Diagnosis is clinical – Focal tenderness in one breast accompanied by fever and malaise.
Patient assessed for risk factors of mastitis.
Treatment
-Encouraged continued breastfeeding in the presence of mastitis. It doesn’t generally pose a risk to the infant.
-If baby dislikes the taste of milk from the mastitis breast, pump to empty the breast and throw away the milk.
-Mother educated that the risk of mastitis can be reduced by frequent, complete emptying of the breast and by optimizing breastfeeding technique.
-Discussed changing breastfeeding technique
-Lactation consultant referral.
-Drink plenty of fluids and get adequate rest.
–Antibiotics: Keflex 500mg TID for 10-14 days, to cover for MSSA.
-Will consider antibiotics that cover MRSA if poor response.
-Will watch out for breast abscess which is the most common complication of mastitis. Early tx and continued breastfeeding should help prevent abscess formation. If an abscess develops, we will continue breastfeeding and treat the abscess.
-Frequent handwashing encouraged. Technique demonstrated.
-Infant evaluated to r/o cleft lip, cleft palate, and short frenulum.
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Vertical transmission of HIV is more likely when the baby is breastfed during mastitis. If HIV mother must breastfeed her baby, she should avoid breastfeeding from the infected breast when she has mastitis. She may continue the other side.
Typical Presentation: “Patients typically present with localized, unilateral breast tenderness and erythema, accompanied by a fever of 101°F (38.5° C), malaise, fatigue, body aches, and headache.”
Reference
Am Fam Physician. 2008 Sep 15;78(6):727-731. http://www.aafp.org/afp/2008/0915/p727.html