Plugged Ducts, Breast Infections, and Mastitis

Some women breastfeed without problems. Obviously breastfeeding is a process that tends to work, or the human race would not have survived until this century. But if a breastfeeding problem does arise, information and support are available to help overcome it, almost always without sacrificing breastfeeding in the process.

A plugged duct or breast infection, also known as mastitis, is one breastfeeding problem some nursing mothers encounter. Often it starts small, just a sore spot or lump in one breast. It may go away on its own, without doing anything special. Or it may not. The pain may worsen, and instead of staying confined to a small area, the soreness may spread through the breast, making breastfeeding painful and leaving the mother feeling feverish and ill.

In most cases, a mother can treat and heal a plugged duct or breast infections on her own. But whether a mother handles it herself or consults her doctor and receives medication, continuing to breastfeed is nearly always best for her and her baby.

PLUGGED DUCT OR BREAST INFECTION?

The difference between a plugged duct and breast infection is usually one of degree. A plugged duct refers to a sore or tender spot or lump in the breast not accompanied by a fever. This happens because a milk duct is not draining properly and has become inflamed. Pressure builds up behind the plug, causing inflammation in the surrounding tissues. This is also sometimes referred to as “caking,” and it usually occurs in only one breast.

If the soreness or lump is accompanied by a fever and/or flu-like symptoms (feeling tired and achy or run-down), it is called a breast infection. Other symptoms, such as nausea and vomiting, may also occur with a breast infection. A breastfeeding mother will sometimes develop a breast infection when other members of the family suffer from colds or the flu. Like a plugged duct, a breast infection usually occurs in only one breast.

TREATMENT IS THE SAME

Whether breast soreness is caused by a plugged duct or a breast infection, the treatment is the same: apply heat, breastfeed often on the affected side, and rest.

Applying heat increases the circulation to the sore area, speeding healing. Some mothers use a heating pad or baby-sized hot water bottle. It can also help to gently massage the area. While applying heat, gently massage the area and remove any dried milk secretions on the nipple by soaking it with plain water. One easy way to do this is to soak and massage your breast while lying on your side in a warm bath or while standing in a warm shower. When massaging, gently press on the lump using the palm of your hand and all your fingers in a gentle but firm circular motion, working toward the nipple. To help loosen the plug, breastfeed the baby or express some milk right after treating the sore area with warmth and massage.

Frequent nursing will keep the breast from becoming overly full and keep the milk flowing freely. As long as the breast is tender or warm to the touch, encourage the baby to nurse at least every two hours, including during the night, nursing on the affected side first.

Rest is the third crucial part of the treatment. Often a plugged duct or breast infection is the first sign that a mother is trying to do too much and is becoming overly tired. If possible, clear your schedule and go to bed with the baby until you’re feeling better. If that’s not possible, at the very least eliminate all extra activities and spend an extra hour or two relaxing with the baby at the breast and your feet up.

There are also other things that can help speed healing. First, loosen any tight clothing, especially your bra. Second, check the baby’s position and latch-on. Make sure when the baby latches on to the breast, she is facing the breast (so she doesn’t have to turn her head to nurse) and opens her mouth wide (like a yawn) so that she gets a big mouthful of the breast in her mouth. As she is going on to the breast, pull her in close. Good positioning and latch-on enable the baby to drain all the milk ducts more effectively at every feeding. Third, try different nursing positions. If you usually nurse sitting up, try nursing lying down or in the football hold for a couple of feedings. Some suggest positioning the baby so her nose or chin point in the direction of the plug.

WHEN TO CONTACT THE DOCTOR

By following these measures most mothers feel better within twenty-four hours. But if this doesn’t happen–if the fever persists or the symptoms worsen–contact your doctor, who may prescribe an antibiotic.

With some types of breast infection, a doctor should be contacted without delay. For example, if both breasts are affected, the nipple looks infected, if there is any pus or blood in the milk, if there are red streaks near the sore area, or if the symptoms came on suddenly and severely, these are signs of a bacterial breast infection and it should be checked by a doctor immediately.

Even if an antibiotic is necessary, continuing to breastfeed is best for you and your baby. Most antibiotics are compatible with breastfeeding. Babies are prescribed antibiotics when ill, and the baby would receive far less of the antibiotic through his mother’s milk than he would if he were receiving a treatment dose. If your doctor is not sure that the antibiotic is compatible with breastfeeding, check with the baby’s doctor. If the drug is questionable, ask the doctor to prescribe an antibiotic that is compatible with breastfeeding. If an antibiotic is prescribed, be sure to take it for the whole course of treatment.

POSSIBLE CAUSES

Knowing the reason for the plugged duct or breast infection can be reassuring and can help prevent it from happening again. The most common causes of a plugged duct or breast infection are: missed or shortened feedings, consistent pressure on the breast, and poor latch-on or positioning.

Anything that postpones nursing or reduces a baby’s time at the breast can result in overly full or engorged breasts and increase the risk of mastitis. For example, if a mother limits feeding times, she may cut nursings short before the baby has a chance to soften the breast, leaving her uncomfortably full. Giving supplementary bottles, whether of water, juice, formula or her own milk, can increase the time between nursings. Overuse of a pacifier can also contribute to this problem, because the baby spends less time at the breast. Busy schedules around holidays and vacations may mean nursings are postponed. Also, if the mother is beginning work or school outside the home, changes in routine may cause nursings to be postponed or eliminated. In this case, the mother may need to express her milk (or express it more often) while she is away from her baby.

Sometimes, though, it is the baby who changes the nursing pattern, either by starting to sleep through the night or breastfeeding more often during one part of the day and less often at other times. A baby who is teething or has an ear infection or cold may also cut nursings short or refuse to nurse altogether due to discomfort. Some babies simply go longer than usual between feedings yet still have a healthy weight gain and thrive. Eventually, the mother’s milk supply will adjust to the baby’s pattern, but until it does she may need to express her milk whenever she begins to feel full.

Consistent pressure on the breast is another common cause of a plugged duct or breast infection. Any consistent or sustained pressure on any part of the breast can restrict the flow of milk and cause inflammation. Possibilities include: a tight bra or one that does not support well; a tight bathing suit; a baby carrier, heavy purse, or diaper bag with straps that put pressure on the breasts; thick breast pads or breast shells that cause a bra to be too tight; pressure on the breasts from sleeping on your stomach; the baby resting on your breasts; and pressing down on the breasts during feedings.

Another common cause is poor latch-on or positioning. If the baby is not latching on well–if she is grasping the breast near the end of the nipple rather than further back on the areola–she may not be milking the breast effectively, causing the breast to become overly full or the ducts to be emptied unevenly. Poor positioning and latch-on can also cause sore nipples, which may result in postponed feedings.

Other, less common causes include: a baby with a weak suck, who is not able to empty the breast (the baby would also gain weight slowly), fatigue, stress, and/or anemia in the mother, an overabundant milk supply, nipple damage, use of a nipple shield (worn over the nipples during feedings), and breast abnormalities.

BREASTFEEDING CAN AND SHOULD CONTINUE

At one time it was standard procedure to recommend weaning with a breast infection. But experience has shown that a breast infection clears up more quickly when the breast is not allowed to become overly full, and there is less risk of it developing into an abscess. Also, even temporary weaning is a hardship when a mother is not feeling well. As for the baby, antibodies in the mothers’ milk protect the baby from any bacteria.

In almost all cases, the best thing a mother with a plugged duct or breast infection can do for her and her baby is to keep nursing.