I just received a phone call from a client whose baby is now a year old. Mom
nurses baby only in the evenings, starting when she gets home from work.  Mom
has had several colds and is currently on amoxicillin for secondary
infections.  She reports having had a bout of mastitis early on in lactation,
and felt that she was now combatting mastitis again.

Her symtoms are this: started with nipple pain and stinging (left breast
only); nipple pain went away, and plugged ducts have appeared, with the
discomfort having now moved to the breast. The plugs are apparently randomly
distributed in all quadrants.  No redness, fever, or malaise. The strangest
part is this: she reports that for the past two days, every time she nurses
her son, he throws up immediately after wards. Last night being her second
round of this, she nursed him at 6:30 pm, after which he immediately threw
up; at 8:30, she gave him only the "good" right breast, and he had not thrown
up as of 9:00pm.

I didn't think she was mastitic, but could I be mistaken, and could the milk
be salty on that side and causing the upset stomach?  She's been on
amoxicillin for "a while", but could she still have a low-level latent
infection?

My immediate recommendations were for her to feed the baby on the "good"
side, and pump the other every time she feeds; that before she does pump, to
use hot compresses and do some massage of the plugged areas first. I also
recommended she take ibuprofen to help with any inflammation that may be
occurring with plugs and impeding milk flow.  I am hoping that keep baby to
the "good" side until the plugs and whatever else resolves, then put him back
again.  I also suggested that if the plugs are not resolved within 12-24 hrs
of this current treatment, to add cabbage leaf therapy, and that I would need
to see her and do a more detailed work-up.

I'd be interested in how others interpret the above information. I've
considered the possibility of a yeast-based mastitis, especially because of
the multiple spaced out plugs, but do wonder about the fact that it is only
on one side, "the trouble side".

-Lisa Marasco, BA, LLLL, IBCLC