If a breast-feeding mother becomes unwell with general flu-like malaise and red-hot, painful or swollen patches (with focal tenderness) appear on the breast, she may have mastitis.1,2 Urgent medical review is essential and antibiotics compatible with breast-feeding may be necessary, although evidence for this is mixed.3Mothers with mastitis should usually be encouraged to breast-feed more frequently; mastitis generally poses no risk to the infant. It is important to check the feeding technique and positioning. Regular expression may also be beneficial, since not removing milk from the breast will make the situation worse, and may lead to the development of a breast abscess.1,2Mastitis may be a complication of engorgement, or may be a consequence of nipple damage, infection, maternal illness or fatigue.1,4 The mother may use paracetamol to help alleviate pain and fever symptoms.

References1. Academy of Breastfeeding Medicine [ABM]. Clinical Protocol No. 4: Mastitis. Revised May 2008. Breastfeeding Medicine 2008; 3(3): 177-180. Available at www.bfmed.org. Accessed 24 Sep 2009.

2. Spencer JP. Management of mastitis in breastfeeding women. Am Fam Physician 2008; 78: 727–731.

3. Jahanfar S et al. Antibiotics for mastitis in breastfeeding women. Cochrane Database Syst Rev 2009; 1: CD005458.

4. Amir LH et al. A case-control study of mastitis: nasal carriage of Staphylococcus aureus. BMC Fam Pract 2006; 7: 57.

From: Journal of Family Health Care Bulletin. Directory of Breast-Feeding Advice. December 2009. Published with JFHC 2009; 19(6). http://www.jfhc.co.uk/images/stories/breastfeeding.pdf