Should a woman with mastitis continue to breastfeed?

Management of Mastitis During Breastfeeding

Women with mastitis should continue to breastfeed to help resolve the condition more quickly and prevent complications. 1, 2

Understanding Mastitis and Its Impact

Mastitis is an inflammation of the breast tissue that occurs in approximately 10% of breastfeeding women in the United States 3. It typically presents with:

• Focal breast tenderness
• Overlying skin erythema or hyperpigmentation
• Systemic symptoms such as fever and malaise
• Recent history of breastfeeding 2

Benefits of Continued Breastfeeding During Mastitis

Continuing to breastfeed during mastitis treatment provides several important benefits:

• Helps prevent engorgement and blocked ducts 2
• Facilitates milk removal, which is crucial for resolving the infection 2
• Does not pose a risk to the infant 1
• Prevents potential complications like breast abscess formation 3

The American Academy of Pediatrics specifically recommends that mothers with mastitis continue breastfeeding as it helps resolve the condition and is safe for the infant 2.

Treatment Approach for Mastitis

First-Line Management (1-2 days)

• Continue regular feeding or expression of milk from the affected breast 1
• Optimize breastfeeding technique with proper infant latch 2
• Apply ice to reduce inflammation 4
• Use pain medications compatible with breastfeeding (ibuprofen, paracetamol) 2

If Symptoms Persist Beyond 24-48 Hours

• Initiate antibiotics effective against Staphylococcus aureus:
  • Dicloxacillin or cephalexin are preferred first-line options 2, 3
  • Consider antibiotics effective against MRSA if initial therapy fails 2
  • Continue antibiotics for 10-14 days 2

Potential Complications and Prevention

Breast Abscess

• Occurs in approximately 10% of mastitis cases 1
• Can be prevented by early treatment of mastitis and continued breastfeeding 3
• If symptoms worsen despite antibiotics, ultrasonography should be performed to evaluate for abscess 2
• Treatment may require surgical drainage or needle aspiration 2
• Breastfeeding can usually continue even with a treated abscess 3

Risk of Breastfeeding Cessation

• Improperly treated mastitis may lead to premature cessation of breastfeeding 5
• Stopping breastfeeding during mastitis treatment may contribute to early cessation of breastfeeding altogether 2

Common Pitfalls to Avoid

1. Discontinuing breastfeeding: This can worsen engorgement and slow recovery 1, 2

2. Overstimulation practices: Excessive pumping, aggressive breast massage, and heat application may worsen the condition 4

3. Delayed antibiotic therapy: If symptoms persist beyond 24-48 hours of conservative management, antibiotics should be initiated 2

4. Inadequate duration of antibiotic treatment: Complete the full 10-14 day course of antibiotics even if symptoms improve quickly 2

By following these evidence-based recommendations and continuing to breastfeed, most women with mastitis can expect complete resolution of symptoms while maintaining their breastfeeding relationship with their infant.