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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Growth Spurts

“Normal” Behavior During Growth Spurts.

Is your baby…

  • Inexplicably fussy?
  • Nursing around the clock?
  • Waking more often at night?
  • Slapping, head-butting, unlatching and relatching, pinching the breast?
You may be experiencing what is known to many mothers as a “growth spurt” or a collection of “frequency days”. Rest assured that this is a very normal part of a having a rapidly growing baby! Growth spurts typically last anywhere from 2-3 days to a week and often are gone as suddenly as they appeared.

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Why does baby ask to nurse more during a growth spurt?

Breastfeeding works on a demand, supply system. Babies communicate with your breasts by nursing more frequently, fussing at the breast, latching/unlatching repeatedly, head-butting the breast, etc. Frequent emptying and additional stimulation of the breasts creates a “demand” that your breasts fill with a greater “supply” of breastmilk.

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When do growth spurts occur?

Growth spurts often occur a pattern, though it can vary from baby to baby and remember that babies don’t keep track of calendars. Growth spurts often occur at weeks 1, 2, 4 and months 2, 4, 8 and 12. Growth spurts can be early OR late. Remember that baby’s growth may not be entirely physical and that babies need fuel for developmental leaps, emotional growth and just for comfort during these tumultuous times of their young lives.

How can I best cope with growth spurts

Make nursing comfortable, don’t watch the clock
Many mothers find that creating a “nursing nest” and making a plan to hunker down and nurse on demand helps to pass the growth spurt as smoothly as possible. Gather water, snacks and good books for yourself and spend time with baby skin to skin with unlimited nursing and throw out the clocks. For mothers with older children, preparing “busy bags” (little kits of simple toys, books, something that can keep them happy for a while), temporarily borrowing a “mother’s helper” (pre-teen, auntie, grandma, etc. that can offer a separate set of eyes on the older children) or nursing baby in a sling or baby carrier can keep things running smoothly.

Accept help!
Remember all of those well meaning friends and relatives who said, “I’ll do anything you need! Just ask!” Assign them a task. Something as simple as picking up dinner and dropping it off at your door can be a huge help when baby is feasting at the breast buffet.
Turn to other nursing mothers for support.
Every nursing dyad experiences growth spurts. Talk with mothers who have had the same experiences who you know will offer support and commiseration instead of judgment and suggestions that can sabotage a breastfeeding relationship. Lean on your fellow Milky Mommas, check out a local La Leche League meeting or call a LLL leader (http://www.llli.org/webus.html?gclid=CMeDhpn6wbgCFSdp7AodlScAbg). Scan the board and read up on some other mothers who are dealing with the same frustrations.
Remember that this too shall pass
Growth spurts often are over within a week. The round the clock nursing sessions often give way to a few days of sound sleep for younger babies. Enjoy the reprieve!
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Sources:

Low Milk Supply

One of the most common concerns of the breastfeeding mother is that they aren’t making enough milk for their baby. Let me assure you, true low supply, or the inability to produce adequate milk, is rarely the problem. What signals your body to make more milk? Removing milk!

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“But he wants to eat all the time!”

Ok…Let’s look at the whole picture:

  • Is baby very young? Newborns have a stomach that, at 10 days old, is still only the size of an egg, and he’s eating a perfect food that is completely digested quickly.
  • How old is he? Just like a teenage boy that eats all the time, babies are growing…and fast! There are several physical and developmental spurts that occur, usually around the same time for each child. Take a look at the Wonder Weeks chart (http://www.whosthatmom.com/wonder-weeks-week-by-week/) and see if your baby is either having a growth spurt or about to have one.
  • Is he latched correctly? Can you hear him swallowing? A proper latch is comfortable for you, not painful, and allows baby to efficiently remove milk from the breast. If you have access to an IBCLC, have them check baby’s latch. There are several valuable resources here, as well: http://kellymom.com/ages/newborn/bf-basics/latch-resources/

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“He fusses at the breast. I don’t think any milk is coming out.”

  • Let’s talk about supply and demand. Babies demand milk…and you supply it. Fussing at the breast, beating on you, on-and-off nursing, etc, all signal your body to make more milk. Your breasts don’t ever truly become “empty”, they continuously make milk.
  • Does he need to burp? Is he distracted or overstimulated? Are you distracted or stressed?
  • Is he getting too much milk? Check our document on oversupply to see if it sounds like you.

“I’m pumping barely anything.”

  • Pumping is never a good way to judge what you’re actually producing. Babies are much more efficient at getting milk out than a pump.
  • Also see our document on Pumping Tips for help when pumping at work.

