief within hours of the first treatment, and the pain is usually
gone or virtually gone by the third day. If it is not, it is unlikely that Candida was
the problem, though it seems Candida albicans is starting to show some resistance
to gentian violet, as it is to other antifungal agents. Of course there may be more than
one cause of nipple pain, but after three days the contribution to your pain caused by Candida
albicans should be gone. Do not continue the gentian violet if no relief occurs
after 3-4 days of treatment. Instead, get more information.
All artificial nipples that the baby uses should be boiled daily during the treatment,
or well covered with gentian violet. Consider stopping artificial nipples.
There is no need to treat just because the baby has thrush in his mouth. The reason
to treat is the mother's and/or the baby's discomfort. Babies, however, do not commonly
seem to be bothered by thrush.
Uncommonly, babies who are treated with gentian violet develop sores in the
mouth which may cause them to reject the breast. If this occurs, or if the baby is
irritable while nursing, stop the gentian violet immediately, and contact the clinic. The
sores clear up within 24 hours and the baby returns to feeding.
If the infection recurs, treatment can be repeated as above. But if the infection
recurs a third time, a source of reinfection should be sought out. The source may be the
mother who may be a carrier for the yeast (but may have no sign of infection elsewhere),
or from artificial nipples the baby puts in his mouth. Treatment of the mother (usually
with a medication other than gentian violet) at the same time as treatment is repeated for
the nipples will usually eliminate reinfection. Contact the clinic.
by Jack Newman, MD, FRCPC
