by Jack Newman, MD, FRCPC
Mastitis is due to an infection (almost always due to bacteria rather than other types of germs) that usually occurs in breastfeeding mothers. However it can occur in any woman, even if she is not breastfeeding and can even occur in newborn babies of either sex. Nobody knows exactly why some women get mastitis and others do not. Bacteria may enter the breast through a crack or sore in the nipple but women without sore nipples also get mastitis and most women with cracks or sores do not.
Mastitis is different from a blocked duct because a blocked duct is not thought to be an infection and thus does not need to be treated with antibiotics. With a blocked duct, a mother has a painful, swollen, firm mass in the breast. The skin overlying the blocked duct is often red, but less intensely red than the redness of mastitis. Unlike mastitis, a blocked duct is not usually associated with fever, though it can be. Mastitis is usually more painful than a blocked duct, but both can be quite painful. Thus seeing the difference between a "mild" mastitis and a "severe" blocked duct may not be easy. It is also possible that a blocked duct goes on to become mastitis, so things become even more complicated. However, without a lump in the breast, there is no mastitis or blocked duct for that matter.
In France, physicians recognize something they call lymphangite when the mother has a painful, hot redness of the skin of the breast, associated with fever, but there is no painful lump in the breast. Apparently, most do not believe this lymphangite requires treatment with antibiotics. I have seen a few cases that fit this description and yes, in fact, the problem goes away without the mother taking antibiotics. But then, often a full-blown mastitis also goes away without the mother taking antibiotics.
Blocked ducts will almost always resolve without special treatment within 24 to 48 hours after starting. During the time the block is present, the baby may be fussy when breastfeeding on that side because the milk flow will be slower than usual. This is probably due to pressure from the lump collapsing other ducts. A blocked duct can be made to resolve more quickly if you:
1. Continue breastfeeding on that side and draining the breast better. This can be done by:
• Getting the best latch possible (see the information sheet When Latching as well as the video clips on how to latch a baby on at the website nbci.ca).
• Using compression to keep the milk flowing (see the information sheet Breast Compression as the video clips on how to latch a baby on at the website nbci.ca). Get your hand around the blocked duct and compress it as the baby is breastfeeding if it is not too painful to do so.
• Feeds the baby in such a position that the baby’s chin "points" to the blocked duct. Thus, if the blocked duct is in the bottom outside area of the breast (7 o’clock), then feeding the baby in the football position may be helpful.
2. Apply heat to the affected area. You can do this with a heating pad or hot water bottle, but be careful not to burn your skin by using too much heat for too long a period of time.