Blocked Duct vs Mastitis - A Summary

1. Poor drainage of breast causing milk immobility due to poor attachment or poor sucking with inadequate emptying of one or more ducts
2. Trauma due to pressure on one spot caused by mother holding breasts too tightly while expressing, tight or ill fitting bra or other clothing, sleeping on a full breast, kick from older baby or child
3. Maternal exhaustion, anaemia or poor nutrition, a diet high in saturated fat may contribute to this problem

1. Can be non-infective which occurs when foreign body inflammatory reaction occurs following leakage of milk into the surrounding tissue from a blocked milk duct or
2. Infective: 
   there are two forms of this
   1. Cellulitis of the interlobular connective tissue. Pus is not found in the milk as the infection is outside the ductile system. This is the most common form of mastitis.
   2. Adenitis where infection occurs within the ductile system. Pus may appear in the milk but systemic symptoms are less severe.

Predisposing factors of mastitis include those of blocked duct 
as well as the following:

Abrupt weaning, poor general health, stress, tiredness, infection from the infant’s nose (staph carriage) mouth, eyes, (conjunctivitis) or other sites, use of contaminated nipple creams, and occasionally following strenuous upper arm activity as with housework or strenuous exercise

• Dicloxacillin 500mg orally 6 hourly OR
• Flucloxacillin 500 mg to 1 gm orally every 6 hours or
• Cephalexin 500 mg orally every 6 hoursor
• Erythromycin 500 mg orally every 12 hours or
• Roxithyromycin150 mg every 12 hours

Note: If severe cellulitishas developed, antibiotics should be given intravenously

eg. Flucloxacillin 1 to 2 gm intravenously every 6 hours

NB: The medications mentioned in the above summary may or may not be available in your country. If this is the case, please see your doctor for alternative medications.

NB: The medications mentioned in the above summary may or may not be available in your country. If this is the case, please see your doctor for alternative medications.

NB: The medications mentioned in the above summary may or may not be available in your country. If this is the case, please see your doctor for alternative medications.

Cold packs for comfort after feeds

Cold packs for comfort after feeds

Dr. Jack Newman suggests Breast compression while the baby is feeding, getting the mother’s hand around the blocked duct and having her apply steady pressure

Drink adequate amounts of fluids

If the blocked duct does not resolve within 48 hours, therapeutic ultrasound often works. The dose is 2 watts/cm squared, continuous for 5 minutes to the affected area, once daily for up to 2 doses. It usually resolves with one treatment but if 2 treatments over two days have not worked, there is no point in continuing with ultrasound. At this point the blocked duct will need to be re-evaluated by a doctor.

Lecithin, one capsule (1200 mg) 3 or 4 times a day also seems to help prevent recurrent blocked ducts, at least for some mothers.

Note: In addition to the above many mothers find relief for a blocked duct by soaking the affected breast in a bowl or sink filled with 2 tbsp Epson salts in 4 litres of hot water. Soak for 10 minutes every 3 hours for 24 hours.

According to Dr. Jack Newman:

If a mother has symptoms consistent with mastitis for more than 24 hoursshe should start antibiotics.

If the mother has consistent symptoms for less than 24 hours, he will prescribe the antibiotic but suggest she wait before taking it.

If over the next 8 - 12 hours, her symptoms are worsening, then the mother should start the antibiotics.

If over the next 24 hours her symptoms have not improved and not worsened, she should start antibiotics.

However, if the symptoms start to decrease, there is no need to start the antibiotics. The symptoms will continue to resolve and should disappear over the next 2-5 days.