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  3. Recognising Mastitis vs. Normal Engorgement
Course Content
Why Breastfeeding Matters (10 minutes)
Health and developmental benefits for infants Maternal benefits (physical and mental) Economic and community-level advantages Common myths and culturally specific misconceptions
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Health & Developmental Benefits for Infants from Breastfeeding
Maternal Benefits of Breastfeeding (Physical and Mental)
Economic and Community-Level Advantages of Breastfeeding
Common Myths and Culturally Specific Misconceptions about Breastfeeding
Newborn Feeding Cues & Anatomy (20 minutes)
Early vs. late hunger cues and what they mean Normal newborn feeding patterns and stomach capacity Brief breast anatomy (lobes, ducts, nipple, areola) in plain language Signs of effective feeding (swallowing, contentment, diaper output)
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Early vs. Late Hunger Cues in Infants
Normal Newborn Feeding Patterns and Stomach Capacity
Breast Anatomy (in Plain Language)
Signs of Effective Feeding in Breastfed Babies
Positions & Achieving a Good Latch (40 minutes)
Position options: cradle, cross-cradle, football/clutch, side-lying Stepwise approach to help baby latch (prepare — attach — assess) Signs of a good vs. poor latch (comfort, nipple shape, audible swallowing) Small-person adaptations (premature, small mouth, tongue-tie considerations) Safe positioning for mothers with C-section recovery
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Position Options for Breastfeeding
Stepwise Approach to Help Baby Latch
Signs of a Good vs. Poor Latch
Small-Person Adaptations in Breastfeeding
Safe Positioning for Mothers with C-Section Recovery
Protecting & Building Milk Supply (25 minutes)
Establishing supply in the first days and weeks (frequency, skin-to-skin) Night feeds and cluster feeding explained Lifestyle and medical factors that reduce supply (e.g., certain medications, stress) Relactation and increasing milk supply safely Nutrition and hydration myths vs. evidence
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Establishing Milk Supply in the First Days and Weeks
Night Feeds and Cluster Feeding
Lifestyle and Medical Factors That Reduce Supply
Relactation and Increasing Milk Supply Safely
Nutrition and Hydration Myths vs. Evidence in Breastfeeding
Expressing & Storing Breastmilk (20 minutes)
Hand-expression steps and common mistakes Choosing and using pumps (manual vs. electric) — practical tips Safe collection, labeling, storage, thawing and warming guidelines (low-resource options included) Cleaning and hygiene for bottles and storage containers Feeding expressed milk to infant (cup, spoon, paladai, bottle considerations)
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Hand-Expression Steps and Common Mistakes
Choosing and Using Breast Pumps (Manual vs. Electric)
Safe Breast Milk Handling
Cleaning and Hygiene for Bottles and Storage Containers
Feeding Expressed Milk to Infants
Common Problems & Practical Solutions (25 minutes)
Causes of sore nipples and immediate relief techniques Managing engorgement and preventing blocked ducts Recognising mastitis vs. normal engorgement and when antibiotics may be needed Low weight gain: assessment steps and feeding plan adjustments Non-judgmental approach to supplementation and safe short-term options
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Causes of Sore Nipples and Immediate Relief
Managing Engorgement and Preventing Blocked Ducts
Recognising Mastitis vs. Normal Engorgement
Low Weight Gain — Assessment and Feeding Plan Adjustments
Non-Judgmental Approach to Supplementation
Returning to Work or School; Feeding Outside the Home (15 minutes)
Creating an express-and-feed routine (timing, containers, transport) Practical storage and transport tips for different commute types Rights and workplace basics (general guidance; encourage local legal verification) Communicating with caregivers and preparing safe feeder notes Emotional coping and practical fallback plans
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Creating an Express-and-Feed Routine
Practical Storage & Transport Tips for Expressed Breast Milk by Commute Type
Rights and Workplace Basics for Breastfeeding Mothers
Communicating with Caregivers and Preparing Safe Feeder Notes
Emotional Coping and Practical Fallback Plans
Special Situations (20 minutes)
Feeding preterm or low-birthweight infants: kangaroo care, cup or tube feeding basics Managing twins/multiples: tandem feeding tips and time-saving routines Mothers on medication or with infectious illness: how to check drug safety and local guidelines (HIV, TB, etc.) Using donor milk or milk banks (where available) — safety basics
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Feeding Preterm or Low-Birthweight Infants
Managing Twins/Multiples — Tandem Feeding Tips and Time-Saving Routines
Mothers on Medication or with Infectious Illness — Drug Safety & Guidelines
Using Donor Milk or Milk Banks — Safety Basics
When to Seek Help & Building a Support Network (15 minutes)
Red flags for baby and mother (e.g., poor weight gain, fever, severe pain) Where to seek help: clinic, CHW, lactation consultant, emergency care Building a support network: partners, family, peer counsellors, community groups Using telephone/text supports, community groups, and referral pathways
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Red Flags for Baby and Mother
Where to Seek Help for Breastfeeding Challenges
Building a Support Network for Breastfeeding Mothers
Using Telephone/Text Supports, Community Groups, and Referral Pathways
Wrap-up, Resources & Final Assessment (15 minutes)
Key takeaways and common pitfalls to avoid Next steps: seeking local support, advanced training options How to use course materials beyond the course (groups, sharing, peer support) Final 20-question multiple-choice quiz (80% pass mark)
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Key Takeaways and Common Pitfalls to Avoid
Next Steps — Seeking Local Support & Advanced Training Options
How to Use Course Materials Beyond the Course
Final 20-question multiple-choice quiz (80% pass mark)
How to Breastfeed — Self-Paced, Evidence-Based Course for African Moms

