16 SepNipple Shield Guidelines

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:nipple shield

  1. 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
  2. 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.
  3. 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   
  4. 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.
  5. 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.
  6.    GOOD Latch


    BAD LatchCopyright© 2011 Danielle Gauss – JustBreastFeeding.com. All Rights Reserved.

81 Responses to “Nipple Shield Guidelines”

  1. Robert says:

    Thank you for posting this. The lactation consultant that my wife rented a pump from was horrified when my wife said she had been using a nipple shield. She basically told my wife that her milk was going to dry up and she (the consultant) would not be liable. Seems like the consultant is not up to date on modern nipple shields. Also she seemed a little preachy to me. Like she thinks direct skin to skin contact is the only way to feed a child and that any other method is horrendous and unhealthy.

    • Admin says:

      Hi Robert! So nice to see a daddy is reading my articles! I am so sorry to hear about the bad experience you are having with the other lactation consultant. There is nothing wrong with using a nipple shield, as long as it is put on correctly, it wont affect your milk supply at all. In fact for some women the only way they can breastfeed their baby is by using a nipple shield. A woman and baby should be able to feed in ANY position that is comfortable for them. As long as mom feels confident, has no pain, and the baby is getting fed and gaining weight, there is no wrong way to breastfeed. I’m glad you found this article helpful. Please know if you would ever like a second opinion I would be happy to lend my services. Thanks for your reply.

      • marina says:

        My lactation consultant said that there is nothing wrond with nipple shield, she said that milk will not diminish with it and she even used it herself for both her children, im using it now but im having a hard time seeing my babies drunk face on. He is pooping and peeing great.

        • Admin says:

          As long as you are using the correct size nipple shield and the baby is on deeply, It should be okay. I agree with your consultant, there is nothing wrong with the nipple shield as long as it is used correctly. However, a baby will transfer more milk without the shield simply because it is a more direct contact. I have yet to meet a baby however, who at some point in their breastfeeding journey doesn’t decide that they are over the shield and naturally wean off of it. If you are not having sore nipples, you can always try without it. If the baby is gaining weight, peeing and pooping, than it sounds like the baby is getting plenty! Great job!

      • Jenifer says:

        My LC told me that using the shield will hinder my breast milk supply and that I need to pump 20 min after every feeding to make sure I am still producing enough milk. This is so hard to do, my 2 week old feeds every two hours and finding time to pump on top of that is impossible. Right now I am only pumping and bottle feeding him either breast milk or formula when there is not enough breast milk being pumped. What are your thoughts on this?

        • Admin says:

          As long as you are using the correct size nipple shield ( I recommend the 24 mm) and you are putting the shield on correctly, there is absolutely nothing wrong with using it. I have seen a supply decrease using a 16mm or 20 mm nipple shield, but never with a 24mm. You do not need to pump every time you feed, especially not for 20 min. I often recommend pumping 3 times a day, 10 min after a feed, for 10 min. This will make your body think that the baby is having a growth spurt and will up it’s game. If you are still having some trouble with getting milk increased you can always use some herbs. Eventually your baby will not need to use the shield, and will most likely self wean off of it. Keep doing what you are doing, and monitor the pees and poops. If the baby is peeing at least 6 times and pooping at least 3 you are doing great.

  2. Melinda says:

    I was so happy to find this article. I have been worried and considering EPing because my baby will not latch with out a nipple shield. I have tried everything an the LCs make you feel like a terrible mom for using one! Just the reassurance I needed!

    • Admin says:

      I am so glad that you found it helpful! There is absolutely nothing wrong with using a nipple shield as long as it is placed on correctly! Like I said in the article for some women this is the only way they are able to breastfeed. Good job doing what works best for you to make you the best mommy possible for your baby! Best of luck!

  3. Anna says:

    Like the other posters, I’m very glad to have found this article! I use a nipple shield to breastfeed my 3 week old premature baby girl and it works for us. But I’ve certainly been made to feel very guilty from lactation consultants and doctors for using one despite my receiving one from a nurse in the first place! And so very glad to hear that using one will not affect the amount of milk I produce- despite what the lactation nurse told me!

  4. Kate says:

    I was wondering how early can you use a shield? The lactation nurse said not until the milk comes in and the midwife said as soon as I can express about 5 mls. I’m confused.

    • Admin says:

      Hi there. You can use a nipple shield from day 1 if you needed to. It does not matter if your milk is in or not. All that matters is if it is placed on correctly. As long as you slightly invert it, and stretch it over to vacuum your nipple in, you should be fine. I recommend using a 24 mm shield as well. Sorry for the confusion. Good luck to you and your little one!

  5. Kelsey says:

    I have a one month old and have been using a nipple shield pretty much the whole time breastfeeding. I feel I’m addicted to it and so is my baby. I’ve tried transitioning her off the shield with no success. She gets frustrated and then so do I and the shield goes back on. I now have really sensitive nipples. Could this be from using the shield and not giving my nipples time to “toughen up”?

    • Admin says:

      Hi there, first let me say that as long as the nipple shield is being used correctly, there is nothing wrong with using one. And I have yet to meet a baby that at some point in his/her breastfeeding journey decides they no longer want to nurse with the shield. One day he will come off your breast, swat the shield off, and go straight for your breast no questions asked. What I generally recommend doing is start a feed with the shield, then when you switch to the second breast take off the shield. This way baby isn’t super hungry and will be more willing to cooperate. If you are still having trouble I would schedule an appointment with a lactation consultant who can help you transition off. If you are local to Orange County, CA I would be happy to help. As for the nipple tenderness, that is something that your breasts will get used to, but generally it is because of a good latch. You can take Prim Rose oil capsules 500 mg 1-3 times a day and this will cut back on some of the tenderness. Hope this helps.

