Blocked Duct vs Mastitis - A Summary
© Lenore Goldfarb, B. Comm, B. Sc., Dip.C., IBCLC. Revised November, 2002• Presentation • Symptoms • Treatment • Breastfeeding Management • Other •
Presentation
Blocked duct | Mastitis |
---|---|
|
Predisposing factors of mastitis include those of blocked duct
Abrupt weaning, poor general health, stress, tiredness, infection from the infant’s nose (staph carriage) mouth, eyes, (conjunctivitis) or other sites, use of contaminated nipple creams, and occasionally following strenuous upper arm activity as with housework or strenuous exercise |
Blocked duct | Mastitis | |
---|---|---|
General | Painful, swollen, firm mass in the breast, skin quite red | Red skin, more intense than blocked duct, intense pain, more than blocked duct, rigors “flu-like” aches |
Fever | Not usually | 38.5 degrees C |
Malaise | Not usually | Yes, generally feeling very ill |
Local | Firm mass in breast, skin quite red | Red skin, more intense than blocked duct |
Symptoms during a feed | Baby may be fussy due to reduced milk flow | Breast refusal may occur since breastmilk tastes more salty during mastitis |
Blocked duct | Mastitis | |
---|---|---|
Should clear within 24 - 48 hours | If symptoms persist for more than 24 hours, begin treatment with antibiotics | |
Antibiotic | No | Yes |
Which one? | N/A | Suitable antibiotics include:
Note: If severe cellulitis has developed, antibiotics should be given intravenously eg. Flucloxacillin 1 to 2 gm intravenously every 6 hours NB: The medications mentioned in the above summary may or may not be available in your country. If this is the case, please see your doctor for alternative medications. |
Analgesia | Paracetamol or acetaminophen or ibuprofen, as needed NB: The medications mentioned in the above summary may or may not be available in your country. If this is the case, please see your doctor for alternative medications. |
Paracetamol or acetaminophen or ibuprofen, as needed NB: The medications mentioned in the above summary may or may not be available in your country. If this is the case, please see your doctor for alternative medications. |
Local pain relief | Hot packs before and during feed to help let-down (not too hot
and not for too long so as not to injure the skin), gently massage
affected area towards nipple while feeding or expressing
Cold packs for comfort after feeds |
Hot packs before and during feed to help let-down, gently
massage affected area towards nipple while feeding or expressing
Cold packs for comfort after feeds |
Activity | Rest | Bed rest |
Blocked duct | Mastitis |
---|---|
Continue breastfeeding | Continue breastfeeding |
Check positioning and attachment (latch) | Check positioning and attachment (latch) |
Frequent feeding starting with the affected side and pointing
baby’s chin towards the blocked duct helps drain the breast and
remove the blockage
Dr. Jack Newman suggests breast compression while the baby is feeding, getting the mother’s hand around the blocked duct and having her apply steady pressure |
Frequent feeding and complete emptying of the breast. Pointing baby’s chin towards affected area helps drain the breast and remove blockage if there is one |
Dr. Newman suggests rest. Take the baby to bed if necessary | Bed rest and discussion of ways of coping with household
concerns (get extra help)
Drink adequate amounts of fluids |
Blocked duct | Mastitis |
---|---|
According to Dr. Jack Newman, a toothpaste like material may
flow out of the affected breast, which will effectively unlock the
duct.
If the blocked duct does not resolve within 48 hours, therapeutic ultrasound often works. The dose is 2 watts/cm squared, continuous for 5 minutes to the affected area, once daily for up to 2 doses. It usually resolves with one treatment but if 2 treatments over two days have not worked, there is no point in continuing with ultrasound. At this point the blocked duct will need to be re-evaluated by a doctor. Lecithin, one capsule (1200 mg) 3 or 4 times a day also seems to help prevent recurrent blocked ducts, at least for some mothers. Note: In addition to the above many mothers find relief for a blocked duct by soaking the affected breast in a bowl or sink filled with 2 tbsp Epson salts in 4 litres of hot water. Soak for 10 minutes every 3 hours for 24 hours. |
According to Dr. Jack Newman: If a mother has symptoms consistent with mastitis for more than 24 hours she should start antibiotics. If the mother has consistent symptoms for less than 24 hours, he will prescribe the antibiotic but suggest she wait before taking it. If over the next 8 - 12 hours, her symptoms are worsening, then the mother should start the antibiotics. If over the next 24 hours her symptoms have not improved and not worsened, she should start antibiotics. However, if the symptoms start to decrease, there is no need to start the antibiotics. The symptoms will continue to resolve and should disappear over the next 2-5 days. |
References:
Lawlor-Smith, C: "Blocked Duct/Mastitis"
Jack Newman, MD: "Blocked Ducts and Mastitis", Revised January 2003
Lenore’s Note: I’ve indicated where Dr. Newman has made suggestions that differ from C. Lawlor-Smith. Otherwise the information from the two websites are in agreement. Most of the information for this article came from Lawlor-Smith’s "Blocked Duct/Mastitis". I’ve quoted virtually word for word from both of these authors with some exceptions and have reorganized the information into this format.
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