Dear Doctor,

Recently, I noticed a swelling on my two month’s old baby’s left breast and thought that she is just chubby. However, when I touched it about two days ago, I felt a small lump. Yesterday when I was going to give her a bath, it had burst and there was pus and blood on her clothes. I am worried sick. She however doesnt seem to be in pain. The swelling has gone down for now. Is this something I should be worried about?

Esperance

Dear Esperance

A lump can form in a baby’s breast even when he/she is about a week old. This causes concern for the parents. But there is nothing to worry about. The baby, when in the mother’s womb, is exposed to a surge of hormones like estrogens. The baby is also exposed to some hormones while breast feeding. This can cause a lump around or below the nipple after birth, which is not inflamed or painful. If squeezed, small milk may also come out from this lump. But with the decline in the level of hormones, gradually, this lump will flatten out. This may take weeks to months.

Rarely, inflammation of the breast (mastitis) can also cause a lump in breast. The source of infection could be the small amount of milk present in the lump. However, here, the lump would be red, swollen and painful. There would be associated fever and excess crying.

Since you described the lump as painless, but when it burst it released pus and blood, this could have been a benign lump initially. Later on, due to handling it (anxious parents may touch it many times to examine it), secondary bacterial infection could have occurred causing pus and blood to accumulate.

Since the infection and release of pus would have happened over a short span of time, there were no features of acute bacterial infection and inflammation like high fever or crying of the baby due to pain. The lump could have been a lipoma (collection of fatty tissue), which could have been infected later.

If very good hygiene is not maintained during handling of a baby, he/she is exposed to risk of infections. Though many people love to hold a small baby, all should not be allowed to do so. Small quantity of microbes present over the hands of one holding a baby or present inform of mild cold or cough can translate into big infection for the baby. In case of a lump, it can be secondarily infected.

It is vital to maintain very good hand hygiene for all who are involved with the care of the baby. Those with any sickness, however mild, should not be allowed near the baby.

It is also important to give attention to clothes worn by an infant. The clothes should ideally be very soft, very clean and made of cotton. Nylon clothes look shiny and beautiful but are not healthy. They can cause irritation of the very soft baby skin thus resulting in discomfort and secondary infections.

Now that the lump has disappeared, the infant does not have pain, is feeding and sleeping without problem; there is nothing to worry about.

Dr. Rachna is a specialist in internal medicine at Ruhengeri Hospital.