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.
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 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.
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, you may need to call your doctor
today. Prompt treatment helps keep infection from rapidly getting worse and
usually improves symptoms after about 2 days.
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:
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, you may need to call 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.
The American Academy of Family Physicians produces a
variety of health-related educational materials. Its Web site offers a health
library and bulletin board, news, and comments sections.
American Academy of Pediatrics
141 Northwest Point Boulevard
Elk Grove Village, IL 60007-1098
Phone:
(847) 434-4000
Fax:
(847) 434-8000
E-mail:
kidsdocs@aap.org
Web Address:
www.aap.org
The American Academy of Pediatrics (AAP) offers a
variety of educational materials, such as links to publications about parenting
and general growth and development. Immunization information, safety and
prevention tips, AAP guidelines for various conditions, and links to other
organizations are also available.
American College of Obstetricians and Gynecologists
(ACOG)
409 12th Street SW
P.O. Box 96920
Washington, DC 20090-6920
Phone:
(202) 638-5577
E-mail:
resources@acog.org
Web Address:
www.acog.org
American College of Obstetricians and Gynecologists
(ACOG) is a nonprofit organization of professionals who provide health care for
women, including teens. The ACOG Resource Center publishes manuals and patient
education materials. The Web publications section of the site has patient
education pamphlets on many women's health topics, including reproductive
health, breast-feeding, violence, and quitting smoking.
La Leche League International (LLLI)
P.O. Box 4079
Schaumburg, IL 60168-4079
Phone:
1-800-LA-LECHE (1-800-525-3243) (847) 519-7730
Fax:
(847) 969-0460
TDD:
(847) 592-7570
Web Address:
www.llli.org
La Leche League International (LLLI) offers information and
encouragement—mainly through personal help—to all mothers who want to
breast-feed their babies. It also offers support and information about
breast-feeding babies with various disabilities, such as cleft lip or cleft
palate. Call for information about a chapter in your area.
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.
Cunningham FG, et al. (2005). The puerperium. In
Williams Obstetrics, 22nd ed., pp. 695–710. New York:
McGraw-Hill.
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 and 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. New York: McGraw-Hill.
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.
This information does not replace the advice of a doctor. Healthwise disclaims any warranty or liability for your use of this information. Your use of this information means that you agree to the Terms of Use. How this information was developed to help you make better health decisions.This information does not replace the advice of a doctor. Healthwise disclaims any warranty or liability for your use of this information. Your use of this information means that you agree to the Terms of Use. How this information was developed to help you make better health decisions.