Mastitis While Breast-Feeding

What is mastitis?

Mastitis is a breast inflammation usually caused by infection. It can happen to any woman, although mastitis is most common during the first 6 months of breast-feeding. It can leave a new mother feeling very tired and run-down. Add the illness to the demands of taking care of a newborn, and many women quit breast-feeding altogether. But you can continue to nurse your baby. In fact, breast-feeding usually helps to clear up infection, and nursing will not harm your baby.¹

Although mastitis can be discouraging and painful, it is usually easily cleared up with medicine.

What causes mastitis?

Mastitis most often happens when bacteria enter the breast through the nipple.² This can happen when a nursing mother has a cracked or sore nipple.

Going for long stretches between nursing or failing to empty the breast completely may also contribute to mastitis. Using different breast-feeding techniques and making sure your baby is latched on properly when nursing will help with emptying the breast and avoiding cracked nipples.

What are the symptoms?

Mastitis usually starts as a painful area in one breast. It may be red or warm to the touch, or both. You may also have fever, chills, and body aches. If you have these symptoms, call your doctor today.

Signs that mastitis is getting worse include swollen, painful lymph nodes in the armpit next to the infected breast, a fast heart rate, and flu-like symptoms that get worse. Mastitis can lead to a breast abscess, which feels like a hard, painful lump.

What increases your risk of getting mastitis?

You are more likely to get mastitis while breast-feeding if:

• You have had mastitis before.³
• You delay or skip breast-feeding or pumping sessions. When you don't empty the breast regularly or completely, your breasts become engorged or too full, which can lead to mastitis.
• You have cracked or irritated nipples, which can be caused by poor positioning or poor latching on.
• You have anemia. Anemia makes you tire more easily and lowers your resistance to infections like mastitis.
• Your nursing bra is too tight.
• You wear breast binders, which are used to suppress milk production.

Breast-feeding mothers can get mastitis at any time, but especially during the baby’s first 2 months. After 2 months, the baby’s feeding patterns become more regular, which helps prevent mastitis.

How is mastitis diagnosed?

Your doctor can tell whether you have mastitis by talking with you about your symptoms and examining you. Testing is usually not needed.

How is it treated?

Antibiotics can usually cure mastitis. If your doctor prescribes antibiotics, take them as directed. Do not stop taking them just because you feel better. You need to take the full course of pills. The antibiotics will not harm the baby. If treatment doesn't work at first, your doctor may send a sample of your breast milk to a lab to help identify the type of bacteria causing the infection.

You can help yourself feel better by getting more rest, drinking more fluids, and using warm or cold packs on your painful breast.

Before breast-feeding your baby, place a warm, wet washcloth over the affected breast for about 15 minutes. Try this at least 3 times a day. This increases milk flow in the breast. Massaging the affected breast may also increase milk flow.

You can safely take acetaminophen (such as Tylenol) for pain. You can take ibuprofen (such as Advil) along with acetaminophen to reduce inflammation.

Breast-feeding from your affected breast is safe for your baby and helps to treat your mastitis.³ If starting with the affected breast is too painful, start feeding on the other side, then switch sides after your milk lets down and starts flowing easily. If your nipples are too cracked and painful to breast-feed from that breast, use a breast pump to empty the breast of milk. Use it each time that you cannot breast-feed.

This is a good time to consider getting help from a lactation consultant. This person—usually a nurse—specializes in helping women with breast-feeding. You can breast-feed more effectively with less pain and help prevent future mastitis if you remember to change positions and make sure that your baby is latching on properly.

It’s important to get treatment for mastitis. Delaying treatment can lead to a breast abscess, which can be harder to treat.

Frequently Asked Questions

The symptoms of mastitis most often appear within 4 to 6 weeks after childbirth. Call your doctor today if you develop any of the early symptoms of mastitis.

If you have mastitis, you may first notice:

• A painful area on one breast. It may be reddened, warm to the touch, or both.
• Chills, aches, and flu-like symptoms.
• A temperature of 100°F (37.8°C) or higher.

These initial symptoms may start after you have resolved a blocked milk duct.

Worsening symptoms

As a mastitis infection gets worse, you may notice:

• An increased heart rate (more than 100 beats per minute).
• Thick, yellow drainage (pus) coming from the nipple.
• Swollen and tender lymph nodes in your armpit on the same side as the infected breast.