  6. Barb says:

    I have been searching all over for articles that included pictures of correct usage of shields. My baby is 3 weeks old and we have tried latching with and without. LC in hospital tried for hours with us as I have inverted nipples. I have mostly been pumping lately since its just too frustrating and time consuming to pump to draw out nipple, work with my darling to get a good latch and then to nurse. This is baby #5 and pumped exclusively with others. Now, with soccer practice and ballet classes and other activities for older children, hauling around the pump is not always appropriate. Is it too late to try and work with the shield? Did I mention also that one of my nipples is so cut up that even with constant lanolin, it’s bleeding and sore. I’m committed to get breast milk to my baby any way I can, just wish it were easier. Any advise?

    • Admin says:

      Hi There! Thank you for your response! Yes you can absolutely try to use a nipple shield as it will probably help you a great deal. It is all about positioning and inverting the shield first so that it can vacuum the nipple in. If you are having trouble, I would recommend scheduling an appointment with a lactation consultant to help you. If you are local to southern California, I would be happy to meet with you personally.
      Just remember to lean back, bring the baby to you…and of course remember to rub your nipple (or in this case nipple with the nipple shield on) from his nose to his chin until you see a wide open mouth then shove him in.
      If pumping is hurting, you can always put lanolin in the pump to help lubricate it so that it wont cause more nipple damage while pumping. As always if you have further questions please let me know. Good luck!

  7. Michelle says:

    Great article! I have been using a nipple shield since day 2. I was given one by a great LC in the hospital. When I got home I started looking online and panicked due to all the poor information out there about the evils of shields. My LO would not latch well without it, likely due to not very prominent nipples. With the nipple shield he was back to birth weight by day 5! He does take forever to nurse, but I think this is more due to his personality and feeding style than the shield. Now at one month he will latch without the shield, but keeps falling off and gets frustrated so we always end up putting it back on. Again, thanks for the great article. Many of us new moms who stumble upon it find great comfort from it right when we need it most.

  8. Kristin says:

    Thank you for this article, I echo everyone else’s comments of gratitude. About the size of the nipple shield, can you use a 24mm shield with a 5 week old or do you need to wait until the baby is older/bigger for this size? I was given a 20mm by the LC and sometimes the outer rim of my nipple has some bleeding, it seems too small.

    • Admin says:

      I never recommend a 20 mm shield unless it is a teen mom or a really preemie baby. If you use too small of a nipple shield it can decrease your supply and cause more discomfort. I recommend using a 24 mm from the start if possible. Just remember to stretch it on so that it suctions in. Hopefully that helps. Let me know if you have any further questions.

  9. Sydney says:

    Thank you for sharing your expertise. My issue is that my baby doesnt open wide enough. I know he is able to but it is rare that he does. he is also compressing my nipple and not sure if it it due to overactive letdown or over supply ( how do you figure that out) so my nipple turns white and I get nipple and also breast shooting pain which can last hours :-( He is gaining weight like a champ thankfully but is also very fussy and spits up alot as well. sometimes when he spits up it doesn’t seem to phase him and other times he cries and arches his back after spitting up. I was going to try the nipple shield to help with overactive let down if that is causing him to compress and I will begin to suck train. his lips are rarely out like a fish, he curls them in, should I manually pull them out once he is on? Any way I can talk to you via phone??

    • Admin says:

      I’m so sorry you are having such trouble. I would try some suck training on him, and make sure you are leaning back and bringing him to you. Gravity will help open up his mouth wider. You never want to go to your baby as this will cause him to be more on his back thus resulting on him clamping down more. I would be happy to talk to you on the phone, however you might benefit from seeing a lactation consultant in your area that could look and see what else is going on. I could recommend some if you would like to message me privately.

  10. Kim says:

    Love this, thank you for putting this out there! I had my son two weeks ago and while in the hospital, a nurse handed me a shield. No questions asked and never told me to meet with an consultant. I’d done my research but never came across a shield. I was so sleep deprived and medicated I agreed. I thought it was amazing until I got home and started researching specifically about shields and became so angry with the nurse…what if I lose my supply? What if he never learns to latch on the breast? They are expensive and not user friendly in public situations etc. Point…there are not positive messages out there on shields and it terrifies me. So, thank you for giving me hope. I met with a lactation consultant last week and it was not very helpful. I feel like she gave me 0 information about how to use them, long term use, how to clean, do they need replaced, should I start pumping? So many questions! I’d be devastated if my supply dried up! My son and I are hooked, although trying to wean from their need. That said, my questions are: my son sucks so hard my nipple goes through the hole…is this normal? Am I being used as a pacifier at that point? And, do I still follow normal bf’ing guidelines or because of the shield do I need to nurse more or less time?For the record, he is gaining weight like a champ! Thank you for reading this and for responding if you have time :) for all new parents out there reading these comments…cheers to you! This job isnt easy but it’s amazing!

    • Admin says:

      I’m so glad you found the post encouraging. It sounds like you are well on your way to a successful breastfeeding start. Based on what you are describing, it sounds like you have the wrong size nipple shield. As long as you are using a 24mm ( medium size) Medela brand nipple shield you should be fine. I never recommend anything smaller then that. As long as a nipple shield is put on correctly it will not lower your milk supply. That being said I have never met a baby that at some point doesn’t wean themselves of the shield. When you latch, make sure to lean back and bring him to you, never go to the baby. He should be tummy to tummy and you should not see your areola. If you see the areola he isn’t on deep enough. Watch his jaw glides, as long as there are big long glides he is latched correctly. When you see the flutter suck take him off. I am always available for facetime appointments as needed if you would like further instructions. Best of luck.

