MASTITIS IS NEVER FUN.Pain, flu-like symptoms, and an often fussy baby make it one of the most dreaded breastfeeding problems. And to add insult to injury, when it's all over many moms discover that their milk supply on the affected breast has declined significantly. HOW TO PROTECT AND REBUILD YOUR SUPPLY DURING AND AFTER MASTITIS:1. Empty your breasts frequently. During the infection and
treatment, nurse or pump as often as you can on the affected breast. Frequent milk removal is the most important factor in sustaining and rebuilding a milk supply. Frequent emptying will also keep milk moving – a key to preventing a recurrence when an infection starts as a plugged duct. Continue to feed or pump often on the affected side after the treatment has ended, and be vigilant about any congestion of milk in the area of infection, using massage and warmth to keep the milk
moving during feeding and pumping. 2. Start on the affected side. Begin each feeding on the affected breast. Babies nurse more vigorously and remove more milk on the first side. Just make sure that the other breast doesn't become overly full. If it does, nurse or pump a bit more on that breast to reduce the pressure. 3. Nurse or pump more often on the affected side. See if you can squeeze in an extra feeding or
pumping (or two!) each day on the affected side. If your baby is fussy on that breast, it may help to offer it in between feedings when he's less hungry and may have more patience for the lower volume of milk. 4. Compress your breast during feeding and pumping. During nursing and pumping, use your hands to compress your breasts. This will result in more milk removal, which in turn will increase your supply. Remember that the emptier your breast is, the stronger the message to your body to produce more. 5. Pump the affected breast after feedings, especially using hands-on pumping. Pumping
for 5 to 10 minutes on the affected side after feedings work to increase milk supply. Especially helpful is a research-proven method for increasing milk supply called "hands-on pumping." Give it a try! 6. If your baby refuses the affected breast,
pump as often as you would be feeding. Sometimes babies refuse the breast that had the infection, usually because the supply has declined significantly. If your baby won't nurse on that side, it's critical that you work to maintain your supply. Pump (especially "hands-on pumping"), or try one of the other recommendations in our post on keeping up supply when your baby won't nurse. 7. Hold your baby skin-to-skin. What breastfeeding list would be complete without a recommendation to hold babies skin-to-skin? Skin-to-skin contact
boosts your milk-making hormones. And for babies who are refusing the affected breast, it's a great way to coax them back. 8. Consider a galactagogue. Galactagogues like those found in our More Milk Moringa, More Milk Plus, and More Milk Special Blend may support the restoration of your milk
supply after mastitis, especially when used along with frequent milk removal. 9. Restore your strength. Mastitis can take a big toll on your already tired, new-mom body. See what you can do to get more rest, including asking friends and family for help, and napping when your baby naps. Increase your intake of immune-boosting herbs and nutritional powerhouses like nettle and dandelion, and stay well hydrated. - How do I know if I have mastitis or a plugged duct?
- Common (and not-so-common) side effects of plugged ducts or mastitis
- What are the usual causes of plugged ducts or mastitis?
- What is the usual treatment for plugged ducts and mastitis?
- Does mastitis always require antibiotics?
- References and additional information
How do I know if I have a plugged duct or mastitis?
PLUGGED DUCT
| A plugged (or blocked) duct is an area of the breast where milk flow is obstructed. The nipple pore may be blocked (see Milk Blister), or the obstruction may be further back in the ductal system. A plugged duct usually comes on gradually and affects only one breast.
| Local symptoms
| Mom will usually notice a hard lump or wedge-shaped area of engorgement in the vicinity of the plug that may feel tender, hot, swollen or look reddened. Occasionally mom will only notice localized tenderness or pain, without an obvious lump or area of engorgement. The location of the plug may shift.A plugged duct will typically feel more painful before a feeding and less tender afterward, and the plugged area will usually feel less lumpy or smaller after nursing. Nursing on the affected
side may be painful, particularly at letdown.
| Systemic symptoms
| There are usually no systemic symptoms for a plugged duct, but a low fever (less than 101.3°F / 38.5°C) may be present.
|
MASTITIS
| Per Maureen Minchin (Breastfeeding Matters, Chapter 6), mastitis is an inflammation of the breast that can be caused by obstruction, infection and/or allergy. The incidence of postpartum mastitis in Western women is 20%; mastitis is not nearly so common in countries where breastfeeding is the norm and frequent breastfeeding is typical. Mastitis is most common in the first 2-3 weeks, but can occur at any stage of lactation. Mastitis may come on abruptly, and usually affects only
one breast.
| Local symptoms
| Local symptoms are the same as for a plugged duct, but the pain/heat/swelling is usually more intense. There may be red streaks extending outward from the affected area.
| Systemic symptoms
| Typical mastitis symptoms include a fever of 101.3°F (38.5°C) or greater, chills, flu-like aching, malaise and systemic illness.
