## Distinguishing Lactational Mastitis from Milk Stasis ### Key Discriminating Feature **Key Point:** The presence of **systemic fever (>38.5°C) and constitutional symptoms (malaise, myalgia, chills)** is the single best discriminator between mastitis and simple milk stasis. Mastitis is an inflammatory/infectious condition; milk stasis is purely mechanical. ### Comparative Table | Feature | Milk Stasis (Engorgement) | Lactational Mastitis | | --- | --- | --- | | **Fever** | Absent or low-grade (<38°C) | Present (>38.5°C) | | **Systemic symptoms** | None or minimal | Marked (chills, malaise, myalgia) | | **Localized signs** | Hardness, tenderness, erythema | Hardness, tenderness, erythema | | **Milk character** | Normal | May contain pus or blood | | **Onset** | First 1–2 weeks postpartum | Any time during lactation | | **Response to emptying** | Resolves with frequent feeds | Persists despite emptying | ### Pathophysiology **High-Yield:** Milk stasis results from incomplete breast emptying and milk accumulation; it is a **mechanical problem**. Mastitis develops when stasis is complicated by **bacterial infection** (usually *Staphylococcus aureus* or *Streptococcus agalactiae*), triggering an inflammatory cascade with fever and systemic toxicity. ### Clinical Pearl **Clinical Pearl:** A breastfeeding mother with breast pain, erythema, and swelling but **no fever** should be managed conservatively with frequent feeds, warm compresses, and analgesia. If fever develops, antibiotics (amoxicillin-clavulanate or cephalexin) are indicated, and breastfeeding should continue to aid resolution. ### Management Implications 1. **Milk stasis:** Frequent feeding, manual expression, warm compresses, supportive care. 2. **Mastitis:** Antibiotics + supportive care + continued breastfeeding (safe for infant). [cite:Park 26e Ch 10]
Sign up free to access AI-powered MCQ practice with detailed explanations and adaptive learning.