A clogged duct is a common ailment experienced by breastfeeding mothers. For that reason, you might find a lot of conflicting advice about what to do to relieve a clogged milk duct. As a Certified Breastfeeding Counselor (CBC) it’s important to provide up to date, evidence-based information to support families navigating clogged ducts.
If you’re a fully certified CBC, you are already familiar with what a clogged duct is. However, a refresher can always be helpful.
What is a Clogged Duct?
In a lactating breast, clusters of alveoli lined with milk-producing cells form lobules, which then come together to create larger lobes. From these lobes, small ducts carry milk toward the nipple, where it is available for your baby to drink.
A plugged duct happens when milk isn’t adequately removed from the breast. This can cause one of these tiny ducts to swell, restricting milk flow. The pressure from the blocked duct can inflame the surrounding breast tissue, resulting in a firm, tender lump in the affected area.
What Causes a Clogged Duct?
There are a few reasons why milk isn’t adequately removed from the breast. Knowing the possible reasons is an important part of preventing or reducing the risk of developing a plugged duct.
Some potential reasons include:
- Engorgement
- Scheduling feeds
- Oversupply
- Missed feedings or pumping sessions
- Anatomical issues which impact baby’s ability to effectively remove milk
- Tight or restrictive clothing
As a CBC, you can chat with the families you’re supporting to find out their possible risk factors. For example, if you have a parent who has an inflexible work schedule and might struggle with keeping a pumping routine, you can help them work towards reducing their risks.
What Are The Symptoms of a Clogged Duct?
Symptoms can vary a bit person to person. However, most people who have clogged ducts feel:
- Pain during breastfeeding
- Hard or tender lump on the breast
- A wedged shape hardened spot on the breast
- White spot on the nipple
If there’s additional symptoms such as red streaking, a lump which lasts more than 24 hours, a fever, or any other concerns, be sure to encourage parents to reach out to their medical providers.
A clogged duct is one of the most common triggers for mastitis. If a clogged duct progresses to mastitis, which is inflammatory, parents may need to try additional things to help resolve it. However, unlike we used to in the past, antibiotics are rarely recommended for mastitis. We now treat mastitis more like a sprain or strain, with ice, NSAIDs, and general physical rest (continue breastfeeding).
That said, as a CBC, we refer families back to their medical provider or an IBCLC for more support if they are experiencing concerns related to mastitis.
Should People Pump Extra With a Clogged Duct?
We used to instruct people to ensure they ‘fully empty’ the breast whenever they experience clogged ducts or mastitis. However, now we know that can exacerbate the problem based on supply and demand. If we continue to demand extra milk, the body will supply it and will increase the risk of clogged ducts.
However, if there is a clog related to baby’s inability to effectively remove milk, pumping might be needed. If that’s the case, they should work with an IBCLC to determine the reason baby is unable to effectively remove milk.
How Do You Treat A Clogged Duct?
As mentioned above, we used to recommend trying to ‘remove’ as much milk as possible. However, that is no longer the recommendation. The Academy of Breastfeeding Medicine (ABM) states:
“[Clogged/Plugged Duct] This may resolve spontaneously, but patients can experience transient residual pain. Patients may feel relief of a “plug” with breastfeeding because this decreases alveolar distention. However, repeated feeding in an attempt to relieve the “plug” will suppress FIL, increase milk production, and ultimately exacerbate inflammation and ductal narrowing. Therefore, physiological breastfeeding and anti-inflammatory measures as described hereunder are most efficacious. Attempts to extrude the “plug” or milk precipitate by squeezing or aggressively massaging the breast are ineffective and result in tissue trauma.”
To read more about clogged ducts, mastitis, and engorgement, you can read Protocol 36 from ABM.
To summarize the above, parents should continue to breastfeed as they typically would. However, if there is a concern about baby’s latch and milk removal, they should have a latch evaluation with an IBCLC. Pain and discomfort can be treated with typical anti-inflammatory measures such as ice and NSAIDs.