1. Introduction

Both engorgement and mastitis cause breast pain and swelling, but their management differs. Misunderstanding the difference can delay treatment and increase complications. Mothers need to know when self-care is enough and when antibiotics or medical attention are necessary.

2. Normal Engorgement

  • Timing: Usually occurs when milk “comes in” (day 3–5 postpartum) or when feeds are skipped/delayed.

  • Symptoms:

    • Both breasts feel heavy, full, firm, sometimes shiny.

    • Nipple may be flat, making latch harder.

    • Tender but no systemic symptoms (fever, chills).

  • Relief: Improves with frequent feeding, hand expression, warmth before feeding, and cold compresses after.

3. Mastitis

  • Definition: Inflammation of breast tissue, often with infection.

  • Causes: Blocked duct, prolonged engorgement, nipple cracks (entry point for bacteria).

  • Symptoms:

    • Usually affects one breast.

    • Red, wedge-shaped area of swelling and pain.

    • Fever (>38 °C), chills, flu-like symptoms (aches, fatigue).

    • Pain does not resolve after feeds.

  • Complications if untreated: Abscess formation, early weaning.

4. Key Differences (Engorgement vs. Mastitis)

Feature Engorgement Mastitis
Onset Day 3–5 postpartum or missed feeds Any time during lactation
Location Both breasts, generalized Usually one breast, localized area
Fever/systemic signs Absent Present (fever, chills, body aches)
Relief after feeds Improves significantly Persists, often worsens

5. When Antibiotics May Be Needed

  • Indicated if:

    • Mother has fever + localized painful red area.

    • Symptoms do not improve within 12–24 hours of supportive care.

    • Suspected bacterial infection (pus from nipple, worsening cracks).

  • Not usually needed for:

    • Normal engorgement.

    • Simple blocked duct without systemic symptoms.

  • Safe antibiotics for breastfeeding mothers (doctor prescribed):

    • Dicloxacillin, flucloxacillin, or cephalexin (first-line).

    • For MRSA risk: clindamycin or TMP-SMX (if baby >2 months).

6. Self-Care While Awaiting Medical Review

  • Continue breastfeeding or expressing from affected breast (safe for baby).

  • Rest, hydrate, eat well.

  • Apply warm compress before feeds, cold after.

  • Wear supportive but non-tight bra.

End of Lecture Quiz

Q1. Which of the following is a sign of mastitis rather than engorgement?
A. Both breasts swollen and heavy
B. Fever and chills
C. Breasts feel full on day 3 postpartum
D. Pain improves after breastfeeding

Answer: B. Fever and chills
Rationale: Systemic infection signs distinguish mastitis from normal engorgement.

Q2. True or False: Mothers should stop breastfeeding if they develop mastitis.
Answer: False
Rationale: Continuing to breastfeed/express helps clear infection and prevents worsening.

Q3. Which is the first-line treatment for normal engorgement?
A. Immediate antibiotics
B. Frequent feeding and hand expression
C. Breast binding
D. Stopping breastfeeding

Answer: B. Frequent feeding and hand expression
Rationale: Engorgement resolves with effective milk removal, not antibiotics.

Curated Online Resources

Key Takeaways

  • Engorgement = full, heavy breasts without fever → usually resolves with frequent feeds.

  • Mastitis = painful, red, one-sided swelling + fever → may require antibiotics.

  • Early recognition prevents complications like abscess and early weaning.

  • Breastfeeding should continue during both engorgement and mastitis.

Call to Action

  • Mothers: Seek medical help if fever or flu-like symptoms accompany breast pain.

  • Health workers: Teach mothers to spot the difference early.

  • Communities: Encourage supportive environments where mothers rest and feed often.

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Ushauri Mama - Your MNCH Guide