      • Kim says:

        Thank you! We do use the 24m Medila shield – I am keeping your FaceTime option totally open! I’d send money!

        • Carissa says:

          I am having the exact same issue. I’ve been using the shield because my little one had such a shallow latch and destroyed my nipples. My nipples were starting to heal but now are getting pulled through the holes in the shield which is so painful! I have the 24 mm size too and have been applying it like described above so I have no idea what to do to help it. Did you have any luck fixing the issue? I am at my wits end with being in so much pain and am trying everything I can to not give up on breastfeeding :(

          • Admin says:

            Are you using the Medela brand Nipple Shield? That is the only brand I would recommend. The other brands have too many holes. If your nipple is being stretched that far, then I would suggest trying to latch the baby without the nipple shield and see how you do. If you need help, I would recommend trying to find a local lactation consultant to observe a feed. If you need help locating one, I would be happy to help. Follow the steps in “How to Latch a Baby in 7 simple steps” for guidence.

          • Summer says:

            I’ve had the same problem, and I specifically have it with the Medela shield. That said, I think I’m having a similar problem with the NUK, but the holes are small enough that I’m not getting pulled all the way through. The shield is smaller, though, and so nursing with it is more painful in the long run. It also seems to mess up her latch after a few feedings. I don’t know what the solution is. At first, I thought might be an issue of the shield being too small (it’s 24mm), but I don’t really see how a bigger shield could resolve the issue. Some sort of weaning shield that has the tip cut off but still encourages a wide latch might be a good solution.

          • Admin says:

            If the baby’s suck is strong enough to pull your nipple through the shield, then it definitely sounds like it is time to try and latch the baby with out the shield, and wean off of it. If you have a hard time doing so, it may be a good idea to make an appointment with a local lactation consultant to hopefully help you through the transition. I am not familiar with the NUK shield, so I can not provide information on that, but I would always recommend using a 24 mm shield. Best of luck to you.

  11. Sara says:

    I had to start using a shield bc my baby had to be supplemented In The hospital and now won’t latch properly. I weigh him before and after nursing and he tends to only get about an oz in an hour long nursing session. Is this due to the shield? I have to offer a bottle of expressed milk after bc he isn’t eating enough. He’s almost 7 weeks old. I really want him to be EBF before I go back to work on jan 3. I don’t want to have to supplement anymore. Would you recommend just cutting out the bottles and he’ll nurse when he’s hungry? Please help!

  12. Flick says:

    Thanks so much for this post, it has given me much needed ‘permission’ to use the shields without so much self-judgement as I’ve been feeling like a but of a failure ! We started using them on day 2 with my slightly premie baby who was unable to latch without them. The advice was to slowly begin to remove them at home. By week three and many painful and frustrating sessions of trying to get rid of them (many tears from baby and mum!) I went to see a lactation consultant who diagnosed baby with a tongue and lip tie that were preventing proper latching and the reason for so much pain and nipple compression. So now we are at week 7 and the ties have been snipped three days ago. Her suck is definitely stronger and seal better, not so much milk spilling out during feeds, and she seems to be more settled on the whole with less cluster feeds in the afternoons and evenings like before, but the pain is still there for me. I feel like she has a fixed pattern for tongue coordination now that might not change…? I liked your post on training tongue position for latching so will give that a try. Fingers crossed, as I would love to experience pain free nipple shild free breastfeeding ! But if we can’t get rid of them then at least she is gaining weight well and we are successfully breastfeeding, even if there is a bit of silicone in between us! Any advice though would be much appciated.

    • Admin says:

      HI there. So thrilled you find this information helpful. Let me assure you I have yet to meet a baby, in all my years of practice, that at some point in their breastfeeding journey did not sit up, swat the shield off, and go straight on the breast no problem. For some babies it may be sooner then later, but like I said as long as you are using the shield correctly (preferably a 24mm medela shield) there is nothing wrong with using one. Research has shown how using a nipple shield with a preemie baby has improved latch and milk transfer which was very apparent with your little one. I would most definitely try the suck training that as mentioned in my previous article, it should help. Make sure to check out “7 steps to latch” as well. Make sure you are ridging your breast like a sandwich, hand under your breast like a “U” not a “C”, lean back, bring baby to you, never go to the baby. Then nose to chin, hug baby in. Flip that lower lip out. Make sure cheek is touching breast and that you do not see the areola. Make sure you are using good pillow support as well. I hope this helps. If you have any further questions, please don’t hesitate to ask. Good luck.

  13. Holly says:

    Hi – I’m wondering about using shields as ny little one is really refusing the breast. He had a tongue tie cut two days ago and has not been breast fed for four weeks. He is now six weeks old and screams when I try breastfeeding. My concern is that ny nipples are so flat, the shield doesn’t seen to suck them out and he just chomps on the end of my nipple. They are already damaged and seem to just rub against the shield. I’ve tried medela contact 20mm and 24mm. Am I doing something wrong?

