Managing plugged ducts, mastitis when breastfeeding

The American Academy of Pediatrics recommends exclusive breastfeeding or breastmilk only for the first six months of life. The group also recommends that breastfeeding be continued up to and beyond the first year of life or as long and mother and child desire. Most women desire to exclusively breastfeed for six months and plan to breastfeed for one year or more.

Breast pain is the most frequently stated reason for early weaning. The longer breast pain is experienced, the more likely the mother will wean her baby before she intended to. Immediate intervention and treatment of breast pain is crucial to preserving the breastfeeding relationship, and help mother and child continue with breastfeeding.

Plugged ducts and mastitis are common conditions in breastfeeding that affect up to 20% of women. Both conditions cause pain and discomfort of the breast, which affects long-term breastmilk feeding goals. A plugged duct is an obstruction of milk flow in a portion of the breast, either at the nipple or further back in the ductal system. Mastitis is inflammation and infection of the breast. These conditions happen most often in the first six to eight weeks postpartum, but they can occur at any time during breastfeeding.

Risk factors for plugged ducts, mastitis

Stress, fatigue, anemia and a weakened immune system are risk factors for plugged ducts and mastitis.

Additional risk factors for plugged ducts include:

• Inadequate breast emptying
  This could be caused by a poor latch or nipple pain, or a baby who is sleepy, tongue-tied or uncoordinated with suck and swallow.
• Missed feedings
  Plugged ducts are possible when there is a longer interval between breast emptying when the baby starts sleeping for longer periods of time, an abrupt weaning or overuse of a pacifier.
• Pressure on the breast
  This could include from fingers during feedings, tight clothing around or on the breast, underwire bras, or pressure from carrying purse or diaper bags, a car seat or baby carrier straps.
• Limited time during feedings
  This could occur if feedings are rushed or if the mother is feeding multiples.

Mastitis can be caused by any of these risk factors, in addition to having sore cracked or bleeding nipples that can serve as an entry point for an infection and possibly lead to a prolonged hospital stay. Women with a history of plugged ducts or mastitis also are at an increased risk for a future infection.

Symptoms of plugged ducts, mastitis

Plugged ducts and mastitis can be uncomfortable for breastfeeding mothers. Plugged duct symptoms progress gradually, and can include pain, a hard lump, a warm and painful localized spot or a wedge-shaped area of engorgement on the breast. Mastitis symptoms appear rapidly and include flu-like symptoms such as fever, chills, fatigue and body aches. The pain typically is more intense than a plugged duct, and the woman also may notice red streaking on her breasts.

Prevention of plugged ducts, mastitis

You may have heard the saying "an ounce of prevention is worth a pound of cure." That is true for breast pain caused by plugged ducts or mastitis.

To get your breastfeeding relationship with your infant off to its best start — and avoid complications such as mastitis — keep these tips in mind:

• Create a frequent feeding schedule and empty each breast completely. With a newborn, this could be eight to 12 feedings in 24 hours.
• Establish a good latch at every feeding to empty the breast better and prevent damaging the nipple.
• Breastfeed in different positions to allow for more thorough emptying of the breast.
• Wear a well-fitting nursing bra, and avoid underwire bras or tight straps from clothing, bags, purses or infant carriers.
• Use high-quality pure lanolin or lanolin ointment for sore, cracked or bleeding nipples.

It also may be helpful to meet with a lactation consultant who can give you additional tips and advice for proper breastfeeding techniques.

Women who have frequent plugged ducts may see improvement by taking a supplement called lecithin which can reduce the "stickiness" of the milk and prevent plugged ducts from occurring. In addition, new research has found that taking probiotics can prevent and decrease the incidence of mastitis and is safe during breastfeeding. Look for a probiotic that contains Lactobacillus fermentum and Lactobacillus salivarius.

Treatment for plugged ducts, mastitis

It is important to treat a plugged duct immediately and aggressively to prevent further progression, reduce pain and eliminate frustration.

Treatment includes:

• Rest
• Increased fluids
• A well-balanced, healthy diet
• Heat applied to the breast before feeding to better empty the breast, which can be applied by filling a disposable diaper with warm water, squeezing out the excess water and placing it on the breast
• Fully emptying the breast during each feeding through frequent feeding, hand expression, or pumping or feeding in different positions
• Massage, emptying breasts often by hand expression, frequent feeding, and pumping and feeding in different positions to thoroughly empty breasts
• Therapeutic breast massage taught by a certified lactation consultant

Antibiotics may be prescribed if a woman has mastitis, is acutely ill and her symptoms are persisting or worsening. Breastfeeding and expressed breastmilk feeding are safe and recommended, even with antibiotic therapy.

It's safe to continue breastfeeding if you have mastitis or a plugged duct. Breastfeeding helps clear the infection or ductal system. Weaning your baby abruptly is likely to worsen your signs and symptoms.

Lisa Brown is a certified nurse-midwife in Mankato, Minnesota.