Breast abscess

Occasionally symptoms of mastitis get worse and the breast develops a pocket of pus (abscess) in the infected area. Symptoms of a breast abscess include:

• A breast lump that is hard and painful.
• A reddened area on the breast.
• Flu-like symptoms that are getting worse.

Thrush infection

Thrush (yeast infection) can occur in your baby's mouth and spread to your nipples and breast ducts. If you have symptoms of mastitis that are not going away in spite of treatment, pain in the nipple area during and after breast-feeding, sharp breast pain in between feedings, or nipples that look very pink, you may have thrush. This condition can also begin with a sudden start of pain or burning when breast-feeding has been going well without problems.

If you have thrush symptoms, both your nipples and your baby's mouth should be checked for thrush. Treatment for thrush requires that both you and your baby be treated, even if your baby doesn't have symptoms. For more information, see the topic Thrush.

Your doctor can usually diagnose mastitis based on your symptoms and an examination of the affected breast. Tests are usually not needed. But they may be done to confirm a diagnosis or to help guide treatment for other problems that can develop.

Breast milk culture

If you have an infection that isn't improving with treatment, your doctor may do a breast milk culture. To provide a sample for a culture, you will squeeze a small sample of milk from the affected breast onto a sterile swab. The culture results help your doctor confirm a diagnosis and to find out the specific bacteria that are causing the infection.

Occasionally, it takes more than one round of antibiotics to clear a breast infection. If you have not been responding to antibiotic treatment, culture results may be used to determine the most effective antibiotic for you.

Abscess

Sometimes a pocket of pus (abscess) forms in the reddened area of the breast. If an abscess is too deep to examine by touching it, your health professional may use a breast ultrasound to examine it. Ultrasound can also be used to guide a needle to an abscess that needs to be drained of fluid. A culture of the abscess fluid is usually done to identify the infecting organism.

Mastitis will not go away without treatment. If you develop mastitis symptoms, call your doctor today. Prompt treatment helps keep infection from rapidly getting worse and usually improves symptoms after about 2 days.

Mastitis treatment

Treatment for mastitis usually includes:

• Oral antibiotics to destroy the bacteria causing the infection.
• Regularly emptying the breast well by breast-feeding or pumping breast milk. Adequate emptying of the affected breast helps prevent more bacteria from collecting in the breast and may shorten the duration of the infection.

You can safely continue breast-feeding your baby or pumping breast milk to feed your baby during illness and treatment.³ Your baby is the most efficient pump you have for emptying your breasts. Your breast milk is safe for your baby to drink because any bacteria in your milk will be destroyed by the baby's digestive juices.

• Before breast-feeding your baby, place a warm, wet washcloth over the affected breast for about 15 minutes. Try this at least 3 times a day. This increases milk flow in the breast. Massaging the affected breast may also increase milk flow.
• If possible, continue breast-feeding on both sides. Ideally, start on the affected side—it's critical that you empty this breast thoroughly. If this breast is too painful to start with, try feeding from the healthy breast first. Then, after your milk is flowing, breast-feed from the affected breast until it feels soft. Switch back to the healthy breast and breast-feed until your baby has finished.
• Pump or express milk from the affected breast if pain prevents you from breast-feeding. Nipple pain can be caused by the baby latching on to sore nipples. For more information on pumping or expressing breast milk, see the topic Breast-Feeding.
• Your baby may seem reluctant to nurse on your painful breast. This is not because your milk tastes strange, but more likely because your breast feels different and it is harder for your baby to nurse. Try expressing a little milk first. This will soften the breast and make it easier for your baby to latch on.

Breast abscess treatment

If you have mastitis because of a blocked duct and you delay treatment, your breast infection may develop into an abscess. Treatment for an abscess includes:

• Draining the abscess. Abscess healing can take 5 to 7 days.
• Oral antibiotic treatment to destroy the bacteria causing the infection. (Antibiotics are given intravenously only in rare cases of severe infection.)
• Emptying the breast well and regularly by breast-feeding or pumping, which is essential to maintaining a good milk supply.

Most women can continue breast-feeding on the affected breast while an abscess heals. With your doctor's approval, you can cover the abscess area with a light gauze dressing while breast-feeding.

If you are advised to stop breast-feeding from the affected breast while an abscess heals, you can continue breast-feeding from the healthy breast. Be sure to pump or express milk from the infected breast regularly.