    • Admin says:

      Hi there. I always recommend using a 24 mm shield, never anything smaller. Anything smaller just adds to the discomfort your already experiencing. Make sure when you use the shield that you invert it slightly, then push onto your nipple and stretch it on so that it vacuums the nipple in. It should be difficult for it to come off. Then make sure you are leaning back, bringing baby in to you, and that you are using good pillow support. Baby’s cheek should be touching your breast and you should not see any of your areola or the shield if the baby is latched correctly. Make sure you are using good breast compressions or massaging the breast to allow more milk to flow. My guess is that the baby is having more of a “Flow” confusion vs. a nipple confusion. Hand express some milk into the shield so that there is milk pooled and waiting for him. Hope this helps.

  14. Anna says:

    Hi there, thanks for the post it seems everyone else thinks I need to come off the shield but I feel I will always use it at least until he knocks it off like you say. I have friends that used a shield for the whole time they breastfeed. My baby was 6 weeks prem and we had am awful time trying to feed him. I have a 16mm medela shield as that is what my lc recommended. (she wants me to try stop using) I have no trouble with it and my nipple pulls right inside vacuumed in like you say…my milk seems fine he always has a face full of it. I am yet to compare his recently but he seems to be getting bigger. He has quite a small mouth and I feel a bigger shield would be to much for him to take. Do you think this sounds ok… I am always concerned my milk will dry up not that it appears to be at this stage. Have been using for 2 weeks now after previously bottle feeding. Thank you.

    • Admin says:

      I’m glad you enjoyed the post. As I mentioned in the post, there is nothing wrong with using a nipple shield as long as it is used correctly. At some point you and your baby will decide to get off the shield and when that time comes, then I would encourage you to do so. However, I would recommend transitioning to a larger shield such as a medium 24mm. I know that seems quite a bit bigger compared to the 16 mm, however the small size you are using will attribute to a lower milk supply because as the baby grows so will his mouth and he needs to learn to suck effectively. The 16mm only covers the nipple not allowing the baby to compress part of the areola sending the nerve messages to your brain to tell your body to make more milk. If you use the 24mm, invert it slightly first, then stretch it on, it will allow the breast to be compressed how it is supposed to, and not lower your supply. This will also help your baby widen his mouth bigger thus resulting in a more effective latch as he grows. Maybe a good solution would be to transition to the bigger size before stopping the shield all together.

  15. Amanda says:

    If my nipple is being pulled through sheild is this affecting transfer n supply? I’m using a 20.

    • Admin says:

      If your nipple is being pulled through the shield it is too small for you. I would recommend using a 24mm medela shield. Any other brand will not work. Also if you are able to fill the entire shield, you may no longer need to use it. Make sure you are monitoring the babies output. Is your little one peeing and pooping enough? 6-8 wets, 3 poops and the poop should be yellow. Let me know if you have any questions.

  16. Mathilde says:

    Thanks a lot for your article – Like many of us – first time mom – we are never too sure we are doing the right things. Because I have flat nipples, my LS recommended to use nipple shields. I start at day 4 and my baby is now 14 days and we are doing great with breastfeeding.
    One thing I have been looking all over internet and can’t find (in the US) : Medela Nipple Shield 24mm CASE/BOX – to transport the nipple shield?! If I can’t find it in the US, do you have an idea of a ‘clean’ way to transport it?
    Thanks a lot in advance :)

    • Admin says:

      I am so glad you found this helpful. I would recommend using a retainer box. If you have an orthodontist close by or even a dentist, usually they are pretty happy to give you one, or sell you one. That is the perfect carrying case. If not Target usually has travel cases you can use, like you would use for bars of soap. Great job!!

  17. katy says:

    Hi, it’s nice to see a positive article about shields. I started using a shield on day 2 as I developed a blister on my nipple and was struggling to feed. Before this my LO was latching well according to the midwife. The blister went away after a few days but LO is now 3 weeks old and won’t latch without the shield. I wouldn’t mind keeping the shield but it is really painful every time and I dread her feeding. My breast feeding advisor has watched a feed and is happy with the latch but I’m not sure how much longer I can grit my teeth for as LO has started cluster feeding for up to 4 hours on an evening. I really want to keep feeding but am really struggling. Any advice would be really appreciated.

    • Admin says:

      Hi there, thanks for the advice. If you are still experiencing pain with latch and with a shield, then either the shield isn’t on right or the baby isn’t latching right. Breastfeeding shouldn’t hurt, although often it does because what “appears” to be a good latch isn’t. If you are using a shield make sure you are using the correct size, a 24mm medela shield. You need to invert the shield slightly then stretch on over your nipple so that it vacuums in the nipple. Next you need to make sure you are leaning back, have good pillow support, and are bringing the baby to you. Never ever go to the baby. When a baby is latched correctly, you should not see any part of your areola (even if you have large ones) your baby’s cheek should be flush with your breast, his ear, shoulder, and hip should be in a line, and he should be tummy to tummy. If you are still having pain I would consult with a Board Certified Lactation Consultant to check. Your LO is also going through his first growth spurt which is causing the baby to want to feed more frequently. It lasts about 4 days. Read some of my other articles to help you: , ,

  18. Miriam says:

    Question. .. breastfeeding my last baby was really painful in one nipple.. so am scared to breastfeed my baby that’s on its way! Mmm will a nipple shield help breastfeeding this time be not so painful? ? ?

    • Admin says:

      It is possible that a nipple shield may help you, however every baby is different. Before going that route I would wait and see what this baby does. In most cases your breastfeeding journey will not repeat itself. You may find that this baby is much easier to feed. Maybe consider meeting with a lactation consultant in your area first, either before you give birth and directly after as well. If you can get started correctly you might find this experience better. If the nipple pain was only one side, it most likely was due to the baby favoring a neck position. Meaning, the baby’s neck was more comfortable on one side, so you would need to do a craddle hold on one breast, and football hold on the other. Hopefully this time will go better and if not I would be happy to provide more advice once the little one arrives.

