Nipple shields: the complete guide

Nipple shields are one of the most infuriating pieces of breastfeeding equipment out there. In the right situation, they are an absolute lifesaver – but they mostly get used in the wrong situations, in the wrong manner, and for the wrong reasons; and then they can do a lot of damage to a breastfeeding relationship. So I thought it might be useful to summarize the important information about what nipple shields are for and how they should be used.

What are nipple shields?

Nipple shields are a thin silicone covering that you place over the nipple – almost like a second skin, but with a slightly harder teat. The goal of a nipple shield is to make it easier for baby to latch and stay latched onto the breast.

When to use a nipple shield – and when not to

There are various situations where nipple shields are recommended to moms. Ironically, some of the most common situations are situations where a nipple shield is completely the wrong solution to the problem! Here’s a breakdown of all the places where you may expect to find a nipple shields being used:

 

Premature babies

Premature babies often find it much easier to latch on to the breast and stay latched on when a nipple shield is used – as long as the nipple shield is not too big! However, I have personally helped dozens (if not hundreds) of premature babies to breastfeed without ever using a nipple shield. The secret weapon? Kangaroo mother care and oral stimulation exercises! (Note from Sanja: If you’re interested in learning more about breastfeeding a premature baby, I’ll be posting on it next week. It’s one of my favourite topics!)

When baby has a difficulty latching

Often, when a baby struggles to latch well despite being in skin-to-skin contact and being positioned correctly, a nipple shield can help baby to at least latch well enough to feed until the problem is addressed. Some cases where a nipple shield may help a baby latch is:

• If baby has any abnormality in the mouth that makes latching and suckling difficult. This can include a high palate, cleft palate, recessed chin, lip tie, tongue tie or any of a number of other things.
• If the baby’s mouth is far too small and the nipple is far too large.
• If baby has a disorganized suck.
• A baby who bites down on the nipple, or who latches on but doesn’t suck.

IMPORTANT: in all of these situations, a nipple shield does not fix the problem – it just buys you time. You should always see a lactation consultant to make sure you address the original problem.

Flat or inverted nipples

Nipple shields are a favourite tool for women with flat nipples. In fact, many nurses will see a flattish nipple and recommend a nipple shield immediately, not even considering whether the baby needs it. So let’s just get one thing clear: in most cases, a flat nipple causes absolutely no problems with breastfeeding. Babies latch on to the breast, not the nipple; the nipple just gives them something to aim for. In most cases, a positioning the baby correctly and helping him latch deeply is all it takes.

Sometimes, however, a baby can struggle to feed. This is usually if the nipple is truly inverted: in other words, if you squeeze the areola of the breast, the nipple pulls in instead of sticking out. In these cases, every time the baby’s tongue pushes against the breast, the nipple pulls away. For true inverted nipples, a nipple shield is often very useful. Over time, baby’s sucking can stretch the nipple enough that it becomes possible to feed without the nipple shield.

(another note from Sanja: I’ll be posting a whole article on flat nipples later this week)

Nipple confusion

“Nipple confusion” is the slightly inappropriate term for babies who prefer the bottle to the breast. These babies can often be coaxed back to the breast by using a nipple shield for a while, because it feels more like a bottle in their mouth. If you’re dealing with nipple confusion, it is important to also do paced bottle feeding, to make sure that the bottle doesn’t become easier for baby to drink from than the breast.

Sore nipples

Sore and cracked nipples are probably the number one reason why nipple shields are used in maternity wards across the world – and it’s completely inappropriate! Sore nipples are a sign that something needs to be fixed, and using a nipple shield does not fix that something. The problem is this: the same things that cause sore nipples can also cause other problems like poor weight gain, low milk supply or mastitis. By using a nipple shield you are soothing the pain without addressing the cause of the sore nipple, and that can cause even bigger problems. When it comes to sore nipples, nipple shields are really a last resort, and only to be used while you are addressing the initial cause of the pain.

Potential risks of nipple shields

Using nipple shields can be very beneficial, but it is not without risk. Perhaps the most well-documented risk is decreased milk supply: skin-to-skin contact from baby’s mouth seems to be more effective in stimulating milk production. However, the modern ultra-thin silicone nipple shields go a long way toward preventing this problem; they allow for nipple stimulation very similar to what would happen during direct feeding. The more common cause of low milk supply is that the original breastfeeding problem was not addressed, and that that problem (e.g. poor latch or ineffective suck) causes baby to not breastfeed effectively. And as we all know, if the breast isn’t emptied effectively, milk production will be decreased. That is why it is important to always use a nipple shield under the guidance of a lactation consultant, who can make sure that all breastfeeding problems are adequately addressed. If your baby isn’t adequately emptying and stimulating your breasts through the shield, you may need to pump to ensure that you keep up your milk production.

The other problem of nipple shields is simply that they are annoying! Who wants to constantly carry around a piece of plastic? And woe betide you if you forget it when going out. I believe in making breastfeeding as easy as possible, so for that reason I will always try to avoid a nipple shield, or at least wean baby from it as soon as is practically possible.

And believe it or not, nipple shields can actually cause sore and cracked nipples! I’ve seen two situations where this happened. The first is more common that you’d think: it happens if the baby doesn’t latch deeply on the shield, so that the baby’s jaws chomp at the nipple with every suck. If the baby’s gums are on the nipple instead of the areola, it will hurt no matter what you do – so fix the latch first.  The other case is where the shield is too small for the nipple, and the baby sucks the nipple out through the holes in the shield’s tip. So be warned: using a nipple shield incorrectly can lead to sore nipples just as easily as breastfeeding incorrectly can.

