How often should I pump when I have mastitis?

Management of Pumping Frequency During Mastitis

When you have mastitis, you should pump or breastfeed regularly every 2-3 hours to ensure complete emptying of the affected breast, as this is an essential part of treatment alongside other measures like antibiotics when indicated. 1

Understanding Mastitis and Its Management

Mastitis is an inflammatory condition of the breast that affects approximately 10% of breastfeeding mothers in the United States, typically occurring within the first 3 months postpartum 2. It presents with symptoms including:

• Focal breast tenderness
• Overlying skin erythema
• Fever
• Malaise

Key Treatment Principles

The American Academy of Pediatrics strongly recommends that mothers with mastitis continue to breastfeed or express milk regularly 1. This approach serves several important purposes:

• Prevents milk stasis, which can worsen inflammation
• Helps clear blocked ducts
• Acts as an adjunct to other treatments like antibiotics
• Reduces the risk of progression to breast abscess (which occurs in about 10% of mastitis cases)

Specific Pumping Recommendations

1. Frequency: Pump or breastfeed every 2-3 hours, including overnight if possible
2. Duration: Continue until the breast feels adequately emptied
3. Technique:
   • Start with the affected breast if tolerable
   • Ensure proper positioning and attachment if breastfeeding
   • Use gentle massage toward the nipple while pumping/feeding

Additional Management Strategies

• Pain management: Use over-the-counter NSAIDs and apply cold compresses between feedings 3, 2
• Supportive measures: Wear a well-fitted, supportive bra that isn't too tight 3
• Antibiotics: If symptoms don't improve after 24-48 hours of conservative management, antibiotics effective against Staphylococcus aureus (e.g., dicloxacillin, cephalexin) may be needed 2, 4

Important Considerations

• Continue breastfeeding: Even with mastitis, breastfeeding should continue and generally poses no risk to the infant 4
• Avoid excessive pumping: While regular emptying is essential, excessive pumping beyond what's needed for emptying may worsen inflammation 2
• Avoid aggressive massage: Tissue trauma from aggressive breast massage can increase the risk of mastitis 2

When to Seek Additional Medical Care

Consult a healthcare provider if:

• Symptoms worsen despite regular breast emptying
• No improvement after 24-48 hours
• Signs of abscess formation (fluctuant mass)
• Severe pain that prevents effective breast emptying

Regular breast emptying through pumping or breastfeeding every 2-3 hours is a cornerstone of mastitis management, helping to prevent complications and promote faster resolution of symptoms.