Mastitis

This document is provided for information purposes only. It is not intended to diagnose, treat, cure, or prevent any disease. It is not a substitute for professional medical advice, diagnosis, or treatment. Always seek the advice of your physician or other qualified health provider with any questions you may have regarding a medical condition. Never disregard professional medical advice or delay in seeking it because of something you have read in Milky Mommas. If you think you’re having a medical emergency, call your doctor or 911 immediately.

Mastitis is the clinical term for breast infection.

Whenever a lactating woman experiences flu-like symptoms, she should consider the possibility of mastitis, contact her provider, and begin measures to treat / prevent mastitis.

Symptoms of mastitis include:

  • Localized tenderness of breast
  • Localized heat or red streaks on breast
  • Fever
  • General sick feeling
  • Sometimes nausea and vomiting

Common causes of mastitis are:

  • Infrequent feedings or scheduled feedings
  • Missed feedings
  • Poor milk removal due to latch issues
  • Illness in mother or baby
  • Oversupply
  • Rapid weaning
  • Plugged ducts and/or blebs
  • Pressure on the breast that restricts milk flow (like tight clothing)
  • Cracks in the nipple that allow bacteria to enter and infect breast tissue
  • Maternal stress and fatigue

How is mastitis diagnosed?

  • Mastitis is usually diagnosed based on symptoms.
  • Lab tests and diagnostics are not routinely needed or performed for mastitis unless there are repeat infections.
  • Your OB or PCP can diagnose and treat mastitis.

How is mastitis treated?

  • The most important step is frequent and effective milk removal (at least every two hours).
  • Breastfeed as frequently as possible, starting on the affected breast.
  • If it hurts too much to start on the affected breast, it might help to start on the unaffected breast and switch sides as soon as letdown happens.
  • Position the baby at the breast with chin or nose pointing to the blockage to help drain the affected area.
  • Gentle massage may also help remove milk. Massage should be directed from the blocked area toward the nipple.
  • After feeding, pumping or hand expressing may help remove more milk and speed recovery.

Should I continue to nurse if I have mastitis?

  • Yes! Frequent and effective milk removal is key, and nothing is more effective at removing milk than a baby.
  • Mothers who can’t continue breastfeeding when they have mastitis, for whatever reason, should pump or hand express at least every two hours because stopping cold turkey leads to a greater risk of abscess than continuing to feed.

What should I do while recovering?

  • Rest. If possible, take baby to bed for a nursing vacation.
  • Hydrate. It’s important to drink plenty of clear liquids to help your body produce plenty of milk to flush the infection.
  • Ask your provider if an NSAID may be right for you, to relieve pain and inflammation.

Do I need antibiotics?

  • It depends. Contact your provider at the first signs of mastitis and ask what they advise.
  • If symptoms are mild, many breastfeeding experts advocate treating conservatively at home for the first 24 hours.
  • If symptoms do not improve in 12-24 hours or you are acutely ill, experts agree antibiotics should be started.
  • Your HCP will help you decide which approach is best for you and your circumstances.

What kind of at-home treatments may help relieve mastitis symptoms and hasten recovery?

  • Nurse, pump, and/or hand express as much as possible (at least every two hours)
  • Rest and hydrate
  • Your provider may recommend an NSAID to relieve pain and inflammation
  • Hot shower
  • Moist or dry heat, whichever feels better
  • Epsom salt soak
  • If inflammation is severe enough to inihibit milk flow, it may be helpful to apply ice for a few minutes before nursing or pumping
  • Gentle massage or pressure from behind the clogged area toward the nipple (use in moderation because massage can make inflammation worse)
  • Stroke gently from behind the clog toward the nipple with a comb or plastic bristled brush
  • If you have a visible bleb or milk blister, notify your provider and ask what s/he would advise

Which antibiotics are commonly prescribed for mastitis?

  • Dicloxacillin
  • Flucloxacillin
  • First-generation cephalosporins
  • Cephalexin
  • Clindamycin
  • If an antibiotic is needed, your provider will prescribe one that’s appropriate for you.
  • Breastfeeding compatibility can be verified at http://toxnet.nlm.nih.gov/newtoxnet/lactmed.htm, via the MommyMeds app, or by calling the InfantRisk hotline Monday – Friday, 8 am – 5 pm, CST, at 806-352-2519.

How soon should I start to feel better?

  • Improvement is usually rapid and dramatic.
  • If symptoms don’t resolve in several days with appropriate management, including antibiotics, you should call and notify your provider.

What can I do to avoid mastitis in the first place?

  • Feed on demand.
  • Get a good latch.
  • Learn to hand express so you can always empty your breasts, no matter what the circumstances.
  • Be on the lookout for signs of milk stasis (milk that is not leaving the breasts). Check for lumps, pain, or redness.
  • If you notice any signs of milk stasis, be quick to completely empty the breast, increase the frequency of feedings, and rest and hydrate.
  • Call your healthcare provider at the first signs of mastitis and ask what they advise.
  • Practice good hand hygiene.
  • Disassemble and wash pump parts thoroughly between uses (may be refrigerated for up to 24 hours) and air dry.

Source: The Academy of Breastfeeding Medicine

Additional resources:

This document is provided for information purposes only. It is not intended to diagnose, treat, cure, or prevent any disease. It is not a substitute for professional medical advice, diagnosis, or treatment. Always seek the advice of your physician or other qualified health provider with any questions you may have regarding a medical condition. Never disregard professional medical advice or delay in seeking it because of something you have read in Milky Mommas. If you think you’re having a medical emergency, call your doctor or 911 immediately.

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