  19. Helena says:

    I’ve found this article so helpful but wondering how you if a shield is to on small. I’m using a madela 24ml but it won’t stay put – my nipped are really large.

    • Admin says:

      Usually I recommend a 24mm nipple shield, but if your nipple is too large for that, then you would need to special order the next size up. Just make sure that you are inverting slightly, place over the nipple then stretch on to vacuum it in. Make sure you are putting the shield on dry, never wet. Hope this helps.

  20. Ashley says:

    Great article! I just have one question. I am currently using a 20mm sheild as that is what I was given at the hospital. Everything has been going well most of the time. I am 7 weeks PP. However I lately have been have extreme pain and bruising on my nipples. And my areola is red and swollen. And I really think its from the sheild being the incorrect size. My areola gets pulled into the sheild which I thought was causing my pain. So I was thinking I needed go go down a size? But you are saying maybe I should go up to the 24mm. How much of the areola is supposed to get sucked into the sheild?

    • Admin says:

      You most definitely need to go up a size to the 24mm. Very rarely will I use anything besides a 24mm. If your baby’s suck is that strong, you may want to try and latch the baby without the shield and see if the pain is less. If it is more uncomfortable to latch with the shield then without the shield, go see my article on “7 steps to latch” to help with better positioning. However, if you do want to continue using the shield then I would for sure go up a size. If you have questions, please don’t hesitate to ask. Good luck!

  21. Lee says:

    I was using a Medela medium 24 mm shield. I had a lot of trouble with it peeling off or leaking. I switched to the Nuk large 24 mm shield. It stays on much better and it doesn’t sound like my baby is sucking a ton of air, but it’s hurting my nipples. When I take it off, half of the nipple is pulled out much more than the other half–it happens on both breasts. Do you know why this is happening? I really hate the Medela shield, but the Nuk is not going to work if it’s hurting me.

    • Admin says:

      I am not familiar with the Nuk shield. Will the baby latch without the shield? If you are open to it, maybe try latching w/o and see how it feels. If it is still uncomfortable, then make sure you are applying the shield onto a dry breast, and that the shield is also dry. Invert slightly, push onto nipple and stretch on. This should vacuum the nipple into the shield, and should prevent leaking. Let me know if you have further questions.

  22. Lindsay L. says:

    Thanks so much for this helpful article. My daughter was an amazing nurser from the start. She absolutely REFUSED all bottles until 5 months old when we finally taught her to 1/2 way accept one in the evenings when we would be out. Then, at 7.5 months we went away for a weekend and she was given bottles almost the whole time we were gone. About a week later she just started refusing the breast on a little strike. In return, my milk supply plummeted. So, I rented the hospital grade pump and started EPing (like I did for a year with my first). I made enough and never had to supplement, but using so much bottle has made her seem to forget how to latch and nurse even now that my milk has come back. If I try to latch her now she just clamps down really hard and acts as though she has never once nursed. In your opinion, could a nipple shield help me bring her back from the bottle to nursing? Any thoughts on this? I am not sure of the size to buy so I have a 20mm and a 24mm. Any thoughts on how to use it to guide her back to the breast? Thanks so much!!

    • Admin says:

      Hi there. Yes a nipple shield may help you in getting her back to the breast as it will give the same texture of a bottle. I would only recommend using a 24mm, never anything smaller. Remember to invert the shield slightly, push over nipple and stretch on. Try to express some milk so it pools into the shield, then latch the baby. Once she is on, breast compressions or massage will help keep her going. If she fights you, you may need to start with the bottle and end with the breast. Please let me know if you have any questions. Best if luck.

  23. Sadie says:

    Hello, thank you for this great article. I have a 5 week old who nurses. I developed cracks in both my nipples when she was two weeks. I have been correcting her latch so it is proper. However my cracks just won’t heal. I put MotherLove on them and they start to heal but when my baby nurses they open up again. If getting a shield will help heal them I’d live to know! I wouldn’t use it after they are healed. I just want it to stop hurting!! Thank you for the help.

    • Admin says:

      It probably would help give them a chance to heal up. However, I would recommend seeing a lactation consultant after to observe a feed and find out why she keeps causing your nipples to crack. It could be a simple positioning problem, or it may be that she has a tongue tie or lip tie that would inhibit her from getting a deeper latch. In the meantime, I would use expressed milk on your nipple, lean back when latching, and absolutely use a 24mm nipple shield from medela. Let me know if you have any follow up questions.

  24. Jane says:

    Thank you so much for this article and your answers to the many questions asked. My baby was born 10 days ago and she has had problems latching and I was given a shield to use in the hospital on day 2. I also started pumping and we are supplementing with breast milk with each feeding because even with the nipple shield she is not able to get a good latch and is not getting enough milk. I have very large nipples, areolas and breasts. When you describe that the areola should go into the shield – I’m not even seeing the full nipple go into the shield. The shield does fill when she sucks, but just with the nipple and not all of it. She also does not have a good latch on the shield. We have talked with the consultants at the hospital (but at that point we were mostly focused on the supplementing to make sure she had enough food) and we met with a consultant yesterday. At that meeting we focused on getting a better latch on the shield, but a struggle I have is that I have also never seen the vacuum latch on the nipple you described. Even when starting dry, using lanolin to “glue” the shield on, and tweaking the nipple a bit the shield is very easy to fall off which makes it hard to get a good latch. We also noticed at the consultation that she was not using her tongue and we think it may be due to us going to fast when we were supplementing her. Since we met with the consultant and since reading this article we have been working with our baby on suck training and on going more slowly with the supplementing and I think we’ve seen improvement with her tongue position and some slightly better latching. But she still has a fairly shallow latch. I also think that the nipple shield may be too small for me (I believe we’re using the medala 24 mm) and I have ordered online the medala 24 mm (I didn’t see a bigger one), a NUK large and a mamivac large to see if a larger shield will help but they won’t come to next week. We plan on continuing to work with consultants, but this article is the best one I’ve seen yet on using a shield and issues with a shield. I’m ok with using a shield but we’re trying to figure out how to not have to also supplement (right now we’re using a syringe) and wondering what we could do to try and improve milk transfer through the shield. I have no problem with supply. I pump after most feedings and am able to pump a significant amount of milk. Thanks so much for any advice you may have.

