Holiday Induced Mastitis

Rates of plugged ducts and mastitis increase from late November to early January. Lactation consultants see this every year. We get more calls for sudden onset breast pain around this time. But it doesn’t have to be this way!

What is Holiday Induced Mastitis?

It’s a term I created to lump (pun intended) together the increased number of mastitis cases that lactation consultants see during the November-December holiday season. 

It’s just regular mastitis that occurs around the holidays.

What causes Holiday inducted mastitis?

Most cases boil down to delayed feeds or incomplete milk removal. But the perfect storm is infrequent/incomplete milk removal + nipple damage (usually from poor latch or the wrong flange sizes…a post for another day).

• Delayed feeds

  • Delayed feeds —> Engorgement

    • Latch is often shallow when engorged

    • A shallow latch is an inefficient latch

    • An inefficient latch leads to incomplete milk removal (keep reading for more on milk removal)

  • Traveling (especially with a baby) is unpredictable and it can be difficult to match a feeding time with a feeding place

    • First of all, getting anywhere with a baby usually takes at least 30 min longer to prep and get out the door than without a baby

    • Secondly, traffic can further delay feeds and typically increases anxiety and stress. Stress increases cortisol production and inhibits oxytocin production which decreases the let down reflex and prevents good milk flow!

  • Family members love to hold and play with babies

    • Good intentions sometimes have negative consequences

      • Family and friends are eager to show their baby whispering skills, however, a fussy baby is often a hungry baby. Calming the baby may seem helpful to them but may actually be delaying a nursing session and increasing your risk of mastitis

    • Babies often sleep longer while held and non-parent adults may not pick up on subtle, early feeding cues

    • Older babies are happy to play for extended periods of time. When they do finally realize they’re hungry (and tired), they’re upset, overstimulated, and difficult to latch

    • Overstimulation

      • Young babies (less than 4ish months old)

        • May sleep longer or fall asleep before they would have normally ate

      • Older babies (4+mo)

        • Tend to have difficulty sleeping when overstimulated. They are fussy and exhausted which lead to a poor latch and ineffective milk removal

  • Postpartum parents may be excited (overwhelmed?) by visitors and time gets lost easily

    • Time flies when you’re having fun…meanwhile, milk accumulates

• Incomplete milk removal

  • Parents are often eager to get back to the action. Feeds may be shorter than usual in an effort to not miss out, or in some cases, to not seem rude* for leaving the party

    • It is NOT rude to feed your baby. Ever. Anywhere.*

      • Ok, it is rude (and gross) for someone to request you feed your baby in a bathroom.

  • Babies may be in new environments which sound, smell, and look different than home.

    • Even if events are in their own home there are new smells, sights, and sounds. Often there are new people, too. What was boring yesterday is suddenly bustling with energy. 

    • A distracted baby is less likely to feed well because there is so much going on. When babies don’t feed well, milk doesn’t move well through the mammary tissue which can result in being full longer than expected.

    • Distraction can cause a poor latch, further contributing to mastitis via poor nursing efficiency (less milk removed) and nipple damage

      • Nipple damage can occur even if you can’t see it

      • Nipple pain is never normal and should always be corrected to prevent damage

Mastitis Prevention

It's wonderful to be around family and friends. But it can be difficult and overwhelming to balance feeding time and visiting time.

When caught early and properly cared for, many times full blown mastitis can be avoided. It’s much easier to prevent mastitis than it is to treat it.

So, how do you prepare and prevent mastitis this holiday season?

A few tips to help prevent mastitis this holiday season:

Take a screenshot so you don’t forget!

1. Make a list of your feeding essentials

   • Make a list of all the things you use in relation to feeding

     • Start your list a few days before the event

   • While your baby is latched, look around at all the stuff near you that you need

     • Nursing pads?

     • Nipple shield?

     • Bottles?

     • Nipple cream?

     • Nursing pillow?

     • Bibs? Burp cloths?

     • Diapers? Wipes?

     • Extra clothes for you just in case things get messy

   • PACK the stuff on your list!

2. Bring a pump

   • Just in case feeding doesn't go as desired, it’s nice to have back up

   • Bring an electric pump or silicone hand pump, whichever works best for you

   • Leave it in the car so you don’t have to lug it around

   • Double check to make sure you pack all the pieces

     • You will be very sad if you need your pump but forget 1 part

       • Hand expression is always an option!

   • Definitely bring a pump if you’re leaving your baby with caregivers. Even if you don’t plan on being gone long enough to need it, bring it…time may run away from you.

3. Establish a quiet feeding/pumping place upon arrival to a new location

   • Get ready! Put all your baby equipment in one place to it’s ready to go for nursing/pumping time

     • If you are able, get things out ahead of time so you feed you babe even quicker

   • Try out a few chairs to see what would work best for how you need to feed your baby

4. Hand the baby off right after nursing/bottle feeding*

   • This extends the amount of time you have to yourself (which some people really want and need)

     • If you prefer to keep your baby, get out the carrier! (see tip #6)

   • Everyone is eager to hold your beautiful bundle of joy, particularly if the baby is not hungry

   • Feed yourself. It may have been awhile since you ate warm food without holding a small human. Enjoy!

   • *Bottle feeding: I do recommend that a parent or main caregiver bottle feed your baby. Because of the new environment that comes with holiday get togethers, it’s helpful for your baby’s routine for at least one thing to remain as close to normal as possible.

5. Set a timer to remind you to check for feeding cues

   • I’m not usually a fan of watching the clock to feed your baby but at parties, time really does slip away and before you know it, you’re engorged

   • If your baby is still sleeping or is very content, check back in 15 min

     • Remember: young babies tend to sleep longer if being held by others; older babies seem happy until they’re suddenly hangry

   • If they’re still not ready to eat, it may be time to reclaim your sleeping baby or take an awake baby to a quiet room to offer them a nursing break

6. Wear your baby to catch early feeding cues

   • Face baby towards you rather than away from you

     • Gives them the option to hide from all the stimulation

     • You can see their face to more easily know what they need

   • Baby wearing has many advantages

     • Keeps other people from breathing on your baby (we are in a pandemic, after all)

     • Keeps them close to their favorite, familiar people

     • Lets people know you’re not going to be passing your baby all around

     • Allows you to recognize feeding cues quickly

     • Gives you 2 hands to set up your feeding space when it’s time

Even if you implement all these tips, mastitis can still occur. If you do develop signs of a plug or mastitis, call your IBCLC and primary care provider right away. Your IBCLC will have techniques that may prevent the need for antibiotics.

Latch early, latch often.

Happy Holidays!