Private mastitis & breastfeeding clinic in London, same-day women's health.

Managing mastitis

1. Keep feeding on both sides, as normal. The milk is safe for your baby. Stopping abruptly makes it worse.
2. Feed to comfort, not to empty. Over-draining signals the breast to make more milk and perpetuates the cycle.
3. Cold packs for 10 to 15 minutes after feeds to reduce swelling and pain.
4. Anti-inflammatories — ibuprofen and paracetamol, both safe while breastfeeding — taken regularly.
5. Rest and fluids, and support the breast with a well-fitting, non-restrictive bra.
6. Review the attachment, since poor drainage from a shallow latch is the usual underlying cause.

Antibiotics are needed if you have a fever and feel unwell, if there is a cracked nipple with visible infection, or if there is no improvement after 12 to 24 hours. Most mastitis is inflammatory rather than bacterial at the outset, which is why the first day is managed without them.

Other common problems

• Sore or cracked nipples — almost always attachment. Pain beyond the first few seconds of a feed is a sign to get the latch checked, not to endure it. A purified lanolin or your own expressed milk helps healing.
• Blocked duct — a tender lump without fever. Feed normally, gentle stroking, cold packs. It usually clears in a day or two.
• Engorgement in the first week — feed frequently, express just enough for comfort, cold packs between feeds.
• Thrush — burning or shooting pain during and after feeds with shiny or flaky nipples. Mother and baby must be treated together, or it bounces back and forth.
• Vasospasm — nipples blanching white then purple after feeds, with intense pain. Keep warm, avoid cold exposure.
• Low supply — genuine low supply is uncommon. Judge by wet nappies and weight gain, not by how full you feel or how much you can pump.

Getting help early

The single most useful intervention in breastfeeding difficulty is a skilled person watching a whole feed. Most problems are positional and are solved in one session. If feeding hurts, or your baby is not gaining as expected, ask early rather than after weeks of struggling — and note that deciding to stop, or to combination feed, is a legitimate choice rather than a failure.