    • Admin says:

      Hi Jane! Glad you found the article helpful! I would recommend using the 24mm Medela nipple shield. I don’t usually recommend using anything to “Glue” on a shield. It should just stretch on. Turn the shield slightly inside out, not all the way, just slightly, push over the nipple, then stretch on dry. That should help. If you are still able to pump out tons of milk make sure he is transferring the milk via the shield correctly. Breast compressions while feeding will help. Best of luck.

  25. pal says:

    Hi ladies,
    i feel i can get some help on this from your experiences. i had my baby on April 30th premature by one month and had high level jaundice. we had to start him off with bottles right away to get the bilirubin flushed out of his system. i started pumpink milk and giving to him in bottle. he got so used to the bottle that when i tried to breastfeed him, he cried and cried umtil i gave him bottle. i finally called a lactation consultant and she said ue had a severe tongue tie so we got his frenulum underneath the to gue snipped. even after that i had trouble breastfeeding so i finally gave up and started giving him expressed milk in bottle. now its been 3months amd i feel i want to give breastfeeding a good try again. is it still possible to start this after 3months of bottle feeding?

    • Admin says:

      Hi there! I apologize for the delay in response. I do hope that you have given breastfeeding a try again. Usually when a baby hasn’t been to the breast in a while and goes to the breast, it isn’t that they don’t want to breastfeed, it is more that they are confused. Babies don’t get nipple confusion, they get flow confusion. A bottle flows faster then the breast. So sometimes you have to mimic the flow of the breast. A nipple shield is a great starting point because it is the same texture as a bottle. Make sure you use the correct size and once on, express some milk into the shield to get the flow started. Once the baby has latched really massage the breast to keep the flow going. You may also want to consider using a SNS or supplemental Nursing System which is a tube taped to the breast, filled with breastmilk that will add the “instant flow” to get the baby started. A local lactation consultant may be able to help you with this. Remember to do lots of skin to skin, and breast compressions to keep baby going. Best of luck.

  26. Monique says:

    Thank you again for this article. My daughter is 3 weeks 4 days old and at day 5 we started to use the medela shield. While in the hospital I saw the LC several times and also had nurses helping me with no success, due to poor latch. I was told I have shallow nipples, and my little girl likes to bite down. When ever we got a good latch she would pull back and try to take just the tip. Any ways, the shield is the only thing that seems to work, when we try without the shield we run into the same issues. Well my question bis the inverted way to create suction, I have not been able to create any kind of suction, however, my baby girl is getting plenty of milk and gaining weight when we left the hospital she was 6 lbs 15oz, at 3 weeks 8 lbs 1 oz. Should I modify my technique and if so, how?

    • Admin says:

      If you have been having sucess with the shield, not having pain, and she is gaining well, you don’t necessarily need to change anything. However, if you are having some discomfort and need to vacuum it on a bit, hold the shield between both your pointer fingers and then the thumb and roll half way so it looks more like a hat. Then place it on the nipple, push in, and stretch on. Most likely when your daughter is a bit older and she has grown, she on her own, will wean off of the shield. Your nipples may have appeared “shallow” at birth because of fluids you received during the birth process. Once those have subsided it should be able to evert better. Check out the 7 steps to latch article to hopefully help you in getting that baby on deeper. Great job!!

  27. Vanina says:

    Thank you for a great article! I have been using nipple shields with my first son exclusively for the first 1 month because the first time he latched on directly after birth, my nipples got cracked to blood and it was just impossible to nurse without shields. Then gradually we were able to do without them, but from time to time when my nipples would crack again we were still use them. I was breastfeeding him until he weaned himself off at 11 months. Now I am pregnant again and due in several weeks and I plan to use the shields again at the beginning in case I get the cracking and pain. My question is: can I use the shields I have from my son – they are now about 4 years old but look new and have been kept in a closed box, no signs of wear or tear and not even color change. They are silicone Medela nipples. I was planning to boil them for 20 minutes in water, then to put them in a steam sterilizer before the initial use. Would that work or it is better to buy a pair of new ones? Also, I am one of those few women who actually need the 16 mm (XS size) – I guess because I am petite and very thin and my breasts are quite small. I have the feeling that using the shields at the beginning made it much easier for my son to drink, probably because my nipples are very small. The shields were also helping form my nipples to make it easier to him to latch on. So sometimes I would start the feeding and then 1-2 minutes later remove the shield and my nipple would be perfectly “formed” for my son to latch on.

