Is it safe to continue breastfeeding with mastitis or do I need to pump and discard the milk?

Breastfeeding with Mastitis: Safety and Management

Breastfeeding should continue during mastitis as it is safe for the infant and essential for treatment. 1 Continuing to breastfeed helps resolve the condition more quickly by facilitating milk removal and does not pose any risk to the infant.

Safety of Breastfeeding with Mastitis

Breastfeeding during mastitis is not only safe but recommended as a crucial part of treatment. The Academy of Breastfeeding Medicine and American Academy of Pediatrics strongly support continued breastfeeding as it:

• Facilitates milk removal, which is essential for resolving the infection 1
• Prevents milk stasis that can worsen the condition 2
• Helps maintain milk supply during the infection 1
• Does not pose any risk to the infant 1, 2

Discontinuing breastfeeding during mastitis can actually worsen engorgement, slow recovery, and potentially lead to the development of a breast abscess, which occurs in approximately 10% of mastitis cases 1, 2.

Management Recommendations

Continue Breastfeeding

• Feed frequently from the affected breast first to ensure thorough emptying 1
• Ensure proper positioning and latch to minimize nipple trauma 1, 3
• If direct breastfeeding is too painful, express milk manually or with a pump temporarily 1

Pain Management

• Use pregnancy-safe analgesics such as acetaminophen or ibuprofen as recommended by ACOG 1
• Apply cold compresses to reduce inflammation and pain 3
• Avoid excessive heat application and aggressive breast massage as these can worsen inflammation 3

When to Consider Antibiotics

• If symptoms persist beyond 24-48 hours of conservative management 1
• First-line antibiotics should target Staphylococcus aureus (dicloxacillin or cephalexin) 1
• Complete the full prescribed course of antibiotics 1

Special Considerations

Cracked or Bleeding Nipples

The only exception to continued breastfeeding is when nipples are cracked or bleeding. In these cases:

• Express and discard breast milk from the affected breast until healing occurs 4
• Continue breastfeeding from the unaffected breast 4
• Treat the cracked nipples with appropriate nipple care

Breast Abscess

If mastitis progresses to a breast abscess:

• Surgical drainage or needle aspiration may be required 2
• Breastfeeding can usually continue even with a treated abscess 2
• Ultrasound evaluation is recommended if symptoms worsen despite antibiotics 1

Prevention of Recurrence

• Optimize breastfeeding technique with proper infant latch 1, 3
• Encourage physiologic breastfeeding rather than pumping when possible 1
• Avoid overstimulation of milk production through excessive pumping 3
• Treat sore nipples promptly as they can precipitate mastitis 2

Mastitis is not a reason to stop breastfeeding. In fact, continued breastfeeding is a cornerstone of effective treatment and is completely safe for the infant. The old practice of "pump and dump" is unnecessary and can actually impede recovery from mastitis.