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“My breasts feel empty. I think my supply dropped.”

  • Probably not. Most of us only experience super-full feeling breasts for a limited time. What is most likely happening is that your supply is regulating. Your body and your baby’s demands have come to an understanding and your are meeting his needs without becoming overfull.
  • Your breasts always make milk. When milk is removed, they make more. “Your breasts are a factory, not a storage facility.” They are never truly empty.
  • Babies can typically always get out more milk. Even if it’s minimal; they are very efficient at their job.

“How do I make more milk?”

  • Firstly…nurse your baby more. Most concerns about supply can be fixed by simply nursing more.
  • Nurse baby on demand. Let him decide when he wants to eat.
  • Pay attention to baby’s hunger cues. Rooting, smacking lips, sucking hands, etc, are all signs of hunger. Crying is a late hunger cue.
  • Soothe at the breast. Comfort nursing can be frustrating sometimes, but it is the best means of comforting your baby and ensuring an abundant supply of milk.
  • Nurse until baby lets go. Let him decide when he’s done.
  • Don’t be a clock-watcher. Allow baby to run on his own time.

Signs that your baby is getting plenty of milk:

Birth-2 weeks:

  • baby starts gaining weight after your milk comes in. Remember, weight gain varies with every individual. Don’t compare your baby to your friend’s or yourself.
  • baby is having at least 3 quarter-sized poops per day. These can be spread out over a 24 hour period. More than three is fine.
  • baby is swallowing when he’s nursed.
  • baby is nursing at least every three hours until he reaches about 10 pounds. Again, more is fine.

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2-6 weeks:

  • baby passes birth weight by around 2 weeks. Remember to calculate that by baby’s lowest weight.
  • baby continues to gain weight.
  • still has 3 quarter-sized poops per day. Until around 6 weeks, this is what we want to see. Others may tell you that it is normal for exclusively breastfed babies to go several days or even a week or more without pooping. That is not true until around 6 weeks, and even then, not the norm.
  • baby has gotten the hang of latching on and staying attached.
  • baby is sucking with long, steady sucks soon after latching.

6 weeks on:

  • baby continues to gain weight.
  • baby is meeting developmental milestones.
  • baby has plenty of wet diapers and regular poops (they become less frequent around 6 weeks).
  • baby is getting longer and gaining in head circumference.

What if your supply is truly low?

Sometimes baby really isn’t getting enough milk. It’s important to understand why.

It’s important to figure out if he’s not taking enough because you’re not making enough, or if you’re not making enough because he’s not taking enough, or if he’s taking plenty but not using it well.

Source: The Womanly Art of Breastfeeding, 8th ed., p.396

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What might be the issue with baby?

Possible causes of baby taking too little milk are:

  • he’s improperly positioned
  • his nursing time is being cut short
  • he’s being fed too infrequently
  • he has a tongue-tie or other latching issue

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What might be the issue with me?

Possible causes of mother making too little milk are:

  • thyroid problems
  • PCOS (Polycyctic Ovary Syndrome)
  • breast surgeries

If your supply is truly low and your baby is not thriving, it is our advice at Milky Mommas to seek out and meet with an IBCLC to identify and correct the problem.

Most of these scenarios are completely reversible, so don’t give up hope. Remember, if you must supplement due to medical indication – and at the recommendation of a professional – there’s a strong chance that supplementation need be only temporary and you can return to being your child’s sole source of nutrition.

Oversupply & Overactive Letdown

Many mothers jump to the conclusion that they don’t have enough milk, their milk is not “good enough,” or that their baby may be allergic to something they’re eating. Often, quite the opposite is true. A common and oft overlooked problem is oversupply or overactive letdown. This is when you simply have too much milk! Don’t worry, we can fix it.

 

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Signs of oversupply

  • baby pulls off of the breast repeatedly
  • baby seems fussy at the breast, arching his back, twisting, stopping and whining
  • baby spits up frequently and needs lots of burping
  • baby gulps or “chokes” at letdown
  • stools are green, frothy, or mucousy

Why is oversupply a problem?

Oversupply for some babies is simply the dynamic of milk shooting into their mouth at full force at every meal. As a child, did you ever put your mouth over the end of a garden hose pouring water? Same concept.

The rest of the issue has to do with the composition of the milk he is drinking. Many mothers are told that they have “too much” foremilk and that they need to eat more fats or get more calories into their diets. In fact, your body only makes one kind of milk. This is the illustration I use:

When a farmer milks a cow, all the milk goes into one container. If that container is allowed to sit for a while, all the cream rises to the top. The cream is full of the milkfat. The milkfat separates from the less fatty milk. If a spigot were attached to the bottom of the container, a glass of milk would contain only skim milk unless the jar was mixed up.