    • Admin says:

      I am so glad you had a positive experience. Each baby is different however. You may find that this time around you don’t need the shields. Often times it depends on the shape and anatomy of the baby’s mouth. Most moms find, although they have the same pair of breasts, each of their children fed differently, because of different suck patterns, anatomy, etc…. So my initial advice would be to wait and see, you may be presently suprised. Read my article on the 7 steps to latch to help prepare you ahead of time, and schedule a time to meet with a lactation consultant once your little one arrives. If you do in fact need a nipple shield, and you may want to have one ahead of time, I would get a new one, especially since your last one is 4 years old. All plastic and silicon break down over time, and you NEVER want to boil a nipple shield. That will make it very difficult to suction on to the breast in order to have it work correctly. I would recommend, if you do have smaller nipples, to use a 20mm vs. the 16mm. This will protect your milk supply the best. Remember to invert slightly, push onto the nipple, and stretch on. If you put the shield on correctly from the get go, it wont hurt at all with latch on. Best of luck!!

  28. Marissa Cantillo says:

    Hi my baby girl is 3 weeks old and we have been using a nipple shield since day 5 because she was not latching properly and was causing my nipples to crack and bleed. My question is I am still having pain when she latches on with the nipple shield for about a minute into nursing and it has been that way ever since I started breastfeeding. I don’t know what size my nipple shield is but I was given it at the hospital before we left. The tips of my nipples are red. Please help because at this point I want to give up on nursing completely. Oh also I used a nipple shield with my other daughter till she was about 2 months and she weaned herself off the nipple shield.

    • Admin says:

      Hi Marissa. I am so sorry to hear that you are having so much trouble. Nipple shields can be helpful with sore nipples, but we often still need to find the direct result of why it is hurting in the first place. Breastfeeding isn’t supposed to hurt, but often does in the beginning because of the baby not being latched correctly or deep enough. Pain just means something needs to be adjusted. The nipple shield, as you know from your first baby, is often temporary. You want to make sure you are using a medela 24mm (medium) size nipple shield, and that you are slightly inverting the shield pushing it on the nipple, then stretching it on. If you have the wrong size and it is not put on correctly it will still hurt. You can get a new shield at Target or Walmart if needed for $10. Make sure when you are latching her, that you are leaning back, bringing the baby to you, that she is tummy to tummy. You want to bring her to the nipple, don’t lean forward and bring your nipple to the baby. If you do that, she is only going to nibble on which hurts, or the whole areola and nipple will not be in her mouth. I have a saying, nose to chin, hug them in. If the baby is at all on her back she will bite, and gravity can’t help you. If you lean back, put your feet up, and use good pillows, gravity will help you. If you are still having pain, I would absolutely recommend getting a lactation consultant in your area to take a look and make sure baby doesn’t have a tongue tie or something else going on making it difficult for the baby to latch on deep enough. Hang in there girl. It gets better. For your sore nipples. Put some expressed milk on the nipples, and then add maybe some soothie gel pads. You can find those at any Target, Walmart, Etc…

  29. […] me to heal.  Sometimes they get a bad rap.  There’s a really good article here with the basics on nipple shields.  I recommend looking into them if you’re having […]

  30. Hailey says:

    Amazing article!!!

    Question.. I am one of those moms that have to use a nipple shield and I’ll always have pain no matter what, but at least the baby is getting enough milk.

    I would like to get a breast pump and was wondering if there is a type of breast pump that has built in nipple shields or what the best option is.

    Thanks!!!

    • Admin says:

      Hi there. I am so glad you found the article helpful. There is not a pump that specifically has a nipple shield in it, but most pumps should not hurt your breasts. I do like the Medela Pump and Style Advance. It is the most effective. Make sure you check with your insurance company as most companies will now send you a brand new pump for free. When you do pump you can lubricate your pump with lanolin or any other nipple ointment so that there wont be any friction. It should feel very similar to the shield. Best of luck to you.

  31. Melanie says:

    Great advice — I think I have visited every single page of this website. I’ve been using a nipple shield for two weeks now. The main reason is such extensive damage on each side was causing too much pain to breastfeed. The LC suggested a nipple shield until I heal and then we will work on a correct latch. However, after two weeks, I still have open wounds on each side. They are getting better, but it seems to be taking forever. My question is, even with the nipple shield, my nipples come out looking a bit like a new tube of lipstick. Is this possible? Also could the nipple shield be inhibiting the healing since my nipple is rubbing against the silicone? We are five weeks into our breastfeeding journey and I thought we would be rounding the corner, but we are still struggling. Agny advice would be much appreciated.

    • Admin says:

      Thank you so much for reading our articles. My first suggestion would be to make sure you are using the correct size nipple shield. You want it to be a 24mm nipple shield by medela. If you are using anything smaller then that, it could be the problem. Also make sure that you are leaning all the way back, bringing the baby to you. If you are leaning forward, and the baby is more on his back, then it would cause your baby to slide more on just the nipple vs. getting the entire thing into his mouth. However, most likely it is something going on inside the baby’s mouth. It could be that the baby has a tongue tie, or posterior tongue tie, or a high arched palate. This would make it difficult for the baby to extend his tongue beyond his lip because the ligaments inside the mouth are “Tethering” his tongue movements. If the palate is high and arched, then he would be drawing the nipple into the palate. If it is a Tongue tie, then a visit to a ENT is the best option as they can easily clip the membrane allowing the baby to extend his tongue. If it is due to a high palate, then simply leaning back will help. I do hope this helps you. Best of luck!.

  32. Cody S says:

    Has anyone had trouble with them losing suction? After about 2 days it seems like the shields are wearing down and not attaching to the breast right? Tried using hot water only to try and see if that works.

