Know who gets mastitis?
Anyone can get mastitis. And some women are at higher risk than others. Be aware that women who are most likely to get mastitis:
- are breastfeeding, but it can occur even after weaning—sometimes, several years after
- are breastfeeding their second, third, or fourth child (as opposed to first-time breastfeeders)
- have twins—because of such a big milk supply
- are diabetic—because diabetics are always at higher risk for infections
- have already had one episode of mastitis— they are more vulnerable to having another episode
Know the misconceptions, misdiagnoses related to mastitis?
Although mastitis is not uncommon, some misconceptions lead to misdiagnosis, overtreatment, or under-treatment. Do not to overlook:
- how the diagnosis was made. Most cases are diagnosed over the phone. That increases the possibility of misdiagnosis.
- whether cultures of the milk were obtained. Most often, no cultures were obtained. Therefore, the treatment sometimes is not well-matched to the particular infection.
- that a false negative result can occur, even when the milk is cultured. Why so? If the milk that is being tested comes from an unaffected duct, the culture will come back negative.
- that mastitis can occur in both breasts, although that is highly unlikely.
- mastitis is usually due to Staphylococcus aureus, or Streptococcus. However, a new strain of staph has been discovered, Staphylococcus lactarius.
- infection may not be present. Remember that mastitis is an inflammation of the breast, with or without infection.
Know which signs, symptoms require quick actions.
In my recent episode of “Born to be Breastfed,” I listed the common signs and symptoms and course of the condition.
However, there are a few signs and symptoms that often go unnoticed or unreported. Pay attention to:
- mild cases, or those with symptoms for less than 12-24 hours; these do not necessarily need treatment with antibiotics.
- a plugged duct. It’s a classic warning sign of mastitis, but sometimes there is no such warning.
- any signs and symptoms, whether they come on suddenly, or gradually. Some mothers can go to bed feeling well, and suddenly wake up with a high fever a few hours later.
Know the usual treatments for mastitis?
Treatment is fairly common around the globe. Here are the most common treatments:
- The most commonly-prescribed drugs for mastitis include dicloxacillin, flucloxacillin, cloxacillin, amoxycillin, or cephalexin. If your client is allergic to these penicillin-related drugs, then it’s likely she will be prescribed erythromycin. If the mastitis is due to a methycyllin-resistant antibiotic, then she is usually given clindamycin, ciprofloxacin, nafcillin.
- The most commonly-prescribed drugs for the treatment of mastitis are generally recognized to be compatible with breastfeeding.
- Although there is no clear evidence to substantiate it, experts and authorities agree that a treatment regimen of less than 500 mg for fewer than 10-14 days is likely to be insufficient.
Know when to call for medical help
Sure, you know the common signs and symptoms. But the presence of unusual or quick-onset signs and symptoms need very prompt attention. Refer your client, and tell her to get immediate help:
- a sudden fever comes on 38.5°C (101.3°F)
- blood or pus is in the milk
- symptoms are severe, or present in both breasts
- red streaking is on the skin of the breast
- symptoms develop before 2 weeks after birth
- if her aches, and pains and related signs and symptoms don’t subside within 24 hours after antibiotic therapy has been started. The antibiotic prescribed antibiotic therapy might not be the one that adequately covers the exact germ causing the infection.
Know what about continuation of breastfeeding
Some women think or have been told that they need to discontinue breastfeeding. Au contraire! Get this:
- Weaning “cold turkey” is the worst thing to do during an episode of mastitis! The milk backs up and makes the condition worse.
- Milk volume may be decreased in the affected breast, but it will return to normal after treatment.
- Milk from the affected side might look stringy. It’s safe for the baby, it just looks odd.
Know that after treating mastitis…then what?
With and without successful treatment, be aware that:
- your client’s redness or tenderness can continue for about a week, even if the infection has been successfully treated.
- Candidiasis (thrush) can result from antibiotic therapy, and it may occur later. Its treatment is different, and your should not mistake the signs and symptoms as another bout of mastitis.
- An unresolved episode of mastitis can lead to a breast abscess, which is very serious and requires special treatment and, in extreme cases, temporary cessation of breastfeeding on the affected side.
This isn’t everything you need to know about helping a client with mastitis. There are many more important details in this Workbook. Remember, like other breastfeeding problems, mastitis is temporary and solvable.
Which of these facts surprised you most?