The Mastitis Treatment Recommendations Have Changed. Here’s What to Know

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Bringing a new baby into the world is full of new experiences, and parents who are breastfeeding have their own unique challenges, including potentially having to figure out how to treat mastitis.

Mastitis refers to an inflammation of the breast, according to the La Leche League International. The condition is relatively common, occurring in one-third of postpartum people, according to the American Academy of Pediatrics. It happens most often before the baby is 3 months of age, the journal the American Family Physician states, although it can happen at any time during one’s breastfeeding journey.

Mastitis can occur with or without an infection, but either way, it can cause breast pain and uncomfortable swelling, and even flu-like symptoms, like a fever. It’s so miserable that it’s one of the top reasons people stop breastfeeding earlier than they initially intended. That’s why it’s important to know how to treat mastitis, including early signs of mastitis, when you can treat mastitis at home, and when you need antibiotics for mastitis.

But the treatment protocol for mastitis recently changed. In 2022, the Academy of Breastfeeding Medicine (ABM) published new guidelines on mastitis management, and they represent a pretty big shift from how mastitis used to be treated. Here, everything you need to know about the early signs of mastitis and how to get rid of mastitis fast.

What Are the Early Signs of Mastitis?

Engorgement, or the feeling that the breasts are uncomfortably full and heavy, or even hard, is an early red flag of mastitis. Other warning signs typcially include a tender, reddish area of the breast, Chrisie Rosenthal, an International Board-Certified Lactation Consultant (IBCLC) and director of clinical resources at The Lactation Network, tells PS.

The La Leche League International notes that an area of your breast may also look “pink, brown, or gray” depending on “your skin tone and which part of the breast is inflamed.” The discolored area may be “triangular” or “wedge” shaped. However, the organization notes that skin changes don’t have to be present for you to have mastitis.

If the mastitis develops, you may also experience “flu-like symptoms including fever, chills, aches, and fatigue,” says Rosenthal.

What Causes Mastitis?

The causes of mastitis vary. It tends to occur when a breastfeeding person is experiencing “infrequent or inefficient milk removal,” and is especially likely if they also have an oversupply (which means they’re producing more breast milk than their infant is eating), Rosenthal says.

If a breastfeeding person isn’t nursing or pumping often enough to remove milk, their breast can become engorged and the pressure can cause the milk ducts to narrow, leading to what’s known as inflammatory mastitis. This can then lead to an infection developing, known as bacterial mastitis.

This is a relatively new understanding of the condition. Previously, you often heard people talk about “clogged ducts.” Now, it’s thought that mastitis is the result of inflammation, not clogs.

How to Treat Mastitis

As mentioned, the treatment protocol for mastitis recently changed. Now, the goal is to treat the inflammation that causes mastitis, rather than to loosen or dislodge a “clog.”

It’s best to talk to your doctor if you suspect you may be at risk of mastitis, but the ABM Clinical Protocol #36 lays out the following advice for how to treat mastitis:

First, be aware of the early signs of mastitis and work fast if you think you may be at risk of developing the condition.”Prompt and effective treatment will halt progression in the spectrum. Many of these measures provide not only treatment but prevention as well,” the Protocol states.

If you’re experiencing pain or swelling in the breasts, use ice to try to bring it down. You can also ask your doctor if it’s safe for you to take over-the-counter anti-inflammatories like ibuprofen.

Avoid applying heat, and do not massage the breasts, as both things can worsen inflammation. (Warm showers are fine if they feel nice, but they won’t help treat the mastitis.)

Nurse your child on demand. It’s safe to do so even if you develop bacterial mastitis. Don’t aim to “empty” the breasts; there’s no need to follow a nursing session with pumping, and in fact, the ABM guidelines call for reducing pump usage in general, since over-pumping can contribute to an oversupply. (If you’re exclusively pumping, you can ask your doctor about the right strategy for you.)

Taking 5 to 10 g of sunflower or soy lecithin daily can help reduce duct inflammation and may prevent mastitis. The ABM guidelines also name probiotics as a way of potentially reducing the risk of mastitis, though more research is needed to say for sure how helpful the good bacteria are.

Are Antibiotics Necessary to Treat Mastitis?

Not always. If you have inflammatory mastitis, using antibiotics “disrupts the breast microbiome and increases the risk of progression to bacterial mastitis,” the ABM Protocol states. “Prophylactic antibiotics have not been shown to be effective in the prevention of mastitis.”

But if you have bacterial mastitis, antibiotics are often necessary. So it’s essential to see your care provider if you suspect mastitis, Rosenthal says.

It’s especially important to see your doctor if you develop a fever or rapid heart rate, she adds. But in general, it’s best to talk to your doctor early to get their recommendations for how to treat mastitis — the condition can progress quickly, so you want to act fast.

Devan McGuinness (she/they) is a Canadian disabled writer, editor, and social strategist who covers politics, entertainment, parenting, and lifestyle. Devan has contributed to POPSUGAR, Fatherly, Parents, Scary Mommy, Mom.com, and more over her 10-plus years in digital media, specializing in stories that matter most to families.

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