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Infection with Candida albicans in the breastfeeding dyad has been associated with extreme pain in the breastfeeding mother and may lead to premature weaning. There is presently a dearth of information on diagnosis, natural history, and treatment of this condition in the literature. Therefore, before such a trial was conducted, a survey was sent to experts in the field of lactation, the members of The Academy of Breastfeeding Medicine, on the diagnosis and treatment of thrush in the breastfeeding mother and baby. Results showed that the majority of respondents relied primarily on history and physical examination of the baby, but not the mother, to make the diagnosis. Laboratory tests were ordered only rarely. The most common initial treatment was oral nystatin for the infant and cream for the mother's breasts. This was followed by oral nystatin for the infant and oral fluconazole for the mother. Treatment of recurrence or persistence was again most commonly nystatin for both mother and infant, followed by oral nystatin for the infant and oral fluconazole for the mother or oral fluconazole for both. In the absence of controlled trials of this condition, these results may serve as suggestions for the clinician, until definitive data are available.

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CME EDUCATIONAL OBJECTIVES: 1.Review the advantages and disadvantages of donor-banked milk over informal milk sharing.2.List disadvantages of proprietary infant formula for use as supplementation.3.Determine the primary ethical concerns when electing to use donor human milk versus propriety infant formula for supplementation. The benefits of breast-feeding, as well as the risks of some artificial formula, are well known. This growing recognition of the advantages of breast-feeding is reflected in the increased incidence of breast-feeding in recent years. However, one of the most common reasons for premature weaning is low milk supply, perceived or real, followed by nipple or breast pain. Given the increased awareness of the superiority of breast milk, however, more parents are turning to human donor milk to supplement their babies after they have been weaned.

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