Basically, your cream is rising to the top. What we want to do is keep the fattier milk mixed with the skim.

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What do I do?

  • Laid-back nursing. Try leaning back with baby on your chest when nursing to reduce the force with which your milk pours forth.
  • Let down into a cloth or bottle, then reattach baby when the flow has slowed.
  • Try a different position, preferably one where baby has control of the amount of milk entering his mouth, such as side-lying or straddling.
  • Nurse on only one side each time. This allows baby to finish the breast and get to “dessert”… the fatty milk that has risen in the milk ducts.
  • Discuss block feeding with your IBCLC. Block feeding is nursing on one side for more than one nursing session. Experiment to find how long works for you. This could mean anything from twice in a row to 4-5 hours. Remember to let baby have a sip from the unused side, or pump enough to relieve pressure, so that you don’t end up with a plugged duct.

Alcohol & Breastfeeding

Alcohol and breastfeeding is a topic that comes up every day in the MM community. The information provided here is intended to help women research and educate themselves to make an informed decision for themselves and their families. We encourage all of our members who choose to drink to do so responsibly, in moderation, and occasionally.

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The American Academy of Pediatrics Committee on Drugs considers
alcohol compatible with breastfeeding. It lists possible side effects if
consumed in large amounts, including: drowsiness, deep sleep, weakness,
and abnormal weight gain in the infant, and the possibility of decreased
milk-ejection reflex in the mother.

Dr. Jack Newman, member of the LLLI Health Advisory Council, says this
in his handout “More Breastfeeding Myths”:

Reasonable alcohol intake should not be discouraged at all. As is the case
with most drugs, very little alcohol comes out in the milk. The mother can
take some alcohol and continue breastfeeding as she normally does.
Prohibiting alcohol is another way we make life unnecessarily restrictive
for nursing mothers.”

 Thomas W. Hale, R.Ph. Ph.D., member of the LLLI Health Advisory Council, says this in his book Medications and Mothers’ Milk (12th ed.):

“Significant amounts of alcohol are secreted into breastmilk although it is not considered harmful to the infant if the amount and duration are limited. The absolute amount of alcohol transferred into milk is generally low.

Alcohol transfers readily into human milk. Alcohol is not stored in milk;
rather it enters and exits according to blood alcohol level. Levels of alcohol in milk peak at approximately 30 to 60 minutes following ingestion, then decline rapidly if no more is ingested.

Evidence shows that excessive consumption of alcoholic beverages during lactation affected infant development, such as weight and linear growth from 1 to 57 months.”

In terms of milk supply, new data now clearly demonstrate that alcohol
actually inhibits oxytocin release from the pituitary, thus impeding the let down process so that milk is not released from the breast as efficiently. One study showed a 23% reduction in milk release while alcohol is present in the mother’s blood. In another study, alcohol completely blocked the release of oxytocin.

While many people believe that dark beer enhances milk supply, that belief is purely anecdotal. If you choose to have one drink while nursing, it should be metabolized before your next nursing session (unless your infant is cluster feeding).

Standard drinks are measured as follows:
12 oz beer,
8-9 oz malt liquor,
5 oz wine, or
1.5 oz liquor.

Pump and Dump?

Because alcohol is not stored in milk, there is no need to pump and dump
to rid your milk of alcohol. However, nursing mothers may need to express
milk for comfort and to avoid milk stasis while too intoxicated to nurse. This milk can be used for a milk bath or diluted with milk that doesn’t contain alcohol and fed at another time.

If you are very concerned or intend to consume several servings of alcohol
in one sitting, you can pump ahead of time and store expressed breast milk to be used in case your infant needs to be fed while you have a drink or two. Then, when enough time has passed for alcohol levels to go down, you may resume breastfeeding.

Please Note:
● Alcohol test strips are NOT reliable.
● Infants should NEVER EVER EVER bed share with an adult who has been
drinking alcohol.
● Chronic or heavy users of alcohol should not breastfeed.

Additional Resources:

http://www.infantrisk.com/content/alcohol-and-breastfeeding

● To calculate BAC based on weight and standard drink count: http://brown.edu/Student_Services/Health_Services/Health_Education/alcohol,_tobacco,_&_other_drugs/alcohol/alcohol_&_your_body.php
http://www.llli.org/faq/alcohol.html