Question:
I am an LC, but this question is actually about a problem I am experiencing personally. I have a 20 month-old who nurses well. Over the course of a few hours I recently came down with fever and chills and the bottom area of my left breast became inflamed and sore. Breastfeeding does not feel uncomfortable, and in fact, feels normal. After resting overnight, my fever and chills were gone, but my breast remained tender and pink underneath. I am taking garlic, echinacea and vitamin C. This episode began on Thursday early evening. It is now Saturday afternoon, and I am wondering if I need to take antibiotics. Since fever and chills are gone isn’t this sign that my body is on the mend? Am I still at risk for abscess by not treating with medications?
Thank you for any feedback!
Name withheld, IBCLC
Answer:
20-month-old nursing toddlers often have sharp new teeth. They may exhibit clenched-jaw feeding behavior (as the result of teething) that can make small cuts on the nipples. If the baby has been sick with a cold or other illness, germs from the mouth can infect the nipple. Mastitis is typically an ascending staph infection, but may result from infection by other bacteria such as strep and also from viral infections (such as herpes).
Teeth marks from a 2 year-old
Nursing toddlers are irregular feeders. Sometimes toddlers stimulate the breasts with marathon breastfeeding sessions. The next day they may nap longer than usual or sleep through the night. This pattern of breast use may cause a woman to suddenly become engorged. The combination of maternal fatigue, potential infection from small cut wounds on the nipple, and engorgement can result in mastitis. While engorgement alone sometimes produces low-grade fever, your combination of chills and fever along with the localized pain and redness suggests an infection rather than an engorgement-related inflammation.
Since we care for women who have mastitis, LCs must remember that infection control is an important way to protect ourselves and our families – as well as those who seek our help professionally. Pathogens have been reported to colonize clothes, equipment, hands, noses, nipples, etc. It is very important to consider the clothes we work in, washing them every day – especially if we sit on the edge of the bed. Hand, clothing, and equipment hygiene is critical to prevent cross-infections.
We have personal knowledge of LCs who have been colonized with MRSA infections. The many recent reports of new and very virulent pathogens must make health care workers much more vigilant about infection control.
Sometimes women can recover from mastitis without medical treatment, depending upon their immune status. We are unaware of any evidence-basis for the measures you have taken (echinacea, Vitamin C, garlic), although they probably won’t hurt you. We are not opposed to alternative kinds of therapy so long as they do no harm. Our big concern after seeing many cases of self-treated mastitis is that inadequate treatment may result in chronic, low-grade mastitis. Such episodes may drag on for weeks, causing headache, increased levels of fatigue, lowered milk production, and periodic resurgence of full-on symptoms.
Animal models (cows, sows) suggest that mastitis may create internal scar tissue in the milk producing glands. Fetherston (1998) reported that having had mastitis previously is an important risk factor for developing mastitis again. This suggests that the scar tissue formation observed in animal models may occur in the human breast, predisposing the breast to chronic drainage problems. This is why it is so important to monitor our clients so that we are confident of full resolution of symptoms. This is equally important in your personal situation.
Ibuprofen reduces inflammatory symptoms. If you take any such medication to see if it helps eliminate your residual inflammatory symptoms, be careful not to mask fever by staying on the medication longer than a few doses (per the label recommendations). If your fever elevates again, call the doctor. If you aren’t fully better by Monday (no tender spots, headache, etc), we would urge you to report the episode to your doctor and see what he/she thinks about a course of oral antibiotics.
The website of the Academy of Breastfeeding Medicine contains the on-line version of a medical protocol for managing mastitis:
http://www.bfmed.org/Resources/Protocols.aspx
This protocol is evidence-based, peer reviewed, and was previously published in the journal, Breastfeeding Medicine, and so it is a credible resource for your physician to also review.
Finally, your abscess risk is probably low. Abscess rates vary depending upon the population, but the risk ranges between 2-7% in women experiencing mastitis. However, it is always wise to be vigilant. Generally, a breast abscess presents as a hard lump that starts to increase in size. The skin over the surface begins to indurate (pull in or pucker) as the mass swells. Abscesses can wall-off and form a solid cyst that contains the infection temporarily. During this time, there may be no fever. Walling-off also prevents antibiotics from reaching the pathogens. This is why the treatment for abscess involves draining the cyst or excising it surgically. Even without fever, localized tenderness typically remains. Because an abscess is filled with live bacteria, the mass grows as the bacteria continue to reproduce. Abscesses eventually will burst — either by rising to the surface, coming to a head and opening, as would any boil, or by seeping internally. Internal rupture creates a high risk of even more serious infection such as sepsis. Certainly you should report any of these symptoms immediately to your health care provider.
After an episode of mastitis it is good to ensure your recovery with extra rest and good nutrition. Reduce your stress and workload as best you can with a small child to care for.
We hope you feel better soon!
B&K
References:
Fetherston, C. Risk factors for lactation mastitis. J Hum Lact 1998; 14(2):101-9.
Protocol Committee, ABM Clinical Protocol #4: Mastitis. Breastfeeding Medicine 2008;3(3):
