ducts and Mastitis
Although breastfeeding is a wonderful gift to
your child, it is not without challenges. However,
the more informed you have, the more aware and
prepared you will be and the more likely you can
deal with the situation.
Another product available from BayB Suuplies
Mastitis is a bacterial infection of the breast that
usually occurs in breastfeeding mothers. However,
it can occur even in women who are not breastfeeding
or pregnant, and can occur even in small babies, of
either sex. Nobody knows exactly why some women get
mastitis and others do not. Bacteria may gain access
to the breast through a crack or sore in the nipple,
but women without sore nipples also get mastitis,
and most women with cracks in the nipple do not.
Mastitis needs to be differentiated from a plugged
or blocked duct, because the plugged or blocked duct
does not need treatment with antibiotics, whereas
mastitis does often, but not always, require treatment
with antibiotics. A blocked duct presents as a painful,
swollen, firm mass in the breast. The skin overlying
the blocked duct is often quite red, similar to what
happens during mastitis, but less intense. Mastitis
is usually also associated with fever and more intense
pain as well. However, it is not always easy to distinguish
between a mild mastitis and a severe blocked duct.
Both are associated with a painful lump in the breast.
Without a lump in the breast, one cannot make a diagnosis
of mastitis or a blocked duct. A blocked duct, can,
apparently, go on to become mastitis. In France, physicians
also recognize something they call lymphangite that
is fever associated with skin which is hot and red,
but there is no underlying painful mass. They do not
believe this requires treatment with antibiotics.
I have seen a few cases that fit this description
in my practice, and indeed, the problem resolves without
antibiotics. But then, often so does full blown mastitis.
As with almost all breastfeeding problems, a poor
latch, and thus, poor draining of the breast sets
up the situation where mastitis is more likely to
Blocked ducts will almost always resolve spontaneously
within 24 to 48 hours after onset, even without any
treatment at all. During the time the block is present,
the baby may be fussy when nursing on that side, as
milk flow may be slower than usual, probably due to
pressure causing collapse of other ducts. Blocked
ducts can be made to resolve more quickly by:
1. Continuing breastfeeding on the affected side.
2. Draining the affected area better. One way of
doing this is to position the baby so his chin "points"
to the area of hardness. Thus if the blocked duct
is in the outside, lower area of your breast (about
4 o'clock), the football hold would be best. Another
way of getting better draining of the breast is using
breast compression while the baby is feeding, getting
your hand around the blocked duct and using steady
3. Applying heat to the affected area (with a heating
pad or hot water bottle, but be careful not to injure
your skin by using too much heat for too long a period
4. Trying to rest. (Not always easy, but take the
baby to bed with you.) If the blocked duct is associated
with a small blister on the end of the nipple, you
can open it with a sterile needle. Flame a sewing
needle or a pin, let it cool off, and puncture the
blister. No need to dig around. Just pop the top or
side of the blister. Sometimes you can squeeze out
a little toothpaste like material from the duct and
the duct will immediately unblock. Or, put the baby
to the breast and he may unblock it for you. Opening
the blister has the added benefit of decreasing nipple
pain, even if the blocked duct does not immediately
resolve. Come to the clinic if you cannot do it yourself.
If a blocked duct has not settled within 48 hours
(unusual), therapeutic ultrasound often works. This
can be arranged at a neighborhood physiotherapy office
or sports medicine clinic. Many ultrasound therapists
are not aware of this use for ultrasound. The dose
is: 2 watts/cm², continuous, for five minutes
to the affected area, once daily for up to two doses.
If two treatments on two days have not worked, there
is no point in continuing with ultrasound. Get the
blocked duct re-evaluated at the clinic or your own
physician. Usually, however, if ultrasound is going
to work, one treatment is all that is needed. Ultrasound
also seems to prevent recurrent blocked ducts that
always occur in the same part of the breast. Lecithin,
one capsule (1200 mg) 3 or 4 times a day also seems
to prevent recurrent blocked ducts, at least in some
If the mother has symptoms consistent with mastitis
for more than 24 hours, she should start antibiotics.
If the mother has consistent symptoms for less than
24 hours, I will prescribe an antibiotic, but suggest
the mother wait before starting to take it. If, over
the next 8-12 hours, her symptoms are worsening (more
pain, more spreading of the redness, enlargement of
the hardened area), then the mother should start the
antibiotics. If, over the next 24 hours, the mother
has not worsened, but not improved, she should start
the antibiotics. However, if symptoms are starting
to decrease, there is no need to start the antibiotics.
The symptoms usually will continue to resolve and
will have disappeared over the next 2 to 5 days. Fever
will usually be gone within 24 hours, the pain within
24 to 48 hours, the breast hardness within the next
few days. The redness may remain for a week or longer.
Once improvement begins, on or off antibiotics, it
should continue. If the course of your mastitis does
not follow this pattern, contact your doctor.
- Continue breastfeeding, unless it is just too painful
to do so.
- If you cannot, at least express your milk as best
you can in the meantime.
- Restart breastfeeding as soon as you are up to it,
the sooner the better.
- Continuing breastfeeding helps mastitis to resolve
- There is no danger for the baby. ·
- Heat (hot water bottle or heating pad), applied
to the affected area helps healing. ·
- Rest helps fight off infection. ·
- Fever helps fight off infection.
- Treat fever if it makes you feel bad, not just because
it is there. ·
- Medication (acetaminophen, ibuprofen) for pain can
be very good. You will feel better and the amount
that gets to the baby is insignificant. Acetaminophen
is probably less useful as it does not have an anti-inflammatory
- Note: Amoxycillin, plain penicillin, and many other
antibiotics often prescribed for mastitis are usually
useless for mastitis. If you need an antibiotic, you
need one that is effective against Staphylococcus
aureus. Effective for this bacterium are: cephalexin,
cloxacillin, flucloxacillin, amoxycillin-clavulinic
acid, clindamycin and ciprofloxacin. The last two
are effective for mothers allergic to penicillin.
You can and should continue breastfeeding with all
Abscess occasionally complicates mastitis. You
do not have to stop breastfeeding, not even on the
affected side. Usually the abscess needs to be drained
surgically, but you should continue breastfeeding.
Contact your careprovider.
A lump That Isn't Going Away
If you have a lump that is not going away or getting
smaller over more than a couple of weeks, you should
get it looked into. You don't have to stop breastfeeding
to get a breast lump investigated (ultrasound, mammogram,
even biopsy do not require you to stop breastfeeding
even on the affected side). A breastfeeding friendly
surgeon will not tell you that you must stop breastfeeding
before s/he can do tests for a breast lump.
by Jack Newman, MD, FRCPC, Reproduced with his permission
Jack Newman, MD, FRCPC, graduated from the University
of Toronto medical school as a pediatrician in 1970.
He started the first hospital-based breastfeeding clinic
in Canada in 1984 at Toronto's Hospital for Sick Children.
He has been a consultant with UNICEF for the Baby Friendly
Hospital Initiative in Africa and has published articles
on the subject of breastfeeding in Scientific American
and several medical journals. Dr. Newman has practiced
as a physician in Canada, New Zealand, and South Africa.
Dr. Jack Newman is a leading authority on infant care
who has implemented breastfeeding clinics throughout
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