When my baby Poppy was 7 months old we were travelling around Mexico on our ‘baby gap year’. I was breastfeeding, but we had just started experimenting with solid food and she was being introduced to all the exotic fruits of Latin America… and she loved it!
I remember finding a sprawling market with endless fresh juice stalls and everyone was finding her so cute sipping on her mango smoothie while I wore her in a carrier. As cute as this experience was the mango smoothies meant that we both completely forgot to breastfeed that day – I think my boobs were ignored for about 7 hours.
Later that evening a hot, red, tender area emerged on one breast.. and it was NOT cute. My boobs had been ignored for too long that day and I now had full blown mastitis… OUCH. It was 2022 and the new guidelines on how to treat mastitis were out there but I wasn’t aware of them (I wasn’t a lactation consultant yet).
My boobs had been ignored for too long that day and I now had full blown mastitis… OUCH.
Instead I followed the old guidance – to massage, use heat and excessively empty my breast. And yes… unsurprisingly the mastitis got far worst and I ended up needing a long course of antibiotics. I was more careful about letting my baby indulge on free-for-all smoothies after that…
Mastitis is a common breast issue during breastfeeding, and for years, the advice was to use heat, feed, massage and take antibiotics if needed. But new research has changed how we understand and treat it. Here’s a look at how the new guidelines (Academy of Breastfeeding Medicine 2022) differ from the old ones.
Old Mastitis Guidelines (Traditional View)
- Mastitis = Infection: Most cases were treated like infections, with antibiotics prescribed quickly.
- Empty the breast completely: Parents were told to ‘drain the breast fully’ each feed.
- Massage it out: Deep or firm breast massage was recommended to help ‘clear blockages.’
- Hot compresses: Warmth and showers were often used to ‘loosen’ clogs.
Deep or firm breast massage was recommended to help ‘clear blockages.’
New Mastitis Guidelines (Updated 2022 & Beyond)
New research shows mastitis starts as an inflammatory condition – would you aggressively massage and use heat packs after twisting your ankle?!
Here’s what’s changed:
Not always an infection
- Most cases start as inflammation due to milk backup – not bacteria.
- Antibiotics are often not needed and should only be used if symptoms don’t improve in 24–48 hours.
Focus on comfort, not ‘emptying’
- You don’t need to forcefully empty your breast.
- Instead, feed or pump just enough to stay comfortable. Over-pumping can actually make things worse by increasing supply and pressure. Please don’t do what I did and obsessively try and empty every last drop from my breast!
Gentle touch only
- Deep or hard massage can damage delicate tissue and worsen swelling.
- Light, gentle movements (like stroking a pet) or natural movement (called ‘breast gymnastics’) are encouraged.
Cold over heat
- Cold compresses help reduce inflammation and breast pain.
- Heat might actually increase swelling in some cases – so it’s no longer routinely recommended. This was bad news for me as I’ll take any excuse to have a long hot bath!
Frequent, baby-led feeding
- Feed on demand and make sure your baby is latching well.
- There’s less focus on strict ‘draining’ and more on responsive feeding and avoiding pressure on the breasts.
Watchful waiting with support
- If symptoms are mild, rest, remove milk gently, and monitor.
- If you’re not improving after 24 hours or feeling very unwell, then contact a doctor
Bottom Line for Parents
- Yes, you can keep breastfeeding.
- Focus on gentle milk removal, good latch, and staying comfortable.
- Seek help early if symptoms worsen or you feel unwell.
- Don’t panic – mastitis is common and manageable with the right support!
Focus on gentle milk removal, good latch, and staying comfortable.
Article written by IBCLC and midwife Milly Godwin
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