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Common (and not-so-common) side effects of plugged ducts or mastitisPlugged duct- Milk supply and pumping output from the affected breast may decrease temporarily. This is normal and extra nursing/pumping generally get things back to normal within a short time.
- Occasionally a mom may express “strings” or grains of thickened milk or fatty-looking milk.
- After a plugged duct or mastitis
has resolved, it is common for the area to remain reddened or have a bruised feeling for a week or so afterwards.
MastitisSide effects may be the same as for a plugged duct, plus: - Expressed milk may look lumpy, clumpy, “gelatin-like” or stringy. This milk is fine for baby, but some moms prefer to strain the “lumps” out.
- Milk may take on a saltier taste due to increased sodium and chloride content – some babies may resist/refuse the breast due to
this temporary change.
- Milk may occasionally contain mucus, pus or blood.
What are the usual causes of plugged ducts or mastitis?
| Plugged duct
| Mastitis
| Milk stasis / restricted milk flow… may be due to: Now infants can get
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by THERALOGIX. Use PRC code “KELLY” for a special discount! - Engorgement or inadequate milk removal (due to
latching problems, ineffective suck, tongue-tie or other anatomical variations, nipple pain, sleepy or distracted baby, oversupply, hurried feedings, limiting baby’s time at the breast,
nipple shield use, twins or higher order multiples, blocked nipple pore, etc.).
- Infrequent/skipped feedings (due to
nipple pain, teething, pacifier overuse, busy mom, return to work, baby suddenly
sleeping longer, scheduling, supplementing, abrupt weaning, etc.).
- Pressure on the duct (from fingers, tight bra or clothing, prone sleeping, diaper bag, etc.).
- Inflammation (from injury,
bacterial/yeast infection, or allergy).
Stress, fatigue, anemia, weakened immunity
| Milk stasis (usually primary cause)- Same as for blocked duct.
- Blocked duct is also a risk factor.
Infection- Sore, cracked or bleeding nipples can offer a point of entry for infection.
- Hospital stay increases mom’s exposure to infectious organisms.
- Obvious infection on the nipple (crack/fissure with pus, pain) is a risk
factor.
- Past history of mastitis is a risk factor.
Stress, fatigue, anemia, weakened immunity
|
What is the usual treatment for plugged ducts and mastitis?CAUTION: Do NOT decrease or stop nursingwhen you have a plugged duct or mastitis,as this increases risk of complications (including abscess).
| GENERAL SUPPORTIVE MEASURES
| Plugged Duct - Rest
- Adequate fluids
- Nutritious foods will help to strengthen mom’s immune system
| Mastitis - Bed rest (preferably with baby)
- Increase fluids, adequate nutrition
- Get help around the house
|
| BREASTFEEDING MANAGEMENT
| — SAME for plugged duct or mastitis
| |
| — important to start treatment promptly
| | “Heat, Massage, Rest, Empty Breast”
|
|
General
| - Nurse frequently & empty the breasts thoroughly.Aim for nursing at least every 2 hrs. Keep the affected breast as empty as possible, but don’t neglect the other breast.
- When unable to breastfeed, mom should express milk frequently and thoroughly (with a breast pump or by hand).
| |
|
| Before nursing
| - Use heat & gentle massage before nursing- Warm compress. Try using a disposable diaper: fill the diaper with hot water (try the temperature on your wrist first to avoid burns), squeeze the diaper out a bit, then put the inside of the diaper toward the breast. This will stay warm much longer than a wet cloth.- Basin soak. Fill sink or bowl with hot water and submerge breast in water while massaging the plugged area toward
the nipple. Some report better results when epsom salts are added to the water — add a handful of epsom salts per 2 quarts (2 liters) of water. Rinse with fresh water before nursing, as baby may object to the taste.- Hot Shower. It can be helpful to massage in the shower with a large-toothed comb. The comb should be drawn through a bar of soap until it is very soapy and then used to gently massage over the affected area in the direction of the nipple.