For more information on pumping or expressing breast milk, see the topic Breast-Feeding.

From the time you begin breast-feeding until your baby is weaned, take measures to prevent mastitis. For example, learn about different breast-feeding techniques so that you will know how to completely empty your breasts. Not emptying your breasts completely when nursing or going too long between feedings may lead to mastitis.

If you have symptoms of mastitis, contact your doctor right away. Delaying treatment can lead to an abscess forming in the affected breast. Severe infection can require intravenous antibiotics in the hospital.

Breast-feeding with mastitis

Along with oral antibiotic treatment, continuing to nurse your baby and being careful to empty your breasts completely will help shorten the duration of the infection.

You can safely continue breast-feeding your baby or pumping breast milk to feed your baby during illness and treatment.³ Your baby is the most efficient pump you have for emptying your breasts. Your breast milk is safe for your baby to drink because any bacteria in your milk will be destroyed by the baby's digestive juices.

• Before breast-feeding your baby, place a warm, wet washcloth over the affected breast for about 15 minutes. Try this at least 3 times a day. This increases milk flow in the breast. Massaging the affected breast may also increase milk flow.
• If possible, continue breast-feeding on both sides. Ideally, start on the affected side—it's critical that you empty this breast thoroughly. If this breast is too painful to start with, try feeding from the healthy breast first. Then, after your milk is flowing, breast-feed from the affected breast until it feels soft. Switch back to the healthy breast and breast-feed until your baby has finished.
• Pump or express milk from the affected breast if pain prevents you from breast-feeding. Nipple pain can be caused by the baby latching on to sore nipples. For more information on pumping or expressing breast milk, see the topic Breast-Feeding.
• A lanolin-based cream, such as Lansinoh, may help heal sore or cracked nipples.
• If you use nursing pads, replace them frequently so they are dry and clean.

Self-care measures for mastitis

In addition to taking your prescribed antibiotics and continuing to breast-feed or pump breast milk, there are other steps you can take to make yourself feel better until the mastitis goes away.

• Take acetaminophen (such as Tylenol) to relieve your pain or discomfort. You can take ibuprofen (such as Advil) along with acetaminophen to reduce inflammation if necessary.
• Rest as much as possible.
• Apply an ice pack or a warm compress to the affected breast to help reduce your pain. If you use an ice pack, place the ice outside of your bra or clothing. Do not put the ice directly on your bare skin.
• Drink extra fluids.
• If your breasts are very full (engorged), pump or express a small amount of breast milk before breast-feeding. This will make your breasts less full and may make it easier for your baby to latch on to your breast.
• If pus is draining from your infected breast, wash the nipple gently and let it air dry before putting your bra back on. A disposable breast pad placed in the bra cup may absorb the drainage.

Most women can successfully continue breast-feeding during a breast infection. If mastitis makes it difficult for you to continue breast-feeding while the infection is being treated, remember that emptying your breasts regularly is essential. Don't hesitate to talk to your health professional or a lactation consultant for further help and support.

Organizations

• Breast Engorgement
• Breast-Feeding
• Thrush
• Weaning

Citations

1. Dixon JM, Bundred NJ (2004). Management of disorders of the ductal system and infections. In JR Harris et al., eds., Diseases of the Breast, 3rd ed., pp. 47–55. Philadelphia: Lippincott Williams and Wilkins.

2. Cunningham FG, et al. (2005). The puerperium. In Williams Obstetrics, 22nd ed., pp. 695–710. New York: McGraw-Hill.

3. Barbosa-Cesnik C, et al. (2003). Lactation mastitis. JAMA, 289(13): 1609–1612.

Other Works Consulted

• Betzold CM (2007). An update on the recognition and management of lactational breast inflammation. Journal of Midwifery & Women’s Health, 52(6):595–605.

• Poggi SBH (2007). Postpartum hemorrhage and the abnormal puerperium. In AH DeCherney et al., eds., Current Diagnosis and Treatment Obstetrics and Gynecology, 10th ed., pp. 477–497.

• Sharma S, El-Refaey H (2003). Puerperal problems section of Postnatal problems. In DK James et al., eds., Evidence-Based Obstetrics, 2nd ed., pp. 393–401. Edinburgh: Saunders.

• Wambach KA (2003). Lactation mastitis: A descriptive study of the experience. Journal of Human Lactation, 19(1): 24–34.