Some mothers with mastitis say their babies are less happy to feed on the affected breast or may refuse the breast altogether. There are a number of reasons for this.
1) Reasons for breast reluctance
1) Less milk available
Pain can interfere with the let-down, resulting in less milk being available to the baby. Swelling from the infection may also block ducts and limit milk flow. Milk supply usually returns to normal after the mastitis has cleared unless it is particularly severe.
2) Changes in the nipple root
Firmness of the nipple root caused by swelling can make it harder for the baby to latch. Nipple root massage may help to soften the area.
3) The taste of the milk
The milk may taste different. It is thought that the milk-making cells of the breast are not connected as tightly when mastitis is present, allowing sodium to pass from the blood, between the cells, and into the milk making the milk taste saltier (Owens 2013).
Milk from a breast that has mastitis has been reported to have less fat, carbohydrate, and energy (Prentice 1985; Say 2016).
The taste and composition return to normal once the mastitis has cleared.
4) The baby is responding to the mother’s pain
Mothers with mastitis may have a lot of pain and their babies can sense that something is different when breastfeeding on the affected side. Babies may notice the following changes:
- The mother is holding the baby more tightly.
- The mother’s body is tense during the feeding.
- The mother’s breathing and heart rate have increased.
- The mother has changed her breastfeeding hold or position.
Mother may need additional ways to manage their pain.
2) Treating breast reluctance and refusal
If the baby is less happy to breastfeed on the breast with mastitis:
- Instead of changing the starting side, start all feeds on the affected side.
- Use the pinch test to ensure that the nipple root is not swollen.
- Treat any nipple root swelling with massage.
- If the baby still feeds poorly on the affected side, consider:
Most babies return to normal breastfeeding as the infection clears.