- Loosen bra & any
constrictive clothing to aid milk flow.
- Massage will help to improve milk drainage and improve symptoms. See Breastfeeding Medicine of Northeast Ohio’s video for a demonstration of the basics of therapeutic breast massage.
| |
|
| While nursing
| - Nurse on the affected breast first; if it hurts too much to do this, switch to the affected breast directly after let-down.
- Ensure good positioning & latch. Use whatever positioning is most comfortable and/or allows the plugged area to be massaged.Note: Advice to point baby’s chin (or nose) toward the plugged area is not necessarily going to be helpful as it is based on the idea that the milk ducts take a nice, direct route to the nipple – recent research tells us
that this is not true, and that a particular duct might begin in one area of the breast but can “wander” in many different directions before terminating in any area of the nipple.
- Use breast compressions.
- Massage gently but firmly from the plugged area toward the nipple.
- Try nursing while leaning over baby (sometimes called
“dangle feeding“) so that gravity aids in dislodging the plug.
| |
|
| After nursing
| - Pump or hand express after nursing to aid milk drainage and speed healing.
- Use cold compresses between feedings for pain & inflammation.
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|
| |
| - See also How do you treat a milk blister?
|
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| MEDICATION *
| | Plugged duct
| Mastitis
| Analgesia- Pain reliever/anti-inflammatory(e.g., ibuprofen)
- Second choice – pain reliever alone(e.g.,acetaminophen)
| Analgesia
| Antibiotic?
| Antibiotic?- No: If symptoms are mild and have been present for less than 24 hours.
- Yes: If symptoms are not improving in 12-24 hours, or if mom is acutely ill.
- Most common pathogen is penicillin-resistant Staphylococcus aureus.
- Typical antibiotics used for mastitis:- Dicloxacillin, flucloxacillin, cloxacillin, amoxycillin-clavulinic acid- Cephalexin, erythromycin, clindamycin, ciprofloxacin, nafcillin
- Most recommend 10-14 day treatment to prevent relapse. Do not discontinue treatment earlier than prescribed.
- Consider probiotic to reduce thrush risk.
- Several studies have
shown that probiotic supplements (certain Lactobacillus strains) are effective in treating infectious mastitis and also resulted in a lower occurrence of repeat mastitis.
- Some mothers also use natural treatments.
| | * Consult your health care provider for guidance in your specific situation. The medication information is taken from the references listed below and is provided for educational purposes only.
|
Does mastitis always require antibiotics?No, mastitis does not always require antibiotics. Mastitis is an inflammation of the breast that is most commonly caused by milk stasis (obstruction of milk flow) rather than infection. Non-infectious mastitis can usually be resolved without the use of antibiotics. However, per the World Health Organization document
Mastitis: Causes and Management, “Without effective removal of milk, non-infectious mastitis was likely to progress to infectious mastitis, and infectious mastitis to the formation of an abscess.” Per the Academy of Breastfeeding Medicine’s
Clinical Protocol for Mastitis: “If symptoms of mastitis are mild and have been present for less than 24 hours, conservative management (effective milk removal and supportive measures) may be sufficient. If symptoms are not improving within 12-24 hours or if the woman is acutely ill, antibiotics should be started.”
If a
mom with mastitis has no obvious risk factors for infection (as noted in the box below), it is likely that the mastitis is non-infectious and, if properly treated, will resolve without antibiotics. When you have mastitis… Talk to your DR about starting antibiotics immediately if: - Mastitis is in both breasts.
- Baby is less than 2 weeks old, oryou have recently been in the hospital.
- You have broken skin on the nipplewith obvious
signs of infection.
- Blood/pus is present in milk.
- Red streaking is present.
- Your temperature increases suddenly.
- Symptoms are sudden and severe.
Follow-up- Re-evaluate treatment plan if symptoms do not begin to resolve within 2-3 days.
- Investigate further if mom has more than 2-3 recurrences in the same location.
- Consider the possibility of thrush if sore nipples begin after
antibiotic treatment.
As always, consult your own health care provider to determine how this information applies to your specific circumstances. @ - How do you treat a milk blister?
