Breastfeeding ( Mastitis ) - The Diagnosis and Treatment of Mastitis in the Breastfeeding Mother and Baby

Publication: 30/06/2007  --
Last review: 13/06/2018  
Next review: 13/06/2021  
Clinical Guideline
CURRENT 
ID: 1148 
Approved By: Trust Clinical Guidelines Group 
Copyright© Leeds Teaching Hospitals NHS Trust 2018  

 

This Clinical Guideline is intended for use by healthcare professionals within Leeds unless otherwise stated.
For healthcare professionals in other trusts, please ensure that you consult relevant local and national guidance.

The diagnosis and treatment of mastitis in the breastfeeding mother and baby

Contents

Aims

To improve the prevention, diagnosis and management of mastitis in the breastfeeding mother and baby.

Objectives

To provide evidence-based recommendations for prevention, appropriate diagnosis, investigation and management of Mastitis in the breastfeeding mother and baby.  

Background

Mastitis is inflammation of part of the breast caused by milk stasis [non infective mastitis] If not dealt with the tissue may become infected

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Diagnosis

  • Red area on part of the breast, often outer upper area which may be painful to the touch
  • Lumpy breast which feels hot to touch
  • Whole breast may ache and become red
  • Flu like symptoms – aching raised temperature, shivering, feeling tearful & tired – this can start very suddenly and get worse very quickly
  • Pyrexia
  • The redness and swelling are not necessarily a sign of infection. Bacteria are not always present and antibiotics are not always necessary if self help measures are started promptly
  • Mothers may not have all the above symptoms

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Predisposing Factors:

  • Sub optimal attachment of baby at the breast causing inadequate drainage 
  • Engorgement 
  • Blocked duct 
  • Sudden change in how often the baby is feeding causing the breasts to feel full 
  • Pressure from tight fitting clothing or a finger pressing into the breast whilst feeding
  • Stress, tiredness 

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Management:

  • Mother should be encouraged to keep breastfeeding
  • Observe full breastfeed to assess for any signs of suboptimal attachment and support mother to achieve optimal attachment
  • Good breast drainage is crucial to prevent further complications such as infection and abscess
    The mother should be encouraged to :
  • Feed baby more frequently or express between feeds if breasts feel uncomfortably full.
  • Feed from the affected side first to drain as thoroughly as possible.
  • Express gently after feeds so that breasts are kept well drained until symptoms have resolved.
  • Try feeding baby using different positions to encourage full drainage of the breast, chin towards the affected area is recommended.
  • If the breast is particularly full soften prior to attaching baby using gentle hand expressing, warm flannels may also be applied to breasts.
  • Breast massage before and during a feed can help with drainage.
  • Ensure clothing is not too tight.
  • Encourage the mother to rest as much as possible.
  • It is advised that the mother gets a prescription for antibiotics which are safe to take when breastfeeding.  She may be advised to continue with self-help measures initially.
  • If self-help measures do not show a reduction in symptoms within a matter of a few hours [there are no firm guidelines for the time delay] or symptoms become more severe antibiotics should be commenced.

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Medical Management

  • For medication please see WHO guidelines: http://whqlibdoc.who.int/hq/2000/WHO_FCH_CAH_00.13.pdf?ua=1
  • Breastfeeding and breast drainage measures should be continued while taking antibiotics.
  • Ibuprofen  400mg three times a day after food may be used to reduce the inflammation [contraindicated with asthma, stomach ulcers or allergy] [7]
  • Paracetamol may be used to relieve pain and reduce temperature [max 8 tablets in 24 hours] [7]
  • Further medical treatment should be sought if there is no response to antibiotics within 48 hours.  Culture is not routine for mastitis, but may be recommended if therapy is not effective.
  • Midwifery care should continue until the situation is resolved, a contact number should be provided for the mother in case of worsening of symptoms and a care plan with review dates maintained.
  • An untreated mastitis can lead to a breast abscess which will often need surgical treatment.