How to use nipple shields correctly

Choosing a nipple shield

Choosing the right nipple shield is important if you want to prevent the problems I’ve been talking about. The first important thing is that you should always use an ultra-thin silicone shield, to allow for maximum stimulation of the nipple. Fortunately, all the major brands of nipple shields are now made from ultrathin silicone. The type that has a cut-away section is also nice: if you place the cut-away in the area where baby’s nose is, it allows baby to smell your breast, which stimulates suckling.

It is also important to choose the right size. In general, newborns do the best with the smallest sizes, because their mouths are so small. Be careful, however, that the “teat” part of the shield is not so small that it pinches your nipple, or that baby sucks your nipple out through the holes in the tip.

Applying a nipple shield

There’s a certain technique to applying a nipple shield to the breast. The goal is to help your nipple be drawn up into the “teat” of the shield. This is the method that I find most effective:

1. Flip up the rim pf the nipple shield, until you’ve turned up about half of the nipple teat – as if you are trying to turn it inside-out, but stop halfway.
2. Position the “teat” of the shield over your own nipple, using one finger to close the holes in the shield.
3. Roll the rim of the shield back down, while still holding the holes closed with a finger. This creates a bit of a vacuum that draws your nipple up into the shield’s tip. This will make it easier for baby to latch deeply.

It takes a bit of practice to get this right, and you may feel like you need three hands, but it gets easier once you’ve done it a few times. It may help if you warm the shield in hot water beforehand to make it more pliable. It also helps if you moisten the rim of the shield with a bit of water or breast milk, to help it “stick” to the skin of the breast.

Making it easier for baby

Some babies don’t immediately understand what they need to do when presented with a shield-covered nipple. To entice baby to latch on to the shield, you can smear a drop of breast milk onto the outside of the teat. It’s also helpful to hand express a few drops of milk into the tip of the shield when it’s in position, so that baby gets an immediate reward when he starts to suck.

It’s a good idea to position the shield with the cut-away section at baby’s nose, to allow him to smell the breast and feel your skin.

Caring for your nipple shields

Like any piece of feeding equipment, a nipple shield can potentially carry germs, especially thrush. It is important to clean your nipple shield after each use. If baby is full-term and healthy, washing with hot soapy water and rinsing with boiling water should be enough. However, if you or baby have thrush, or if baby is sick or premature, you need to heat-sterilize the shield after each use. You can do this by boiling it or by using a steam-sterilizer or microwave sterilizer – just check the manufacturer’s instructions to make sure that these methods are safe to use on your shields.

How to wean baby from nipple shields

I’ve said it a few times: nipple shields are intended as a temporary measure, not as something you have to use for your entire breastfeeding journey. So at some stage you are bound to want to wean baby from them. Initially, you can just try to latch baby without the shield and see what happens. If you’re lucky, it may be as easy as that!

Unfortunately for the rest, some babies get very used to the shields and they really resist feeding without them. Here’s some tips on how to get baby feeding directly from the breast:

• First, make sure that the initial problem was addressed. In many cases, the fact that the baby is bigger will automatically make it easier for him to latch, but sometimes you may need to, for example, have a tongue tie cut or do some exercises to strengthen baby’s suck. A lactation consultant is the ideal person to help you with this.
• For your first attempts at bare-breasted feeding, wait until baby is almost finished and starting to doze off before you gently (but quickly!) unlatch baby, move the shield and latch baby again. It may take several tries over several days, so don’t get discouraged – you will feel like a rock star when it finally happens!
• Once baby is willing to do this, start removing the shield earlier in the feed, until you are ready to do the initial latch without it.
• To help baby latch on to the bare breast, you can try some of the following strategies:
  • Wash the breast with plain water. Sometimes babies prefer the bland taste of the silicone to the stronger flavours of skin.
  • Hand express a few drops of milk onto the nipple and areola; the familiar taste may help baby to understand what he needs to do.
  • Put baby skin to skin. Breastfeeding baby while you’re both in the bath together seems to be especially effective; there’s something about the water and the skin contact that activates baby’s inborn reflexes.
• Whatever you do, don’t cut away the nipple shield bit by bit. This leaves sharp edges that can hurt baby’s mouth and your nipple. I know the edges don’t feel sharp, but the constant rubbing over the delicate skin of the nipple and baby’s mouth can quickly become painful.

In summary

That was such a long discussion, I can barely remember where we started! Let’s recap the main points, the really vital info:

• Nipple shields are useful in situations where baby struggles to latch and/or suck, e.g. for premature babies, or when the mouth or nipple is problematic. They are also useful to entice a baby with a bottle preference (“nipple confusion”) back to the breast.
• Nipple shields are not intended for the treatment of sore nipples, and if you use them without addressing the initial cause of the nipple pain, they will only cause trouble in the long run.
• Nipple shields carry a risk of reduced milk production, especially if you do not treat the problem that caused you to need a nipple shield in the first place. You may need to pump to stimulate your milk production.
• Nipple shields are usually only needed for a short time, and almost all babies eventually go on to feed without the shield.
• Most importantly, make sure that you use nipple shields under the supervision of a lactation consultant. She will help you to address all the underlying problems and to ensure that you don’t end up with milk supply problems.
• And remember: breastfeeding with a nipple shield is still miles better than not breastfeeding at all!

Have you ever used a nipple shield? How did you get your baby off it? Do you feel that the shield was an unnecessary annoyance or a lifesaver? Please share your story by leaving a comment below!