- Non-antibiotic treatment of mastitis
- Recurrent Mastitis or Plugged Ducts
- Lecithin treatment for recurrent plugged ducts
- Breastfeeding and breast abscess
@ other websites- Academy of Breastfeeding Medicine. Clinical Protocol Number 4 – Mastitis (March 2014).
- Newman J. Blocked Ducts
and Mastitis. Revised February 2009.
- World Health Organization. Mastitis: Causes and Management (PDF version) (WHO/FCH/CAH/00.13). Geneva: World Health Organization, 2000.
- Breast care for blocked ducts and mastitis by Ros Fleetwood, Nursing Mothers Association Breastfeeding Counsellor
- Mastitis–Plugged Ducts and Breast Infections by Bonnie Tilson.
From LEAVEN, Vol. 29 No. 2, March-April 1993, pp. 19-21, 26.
- Mastitis and Breastfeeding from The Breastfeeding Network Trust (Scotland)
- Blocked Duct/Mastitis by Carolyn Lawlor-Smith, BMBS, IBCLC, FRACGP and Laureen Lawlor-Smith, BMBS, IBCLC
Amir
LH. Mastitis: Are we overprescribing Antibiotics? Current Therapeutics 2000 (April); 41:24-28. Amir LH. Management of Mastitis. Current Therapeutics 2000 (April); 41:29. Fetherston C. Mastitis in lactating women: physiology or pathology? Breastfeed Rev 2001 Mar;9(1):5-12. Fetherston C.
Risk factors for lactation mastitis. J Hum Lact 1998 Jun;14(2):101-9. Foxman B, D’Arcy H, Gillespie B, Bobo JK, Schwartz K. Lactation mastitis: occurrence and medical management among 946 breastfeeding women in the United States. Am J Epidemiol. 2002 Jan 15;155(2):103-14. Kinlay JR,
O’Connell DL, Kinlay S. Risk factors for mastitis in breastfeeding women: results of a prospective cohort study. Aust N Z J Public Health. 2001 Apr;25(2):115-20. Lawrence R, Lawrence R. Breastfeeding: A Guide for the Medical Profession, 6th ed. Philadelphia, Pennsylvania: Mosby, 2005, p. 299-301, 562-570, 1068-1071. Livingstone VH, Willis CE, Berkowitz J.
Staphylococcus aureus and sore nipples. Can Fam Physician. 1996 Apr;42:654-9. Mohrbacher N, Stock J. Breastfeeding Answers Made Simple, Amarillo, Texas: Hale Publishing, 2010, p. 682-683. Prentice A, Prentice AM, Lamb WH. Mastitis in rural Gambian mothers and the protection of
the breast by milk antimicrobial factors. Trans R Soc Trop Med Hyg. 1985;79(1):90-5. Riordan J. Breastfeeding and Human Lactation, 3rd ed. Boston and London: Jones and Bartlett, 2005, p. 248-253. Riordan JM, Nichols FH. A descriptive study of lactation mastitis in long-term breastfeeding women. J Hum Lact. 1990 Jun;6(2):53-8. Smith A, Heads J. Breast Pathology.
In: Walker M, ed. Core Curriculum for Lactation Consultant Practice. Boston: Jones and Bartlett, 2002, p. 180-190. Walker M. Breastfeeding Management for the Clinician: Using the Evidence. Boston: Jones and Bartlett, 2006, p. 388-394.
How often should I pump to get rid of mastitis?
During the infection and treatment, nurse or pump as often as you can on the affected breast. Frequent milk removal is the most important factor in sustaining and rebuilding a milk supply. Frequent emptying will also keep milk moving – a key to preventing a recurrence when an infection starts as a plugged duct.
Should I keep pumping with mastitis?
Continue pumping or breastfeeding. Emptying the breast reduces inflammation, and stopping milk expression could lead to complications like a breast abcess.
How long does it take for mastitis to clear up?
Management and Treatment
The infection should clear up within 10 days but may last as long as three weeks. Mastitis sometimes goes away without medical treatment. To reduce pain and inflammation, you can: Apply warm, moist compresses to the affected breast every few hours or take a warm shower.
Does milk supply drop with mastitis?
When you're dealing with mastitis, you might notice that your milk supply drops from the affected breast. This decreased output is due to inflammation and the slower movement of milk. Lots of parents worry that their low supply will be long-term, but there's usually no need to worry.
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