Breastmilk culture and sensitivity testing should only be considered in the following cases:

  • no response to antibiotic treatment within 2 days
  • recurrent mastitis
  • a hospital acquired infection
  • Severe and unusual cases**this is when symptoms worsen despite all self help measures being undertaken alongside effective and frequent breastfeeding.  

 the following precautions should be taken to ensure a clean specimen is obtained

Precautions to take when obtaining a breastmilk sample:

Breastmilk samples to be taken for C&S must be collected carefully to avoid contamination

  • effective hand washing and cleansing of the nipple area with water and drying with a disposable paper towel prior to expression will reduce the risk of contamination and false positive culture results
  • The EBM from the affected breast should be hand expressed  with the first 10ml being discarded
  • The sample must then be collected from a midstream clean catch sample that is hand expressed directly into a sterile universal container.  To avoid skin flora contamination , care should be taken to avoid touching the inside of the container with the nipple
  • The breastmilk sample should be sent to the lab promptly as per local arrangements.  Store in a refrigerator until time of collection
  • If an infant is premature or compromised and milk culture is positive for Group A or Group B streptococcus infection or methicillin resistant S Aureus (MRSA), it is necessary to discontinue breastfeeding at this time.  However, the mother should be advised to continue frequent expression to maintain lactation and to discard this milk until the infection has been successfully treated
  • If group A or B streptococcus or MRSA infection is found in the breastmilk of a mother of a term healthy infant this should be discussed with a paediatrician and the mother supported to make an informed choice about feeding this milk to the baby.  In some instances it may be appropriate to withhold breastmilk temporarily until successfully treated
  • If streptococcal or MRSA infection is confirmed it is important to observe and monitor the baby's general condition.  if there are any clinical signs of infection the baby should be assessed by a paediatrician and treated with antibiotics as necessary

Source: Breastfeeding Network Mastitis & Breastfeeding 2009

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Provenance

Record: 1148
Objective:

To provide evidence-based recommendations for prevention, appropriate diagnosis, investigation and management of Mastitis in the breastfeeding mother and baby.  

 

Clinical condition:

Mastitis in the breastfeeding mother

Target patient group: Breastfeeding mothers and babies
Target professional group(s): Health Visitors
Primary Care Doctors
Secondary Care Doctors
Midwives
Adapted from:

Evidence base

Mastitis & breastfeeding.  The breastfeeding network.  2003

  1. Fetherstone C 2002 Mastitis in breastfeeding women: physiology or pathology? MIDIRS 12[2]235-40 (b)
  2. Foxman B et al 2002 New insights with regard to risk factors for lactation mastitis, Am J Epidemiol 155: 103-114 (b)
  3. Hale T 2002 Medications & Mothers milk [10th Ed], Pharmsoft medical publishing
  4. Inch S Fisher C 1995 Mastitis: Infection or inflammation? Practitioner 239:472-476 (b)
  5. Mohrbacher N Stock J 2003 The breastfeeding Answer book [3rd Ed] La Leche League International (c)
  6. Riordan J Auerbach KG 1998 Breastfeeding & Human lactation [2nd Ed] Jones & Bartlett ( c)
  7. WHO 2000 Mastitis: cause & management WHO Geneva (b)
  8. Jahanfars, NJ CJ Teng (2009) Antibiotics for mastitis in breastfeeding women. Cochrane Database of systematic reviews 2009 http//www.cochrane.org/reviews/en/ab005458.html (a)
  9. Scott J, Robertson M, Fitzpatrick J et al. (2008) Occurrence of lactational mastitis and medical management: A prospective cohort in Glasgow.  Int breastfeeding journal 2008;(21) (b)
  10. KvirstL, Wilde Larsson B, Hall-lord ML et al(2008) The role of bacteria in lactational mastitis and some considerations of the use of antibiotic treatment. Int breastfeeding journal 2008:3,6 (b)
  11.  Guidelines on the treatment, management and prevention of mastitis. 

(C)

Approved By

Trust Clinical Guidelines Group

Document history

LHP version 1.0

Related information

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