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Breastfeeding

Blocked Duct vs Mastitis - A Summary

© Lenore Goldfarb, B. Comm, B. Sc., Dip.C., IBCLC. Revised November, 2002
PresentationSymptomsTreatmentBreastfeeding ManagementOther

Presentation

Predisposing factors
Blocked duct Mastitis
  1. Poor drainage of breast causing milk immobility due to poor attachment or poor sucking with inadequate emptying of one or more ducts
  2. Trauma due to pressure on one spot caused by mother holding breasts too tightly while expressing, tight or ill fitting bra or other clothing, sleeping on a full breast, kick from older baby or child
  3. Maternal exhaustion, anaemia or poor nutrition, a diet high in saturated fat may contribute to this problem
  1. Can be non-infective which occurs when foreign body inflammatory reaction occurs following leakage of milk into the surrounding tissue from a blocked milk duct or
  2. Infective:
    there are two forms of this
    1. Cellulitis of the interlobular connective tissue. Pus is not found in the milk as the infection is outside the ductile system. This is the most common form of mastitis.
    2. Adenitis where infection occurs within the ductile system. Pus may appear in the milk but systemic symptoms are less severe.

Predisposing factors of mastitis include those of blocked duct
as well as the following:

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

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Symptoms
  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

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Treatment
  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:
  • Dicloxacillin 500mg orally 6 hourly OR
  • Flucloxacillin 500 mg to 1 gm orally every 6 hours or
  • Cephalexin 500 mg orally every 6 hours or
  • Erythromycin 500 mg orally every 12 hours or
  • Roxithyromycin 150 mg every 12 hours
Treatment should be started early and continue for 10 days

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

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Breastfeeding Management
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

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Other
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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