    • Admin says:

      You want to make sure you are putting the shield on dry, not wet. Also make sure you are inverting the shield slightly, push over the nipple, then stretch it on. Also size does matter. When you clean it do NOT boil the shield. Just use warm soapy water.

  33. Lindsay says:

    I am so glad I found this site and this post in particular. My son was born at 36 weeks and we had issues getting a good latch. The LC provided me with nipple shields and instructions to only use them for two weeks; however, she didn’t show me how to put it on. I’ve had so many frustrating feedings because the shield wouldn’t stay in place. I just followed your instructions and marveled at the difference. I’m also glad to hear as long as my supply isn’t suffering it’s okay to continue using it. Thank you very much for the help!

  34. Lily says:

    I have a preemie (currently 34 weeks gestational age), and tiny, flat nipples. I nursed my other full term babies just fine without a shield. My question is about your sizing rule. I needed the 21 mm flange inserts for my pump. Given that she is a preemie and I need smaller pump flanges, can I use the 20 mm shield? I can get it to pop on my nipple and draw up a few wrinkles of areola, but now your post has made me nervous about the size. Right now, the baby is just “playing” at nursing, and gets fed by tube. I did see some milk in the end of the shield from the few sucks she did do today.

  35. Jessica says:

    My lactation consultant recommended a nipple shield because my baby would not latch on without one. I was pumping and bottle feeding him the first few days. Now my baby will only eat with the nipple shield and I am experiencing some problems. At times he is sucking so hard that it is pulling my nipple through the holes on the shield, which is painful. He is also sucking in his bottom lip. My consultant instructed me to slide my finger over his chin and pull down the lip, but he will immediately pull the lip back in no matter how many times I try or how tightly I try to keep him in the correct position. I don’t want to give up but it’s becoming a struggle every feeding with these new habits he is developing. I feel like the problems would go away if he could just eat without the shield, but we have not been successful with that yet.

    • Admin says:

      First I would make sure you are using the correct size shield. Next I would find someone to look and see if it really is a latch issue or is there a anatomical issue causing him to suck poorly. He may need cranial sacral therapy or physical therapy to help him learn to suck better. Your lactation should have some recommendations in your area, if not it may be time for a second opinion! :)

  36. Nausheen says:

    I’ve read your post and feeling much satisfied that I’m not the only victim … and that im not doing a crime using a nipple shield. I’m using Medela 24mm shield. I had one flat nipple and the other was OK. My baby was latching but my one nippke she was using was cracked and sore and was bleeding ( I assume positioning problems in first few days). I started using nipp shield on my inverted nipple and the other sore nipple too since day 5. my lo is now 4 wk and refuse to take without nipp shields. I wasn’t aware of disadvantages and hadn’t researched before about it till week 2. since then I’m trying to wean her off shields. initially she will take a few sucks and the realise there’s no shield and refuses to take it back ( too much screaming). but now in week 4 she doesn’t even want to try latching without shield as if she has already made a choice not to ever try :(

    also she sleeps in 5-7 min after having few sucks on my breast and goes in deep sleep wouldn’t wake up. as soon as I put her down she’s awake and ask for feed. its too tiring as she takes 75 to 90 min each feed and never delatch herself. my milk supply isn’t bad as I pump and take 3 oz Max … but she’s too lazy to quicken up and sleeps…

    also she’s a very light sleeper… I’ve tried everything swaddling, dark room etc… but she never seem to be sleeping more than 40 min in day after struggling for 30-40 and sometimes an hour to push her to sleep. its so frustrating as I don’t get anytime for myslf. any advise

  37. Audrey O. says:

    I have a 2 1/2 month old and we have been using shield since the beginning. I have short, flat nipples and he couldn’t latch without the shield. I have tried several times to wean over the last month or so without success. He might latch briefly but then becomes frustrated and cries so I apply shield. I was given a 16mm shield. It fits over my nipple just fine, but should I be using a bigger one? My pediatrician is concerned about my milk supply because my baby is not gaining as quickly as she would like. I am taking fenugreek and eating lactogenic foods. Is there any benefit in getting a bigger shield or is it too late since my baby is used to this one. Any other tips for weaning? Thanks!

    • Admin says:

      I would recommend trying a larger shield. The 16mm, has been known to lower a milk supply. Ideally latching the baby without the shield would be best, but it would take some training. You could try to meet with a lactation consultant in your area who can help wean you from the shield. My advice would be to lean back as much as possible, ridge your breast like a “TACO” so that the baby has something to hold onto. Hold that “TACO” till you feel the baby suck on to it, and then you can let go. Most cases this will work, but you need to lean back, most important componant. As for increasing your milk, I would be adding some pumping into the mix, as that will help to increase your supply also. More demand equals more supply!! Fenugreek is okay…but I would maybe use More Milk Plus from motherlove or Traditional Medicines, Shatavari Cardamom tea. Best of luck to you.

  38. Kris says:

    When I pump I use a 30mm shield. Is there any way a 24mm nipple shield will work? I tried it yesterday and it just hurt terribly, but that may have been his latch. My LC was terrible, trying to get a different one. I am ok with pumping exclusively, but heard it is very hard. Id like to get him to nurse if I can.

    • Admin says:

      Yes you can use the 24mm nipple shield, but remember to invert slightly push over nipple and stretch on. Also make sure you are leaning back when you latch the baby, that you are not leaning into the baby. If the baby is on her back she will bite and gravity can’t help you. Make sure to use good pillow support as well. A baby should have the cheek flush to the breast, tummy to tummy. If you are in Orange County California I would be happy to help you. Hope you can find someone who can be of help to you. Hang in there!

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