Breastfeeding problems

Mastitis

Mastitis affects around 1 in 10 breast feeding women. The BNF advises to treat 'if systemically unwell, if nipple fissure present, if symptoms do not improve after 12-24 hours of effective milk removal of if culture indicates infection'. The first-line antibiotic is flucloxacillin for 10-14 days. Breast feeding or expressing should continue during treatment.

If left untreated, mastitis may develop into a breast abscess. This generally requires incision and drainage.

Engorgement

Breast engorgement is one of the causes of breast pain in breastfeeding women. It usually occurs in the first few days after the infant is born and almost always affects both breasts. The pain or discomfort is typically worse just before a feed. Milk tends to not flow well from an engorged breast and the infant may find it difficult to attach and suckle. Fever may be present but usually settles within 24 hours. The breasts may appear red. Complications include blocked milk ducts, mastitis and difficulties with breastfeeding and, subsequently, milk supply.

Although it may initially be painful, hand expression of milk may help relieve the discomfort of engorgement.