Breastfeeding Instructions for Mastitis
Continue breastfeeding from both breasts, including the affected right breast, as this is essential for resolution of mastitis and does not pose a risk to the infant. 1, 2
Rationale for Continued Breastfeeding
- Effective milk removal through continued breastfeeding is the cornerstone of mastitis treatment and helps resolve the condition. 1, 2
- The infant can safely breastfeed from the affected breast unless their mouth would directly contact purulent drainage. 1
- Stopping breastfeeding or avoiding the affected breast increases the risk of complications, including breast abscess development (which occurs in approximately 10% of mastitis cases). 1, 2
- Interrupting breastfeeding can lead to breast engorgement, blocked ducts, and worsening of the mastitis itself. 3
Clinical Management Approach
Frequent, complete emptying of the affected breast is critical:
- Encourage the mother to breastfeed frequently from both breasts, starting with the affected side if tolerable. 2, 4
- If direct breastfeeding from the affected breast is too painful, expressed milk from that breast can be given to the infant. 5
- The American Academy of Pediatrics explicitly recommends continued breastfeeding during mastitis treatment, as most maternal conditions and medications are compatible with breastfeeding. 3
Treatment Considerations
Conservative measures should be initiated immediately:
- NSAIDs for pain and inflammation control. 4
- Ice application to reduce swelling. 4
- A 1-2 day trial of conservative measures is often sufficient before antibiotics are needed. 4
If antibiotics become necessary:
- First-line options include cephalexin or dicloxacillin, which are safe during breastfeeding. 6, 2
- Continued breastfeeding during antibiotic treatment does not pose risk to the infant. 6
Common Pitfalls to Avoid
- Do NOT advise stopping breastfeeding or avoiding the affected breast - this worsens outcomes and increases abscess risk. 1, 2
- Do NOT recommend excessive pumping or aggressive breast massage - these can worsen inflammation through overstimulation. 4
- Reassure the mother that breastfeeding through mastitis is safe for the baby and therapeutic for her condition. 2, 7
The correct answer is C: Breastfeed the baby from both breasts as usual.