An Update on the Recognition and Management of Lactational Breast Inflammation

Christine M. Betzold, NP, CLC, MSN

Disclosures

J Midwifery Womens Health. 2007;52(6):595-605. 

In This Article

Summary

While it may not always be possible to prevent milk stasis, breast inflammation, or mastitis, it is possible to hasten its resolution and prevent complications with prompt attention and careful management. In the aforementioned study of the prevalence of mastitis in the United States, 64% of the women interviewed were diagnosed over the telephone without an examination, and 86% were treated with antibiotics.[1] Given the difficulty of differentiating between these disorders and the tendency to treat without the benefit of a physical exam, one has to question how many of these mothers truly had infectious mastitis necessitating antibiotic treatment. Additionally, many providers do not realize that pertinent diagnostic information can also be revealed by examining the infant.

Taking advantage of an opportunity to examine both mother and child to more precisely pinpoint the diagnosis is important in order to provide optimal anticipatory guidance and avoid inappropriate antibiotic therapy. Providing accurate anticipatory guidance protects and supports breastfeeding. Avoiding the overuse of antibiotics is not only important from a public health standpoint, but because in breastfeeding women it can lead to even more breastfeeding complications, not limited to but including secondary Candida infection and/or early weaning. Some mothers may refuse to breastfeed while on medication and thus unnecessarily expose their baby to infant formula.

In summary, there are still many questions to answer about caring for women with breast inflammation with or without infections and particularly recurrent infections. Additionally, more research needs to be done to improve methods of culturing and diagnosing and treating lactating mothers with breast pain, redness, or inflammation.

Given the complexity of breast pain and inflammation, the most important clinical recommendations are summarized in Table 4 and additional resources for clinicians are listed in the appendix. Breastfeeding dyads given comprehensive care are more likely to receive prompt and effective treatment, thereby minimizing the risks of premature weaning to mother and child and/or preventing future maternal breastfeeding disability.

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