Managing Mastitis Fitzgerald Health Education Associates, Inc

Fitzgerald Health Education Associates, Inc.

Managing Mastitis By Marie L. Bosco, BSN, RNC, IBCLC Private Practice Lactation Consultant, MI

Mastitis is a common condition occurring in up to 20% of lactating women. Many of these cases occur within the first six weeks following delivery, but they can occur anytime during lactation. The clinical conditions associated with mastitis include a tender, hot, edematous breast with a fever 38.5 degrees Celsius (1013 degrees Fahrenheit) or greater. Chills and flu-like symptoms have also been reported. This infection may be viral or bacterial, and may affect one breast or two. In some cases women may experience breast engorgement and a blocked milk duct which may appear to be mastitis but is not. The only evidence-based predisposing factor that may lead to mastitis is the development of milk stasis. However, other associated factors include: nipple damage, infrequent feedings or scheduled feedings, missing feedings, poor latch and transfer of milk, illness of mother or baby, over supply, tight bra, blocked nipple pore of duct, and maternal stress and fatigue. Once the diagnosis is made, the most important management is frequent and effective milk removal. These women should be encouraged to breastfeed frequently beginning with the affected side. A warm, moist compress may be applied to the breast prior to feeding to assist in milk flow. Massaging the breast during feeding from the blocked area to the nipple will encourage drainage. Additionally, pumping after breastfeeding may hasten the recovery of the problem. Ice packs may be applied following breast emptying to reduce pain and edema. It is essential that the mother receive adequate rest, fluids, and nutrition during this time. Diagnosis of mastitis many be based on clinical symptoms with the most prevalent infective being S. aureus. Streptococcus and E. coli can also be found but are less common. The preferred antibiotics are usually penicillinase-resistant penicillins, such as dicloxacillin administered in 500 mg doses four times a day for ten to fourteen days. First generation cephalosporins are also acceptable, but are less preferred because of their broad spectrum coverage. Cephalexin is an optimal choice for women allergic to penicillin, although Clindamycin is suggested for those women with severe penicillin hypersensitivity. If symptoms do not improve with the first line of treatment, a culture and sensitivity is recommended. The nipple should be cleansed to minimize skin contamination, and milk should be hand expressed with the collection occurring midstream. There has been an increasing occurrence of Methicillin-resistant Staphylococcus aureus (MRSA) in cases of mastitis and breast abscess. Appropriate treatment is needed in these cases.

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The acute symptoms of mastitis may cause women to wean from breastfeeding; however, effective milk removal is the most essential treatment, thus, weaning is not encouraged. The acute cessation of breastfeeding may exacerbate the mastitis and increase the risk of an abscess. Treatment and support from the healthcare provider, as well as family, is important during this time. Reassurance that recovery is generally rapid and dramatic will help encourage the hesitant mother to continue breastfeeding. Mastitis is a common condition that occurs in lactating women and may be prevented. Effective management of breast fullness and engorgement is needed. Prompt attention to blocked milk ducts and healthcare provider intervention when symptoms do not improve within 24 hours may also help prevent mastitis.

References: R. Lawrence. Breastfeeding A Guide for the Medical Professional. 6th edition. St Louis: Mosby, 2005.

World Health Organization: Mastitis: Causes and Management, Publication Number WHO/FCH/CAH/00.13, World Health Organization, Geneva, 2000.

Chantry C, Howard C, Lawrence R, Marinelli K, Powers, N. ABM Clinical Protocal #4: Mastitis Breastfeeding Medicine. Volume 3, Number 3, 2008, pg177-180.