Mastitis and Breastfeeding: Causes, Symptoms, and Treatment According to ABM Guidelines
- Melanie Kondrat
- Jun 28
- 3 min read
At Dragonfly Lactation, we understand that the postpartum experience comes with many joys—and sometimes, unexpected challenges. Mastitis is one of the most uncomfortable issues breastfeeding parents can face, but with early support and evidence-based care, it is very treatable.
Here’s what you need to know about mastitis: what causes it, what symptoms to look for, and how to treat it using the most up-to-date guidance from the Academy of Breastfeeding Medicine (ABM).
What Is Mastitis?
Mastitis is inflammation of the breast tissue, commonly occurring during lactation. It often affects one breast and can range from mild to severe.
Common Mastitis Symptoms:
Breast pain or tenderness
Swelling, firmness, or redness
Warmth in the affected area
Fever over 100.4°F (38°C)
Flu-like symptoms (fatigue, chills)
A painful lump or firm area
Not all cases of mastitis are infectious. The ABM emphasizes that inflammation often starts before infection, usually due to milk not draining well from the breast.
What Causes Mastitis?
The root cause is typically milk stasis—milk remaining in the breast too long. This can happen due to:
Infrequent feedings or skipped sessions
Poor latch or shallow suck
Tight bras or pressure on the breast
Oversupply
Rapid weaning or changes in feeding patterns
When milk isn't effectively removed, inflammation can develop. If bacteria (such as Staphylococcus aureus) enter through a cracked nipple, infection may follow.
ABM Treatment Protocol for Mastitis (2022 Guidelines)
The Academy of Breastfeeding Medicine’s Protocol #36 outlines a stepwise approach to treating mastitis based on severity.
1. Inflammatory Mastitis (No Infection Yet)
This is the early stage of mastitis, where milk is blocked and inflammation is building.
Recommended treatment:
Frequent breastfeeding or pumping to keep milk flowing
Improve latch and milk removal techniques
Pain relief with ibuprofen or acetaminophen
Cold compresses, not heat
Rest and hydration
Avoid deep breast massage, which can worsen inflammation
If symptoms do not improve after 24 hours, or get worse, move to the next step.
2. Bacterial Mastitis (With Signs of Infection)
When fever and worsening symptoms persist, infection is likely.
Treatment includes:
All steps above, plus oral antibiotics
First-line antibiotics: Dicloxacillin or Cephalexin
Alternatives for allergies: Clindamycin or TMP-SMX
Antibiotic course is usually 10–14 days
Continue breastfeeding unless advised otherwise—milk removal is essential for recovery.
3. Breast Abscess
If a painful lump does not improve or feels fluctuant, it may be an abscess.
Treatment may include:
Breast ultrasound for diagnosis
Needle aspiration or surgical drainage
Antibiotics and ongoing milk removal
What NOT To Do During Mastitis
According to the ABM, the following approaches are outdated and may cause harm:
Do NOT apply heat to an inflamed breast
Do NOT perform deep tissue massage or use vibration tools
Do NOT stop breastfeeding unless advised—this can worsen milk stasis
When To Call a Lactation Consultant or Provider
Reach out if you experience:
Fever lasting more than 24 hours
Worsening pain, redness, or swelling
A lump that doesn’t improve in 48 hours
Chills, shaking, or feeling acutely ill
Mastitis Support in Knoxville, TN
If you’re dealing with mastitis or other breastfeeding challenges, you don’t have to go it alone. Dragonfly Lactation offers skilled, compassionate care based on the latest evidence—including home visits, office visits or virtual consults, and tailored care plans.
Book a visit or reach out today—we’re here to help you heal, restore your milk flow, and feel confident again. *This post is intended for educational purposes only. This is not meant to replace or be used as medical advice.* Schedule a Lactation Visit in Knoxville Today
📍 10805 Kingston Pike, Suite 100, Knoxville, TN 37934
📞 865-268-3970
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