A nipple shield, or as some new mothers have called it a ” breast shield” or “nipple guard” is used as a breastfeeding tool to help assist some babies with latching difficulties. There are many different reasons why your Lactation Consultant may have recommended the use of a nipple shield. It could be due to a nipple shape such as flat, short, or inverted nipples. Sometimes it is recommend if the baby has a high palate, a tight frenulum or a tongue tie (frenulum is the stringy flap of skin under the tongue) or other oral anomaly making latching difficult. Another reason would be if mom has severely sore damaged nipples, the nipple shield acts as a barrier to allow the nipples to heal without further damage and reduces the pain from already cracked bleeding nipples. Some mothers find the thought of the baby being placed on their nipple uncomfortable, and is more comfortable knowing that there is a “barrier” of sorts between the nipple and the baby’s mouth.
A nipple shield is a small, thin silicone device that fits over the nipple and areola during breastfeeding. It acts as a barrier between the baby’s mouth and your breast. It looks very similar to a hat..some mom’s call it the “Sombrero” or “Witches’ hat”. It works by vacuuming the nipple and part of the areola in to create a sort of suction. Contrary to older versions that were much thicker, this product is made of a lighter clear silicone, with 4 holes at the tip for milk to flow. I only recommend using a Medela brand 24mm nipple shield. Other brands and other sizes can cause more discomfort and allow for a decrease in supply. The shields come in various sizes, extra small (16mm), small(20mm), and medium (24mm). Rarely will anyone need a small or extra small size.I can not stress enough the importance of using the correct size. The majority of women will need a 24mm medium size to adequately suction in the nipple and areola into the shield to allow for milk transfer. The suction allows the baby to transfer the milk correctly. The nipple shield is NOT a breast shell which is worn during pregnancy or in-between feeds to elongate the nipple to make it easier for the baby to grasp. Breast shells are contraindicated now, and should not be used in my opinion for sore nipples.
For some women, the only way they will ever be able to breastfeed is with a nipple shield, where for others it is just a temporary solution. There is nothing wrong with using a nipple shield as long as it is placed and used correctly. Several years ago, the way nipple shields were made and used, the device actually lowered milk supply. This is no longer the case. The way the shield is manufactured actually helps maintain milk supply for some mothers, and in several recent studies it is actually recommended to use a nipple shield with premature babies as it will aid in boosting milk supply. However I ONLY recommend using a 24mm, medium sized shield as this is in my opinion the only size that can aid in production and decrease pain of nipple trauma. If the shield is too small it can decrease your supply which aids the old school train of thought that all nipple shields are bad for breastfeeding. My take on the subject has always been if it helps the mother and the baby maintain a good breastfeeding relationship, and it is not affecting the milk supply there is nothing wrong with using one as long as the mother uses it correctly and follows the below guidelines.
In most cases the Nipple Shield is a temporary solution, and will only be used for 1 week to 10 days. However, if you have used one for longer then 2 weeks your baby may have become accustomed to the texture and shape and it may take some time to wean off of the shield. In most cases I have seen, the baby at some point in their breastfeeding journey, wean themselves off the shield. One moment they will be nursing beautifully with it, and then the next moment they knock it off. Every baby is different, and every mother’s nipples are different. Being flexible is key, and of course lots of patience when it comes to breastfeeding. If you decide to continue using the Nipple Shield here is a list of recommended guidelines:
- BEFORE USE: Always be sure to wash the shield in between uses with warm, soapy water. Rinse and dry. Prior to attaching, use some hand expression to help stimulate milk flow and evert your nipple as much as possible
- HOW TO APPLY: Make sure the shield is dry prior to applying. Invert the shield slightly before placing on breast. Do NOT completely turn it inside out. Make sure the cut out notch is facing the direction that the baby’s nose will turn. With the shield slightly inverted, place at the base of your nipple and stretch it over your nipple. This should allow for a good amount of suction, and your nipple should pull out on it’s own. If needed use your finger to help pop out the nipple. It is normal for there to be a gap between the end of your nipple and the end of the shield.
- HOW TO USE: Once the shield is on correctly, with one hand grasp your breast in a “C’ hold while the other hand is supporting the baby’s head and neck. Gently stoke your nipple against the baby’s nose, lips and chin signalling to the baby to open wide. Once the baby has a wide gaping mouth bring the baby directly onto the shield and onto your breast. Never go to your baby, bring the baby to you. We have a saying: “Nose to chin…and hug them in”! Once latched observe that the baby’s mouth is open wide and the lips are flanged like a fish. The lips and cheeks should be touching the breast rather then sliding back and forth on the shield.
-Listen for audible swallowing
-The baby’s mouth should remain open and wide and the lower jaw should be gliding in a rhythmic motion, not sliding back and forth on the shield
-Watch your baby’s cues for signs that the breast has emptied. The baby will either de-latch on their own, or the audible swallowing and jaw glides will stop. Breast compressions while baby is nursing is extremely important as this will encourage your baby to suck vigorously while also effectively empty the breast while stimulation the breast to also produce more milk for the next feed. For instructions on how to hand express click here
-If the baby’s latch is correct, milk transfer should be adequate. To ensure that your baby is getting enough follow the guidelines in this post: Signs your baby is well fed
- AFTER FEEDING: Observe if your baby is content and if your breasts feel softer, and that milk is present in the shield. These are all signs of good milk transfer. If you have concerns that the nipple shield is hindering your milk supply, or you are unsure if your baby is getting enough consider a visit with your Lactation Consultant who can weigh the baby before and after a feed to see just how much of that precious milk he drank. Remember if you baby is gaining weight, and has adequate amounts of pees and poops you are doing a great job feeding your little one! Weight checks at a breastfeeding support group or at your pediatrician may be recommended periodically to make sure your baby is maintaining and growing well.
- If ever you feel ready to get rid of the shield, gradually begin to remove the shield with each feeding session. A great way to do this would be to start a feed with the nipple shield, and then half way through or when it is time to switch to the next breast, remove the shield and attempt to latch. Sometimes if you try to remove the shield at the beginning of a feed when the baby is most hungry, they baby will not be willing to cooperate. It’s best to wait till their little belly is slightly full before attempting something new. If it doesn’t work the first time, be patient. Place the baby on your chest skin to skin. Eventually your baby will re-orient and before you know it he/she will be feeding just as well without the shield as she/he did with it. Contact your local Lactation Consultant if you need help with this.
Below are examples of a good latch and a bad latch.
- GOOD Latch