What You Need to Know About Using Nipple Shields
It’s fairly common for me to hear from a mom who has been struggling with breastfeeding say, “My friend told me she used a nipple shield and her baby latched great!” It may also be your experience that if you leave the hospital with a newborn who isn’t latching well, you may have been given a nipple shield by hospital staff and told to use it when breastfeeding your baby.
Placed over the nipple and areola, this seemingly simple device looks like a cross between a bottle nipple and a pacifier. It can improve breastfeeding and get a baby to latch better in some cases, but it can also create a false sense of security—and may even prevent milk transfer— if it isn’t fitted right for you and your baby! Adding to the confusion, nipple shields are readily available for purchase online and in almost every store that sells baby and feeding paraphernalia, giving the impression that this common tool is automatically safe to use, a DIY fix, without needing the input of a lactation consultant. Most brands only offer minimal guidance, or warnings to seek professional help when using a shield, often printed on a tiny piece of paper inside the package which is only readable and accessible once you’ve already bought the thing.
Before we go into reasons why a nipple shield might be helpful, here’s some interesting history on nipple shields and why using them continues to be such a controversy among health care professionals.
History of Nipple Shields
Historical medical documents (Study 1, Study 2) show that nipple shields have been used since the 1500’s and were once made from a variety of materials such as animal skins, silver, wood, wax, lead, and even glass (seriously, glass or lead?!). As you can imagine, these hard materials most likely did not allow the baby to latch and suck effectively because the baby could not make contact with the skin or manipulate the breast tissue with his mouth. They were also unlikely to maintain milk supply. Things started changing in the 20th Century and shields were created from more flexible materials like thick rubber, probably allowing somewhat better breastfeeding outcomes. In the 1980s, technology provided newer material options and shields were made from thinner rubber and latex. Today, most shields are constructed from ultra-thin silicone. These flexible designs allow the possibility of latching more easily, having some contact with the mother’s skin, maintaining suction and removing milk from the breast.
Research on how nipple shields affect breastfeeding began more earnestly in the 1980’s and 90’s and most reported that using a nipple shield reduced the amount of breastmilk babies transferred. These studies set up a strong bias against using nipple shields among lactation consultants and other health care professionals. Over the next few years, more recent and sophisticated research revealed that using ultra-thin silicone nipple shields can be an effective tool, may not compromise the contact between baby and mom (which can reduce the hormonal messaging system to make milk), may not reduce or negatively impact weight gain, and may be especially helpful for preterm babies.
Why Are Nipple Shields Controversial?
Even though new research counters the earlier bias and concerns about using a nipple shield, there are few long-term studies, or studies with large numbers of people, evaluating the safety and effectiveness of nipple shields. We have little understanding of the effects on infant imprinting to a mother with a silicone barrier in place, or the impact on the suck reflex and other motor patterns on babies. Also, despite the availability and high visibility of nipple shields in the consumer markets, there are NO professionally peer-reviewed or generally accepted guidelines, protocols or policies for using nipple shields in health care! In addition, there are NO standards for manufacturing, sizing, thickness of materials, or shape of nipple shields.
Nipple shields vary widely in sizes (16-28mm in diameter), lengths, and shapes. Some are more rounded (called “cherry” shape) and some are more pointed on the tip (“conical”). Mothers’ nipples vary in length, diameter and elasticity and may fit well in the shield, or may not even protrude into the shield at all.
How, then, is a new mom supposed to know whether using a shield is the right option to help her with breastfeeding?
Why Use A Nipple Shield?
Nipple shields can be very helpful in certain situations. By creating a stable nipple shape in the baby’s mouth, nipple shields can help provide a shape for babies to practice sucking on if they are unable to latch, or have poor sucking skills. A nipple shield can maintain nipple position in the baby’s mouth during pauses in sucking bursts, and can affect how fast or slow milk flows. Mothers have reported that using a nipple shield helped them preserve a breastfeeding experience for them, and would have given up breastfeeding without one.
Shields have been helpful in the following situations:
Latch difficulty (disorganized or weak suck & slips off the nipple, neurological problem)
Nipple problems (short, flat, inverted, non-elastic, sore, scabbed or blistered)
Premature baby (can help transfer more milk from the breast if baby has a weak suck)
Oral cavity problems (high palate, cleft palate*, extremely small/recessed jaw, tongue or lip tie)
Baby with high or low tone
Overactive (fast) milk let-down
Transition from bottle to breast
Maternal history of sexual abuse
Sometimes a nipple shield is not needed, and other, more effective interventions can resolve the breastfeeding issue. It's important to counsel with a breastfeeding specialist who can help identify the real cause of the difficulty and offer possible alternatives.
Here Is What Nipple Shields Can’t Do:
Correct milk transfer problems or poor weight gain in baby if there is not enough milk supply (mom may need to pump after breastfeeding with a nipple shield to make sure milk supply continues to be abundant, or to help increase milk supply)
Fix damaged nipples if the root cause for the damage is not identified and remedied (like shallow latch)
Replace skilled intervention from a lactation consultant (IBCLC) or replace the need for follow up
Recommendations for Using a Nipple Shield
Despite a lack of standard guidelines, there are a few principles to abide by if a nipple shield is used:
Always involved a lactation consultant for evaluating if a nipple shield should be used, how to use it, which style/size to use, and to create a feeding plan that makes sense for you and your family
Regular breastfeeding follow up appointments are essential to monitor the progress of breastfeeding, and determine if a shield is still necessary, or still the right size (the size needed can change as baby grows), and when/how to wean off the shield
Mom should be comfortable with using a nipple shield and should be able to correctly apply it to her nipple without pain
Parents should be able to view milk flowing through the shield, and hear regular swallowing as baby sucks in a rhythmic pattern
Baby should gain weight consistently and have enough wet and dirty diapers each day
AnNipple shield can be a great device that helps you reach your desired breastfeeding outcomes. But the main take-away message for using a nipple shield is to involve a professional (IBCLC) to guide you through the process of deciding if a shield is necessary and for how long. What works for one mom may not work for another. You may not need to use a nipple shield forever either! Contact me if you are thinking of using a nipple shield or would like follow up or further instructions about how to use a shield. I'm here for you!
You are an amazing mom! You can do it!
*Cleft palate may require a special feeding device, not necessarily a nipple shield, and should be evaluated and treated by a medical doctor.