nipple shields with breastfeeding

What No One Tells You About Nipple Shields for Breastfeeding

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NIPPLE SHIELDS FOR BREASTFEEDING

Nipple shields for breastfeeding are frequently recommended for various nursing problems.

I have seen this happen when a well meaning nurse gives a new mom a nipple shield when she is having difficulty latching. I have also seen them recommended in Facebook groups. They often how up on Pinterest “breastfeeding essentials” lists.

Pinterest is where so many new and expectant moms go to see what accessories they will need for breastfeeding. They want to be ready. I find it somewhat alarming that a nipple shield is considered an essential item.

Once upon a time if I recommended a nipple shield to a mom she would respond that she had heard they were bad to use.

That is clearly no longer the popular thought.

But not every mom needs a nipple shield for breastfeeding. The truth is that most moms won’t need one.

Continue reading to determine if a nipple shield can help you with breastfeeding and what safety precautions you need to take if you decide to use one.

WHAT IS A NIPPLE SHIELD?

A nipple shield is a covering that goes over a mother’s nipple while she is breastfeeding. Most are made of thin, flexible silicone and have holes at the end for the milk to come out.

They kind of look like a Mexican sombrero.


Many of them have a section that is cut away in one area to allow for skin to skin contact. This is called a contact nipple shield.

contact nipple shield

There are different situations where it can be helpful to use a nipple shield for breastfeeding.

They can also cause a variety of problems with breastfeeding.

IS IT GOOD OR BAD TO USE A NIPPLE SHIELD FOR BREASTFEEDING?

A nipple shield is merely a tool to use for certain problems with breastfeeding. If it is the right tool it can be helpful and result in a mom breastfeeding for a longer duration.

If it is the wrong tool it can be harmful to breastfeeding and cause a variety of problems.

Even if it is the right tool a shield needs to be used properly.

WHY DID SHIELDS HAVE A BAD RAP IN THE PAST?

Back in the day nipple shields were made of thick latex. Sometimes even a rubber bottle nipple was used as a nipple shield for breastfeeding. A shield like that usually caused a lot of problems with poor nipple sensation and a baby’s ability to get milk out.

The result was often a poor milk supply and a baby with insufficient weight gain.

Caucasian baby dressed in pink and red outfit on scale

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WHEN IS IT OK TO USE TO USE NIPPLE SHIELDS WHEN BREASTFEEDING?

There are several situations and conditions when a mom and baby can benefit from using a nipple shield for nursing.

  • Inverted nipples
  • A mom with flat nipples who can’t form a teat
  • Latch difficulty because a baby has a posterior suck. That means he doesn’t respond to the nipple until it is further back in his mouth.
  • Premature babies
  • Overabundant milk supply
  • A mother with a forceful let-down because a shield can slow down the flow of milk.
  • Nipple Pain – it is important to determine what is causing the nipple pain and work on correcting the problem.
  • Babies with a bottle preference who are exhibiting breast refusal.

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AVOID USING A NIPPLE SHIELD IN THESE SITUATIONS

A mom should avoid reaching for a nipple shield for breastfeeding in these cirumstances.

  • You are having difficulty latching and feel like everything else has been tried.
  • You heard that everyone should have one on hand.
  • You have sore nipples but the problem that is causing your pain has not been fixed.
  • A friend used one and said it helped her
    • It truly may have helped her. However, the reason your friend used a nipple shiled for nurtsing may be completely different than your problem.

In most of these situations it is best to just say no to using a nipple shield for breastfeeding.

nipples shield for breastfeeding

DISADVANTAGES OF USING A NIPPLE SHIELD

There can be significant disadvantages to using a nipple shield.

  • Your baby may not be able to suck strongly enough to pull enough milk through the shield (Source). This can result in inadequate weight gain.
  • There is the potential for a mom’s milk supply to decrease with nipple shield use. This can happen for two reasons. If a baby can’t pull out enough milk her body gets the message to not make as much milk as her baby needs. Her nipples may also not get enough stimulation.

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SHOULD I USE A NIPPLE SHIELD?

If you are struggling with breastfeeding the best thing to do is have a lactation consult. A lactation consultant can help you determine if a nipple shield would be helpful for your situation.

If you can’t see a lactation consultant in person, do a virtual lactation consult.

NIPPLE SHIELD SIZES

There are different sizes of nipple shields. These are the most common nipple shield sizes:

  • 16 mm
  • 20 mm
  • 24 mm
  • 28 mm

They may be labeled as extra small, small, medium, or large.

It is important to use the correct size.

WHAT SIZE NIPPLE SHIELD DO I NEED?

The right size is determined by both the baby’s mouth size and the size of the mother’s nipple.

A baby needs to be able to latch onto the shield so that he has the entire top part in his mouth. You should not be able to see the part that bends.

A mom’s nipple should fit comfortably in the shield.

The Medela Extra Small is used for babies with very small mouths, usually babies who were born prematurely. An extra small nipple shield might also be used for a mom with very small nipples.

I almost always use a nipple shield small size for the average size newborn. These are 20 mm.

An older baby or a mom with larger nipples may need a 24 mm nipple shield. This size may be called medium.

Mamivac makes a large size shield that is 28 mm.

It is important to use the right size nipple shield.

A nipple shield that is too tight on a mom’s nipple can cause nipple damage. A nipple shield that is too large for a baby to latch properly will result in the baby getting little or no milk.

You should avoid using a nipple shield that doesn’t have any size. Nipple shields are definitely not one size fits all.

WHAT IS THE DIFFERENCE BETWEEN A REGULAR SHIELD AND A CONTACT NIPPLE SHIELD?

A contact nipple shield has an area cut away so that the baby’s mouth can have direct contact with his mother’s breast.

A regular nipple shield is round all the way around.

HOW TO USE A NIPPLE SHIELD PROPERLY

Do these three important things every time you breastfeed using a nipple shield..

1. Learn how to put on a nipple shield correctly.

The nipple shield should be partially inverted and then rolled over the mom’s nipple. This creates a little bit of suction which helps the shield stay in place. It also helps draw the milk out.

It is easier but will not be nearly as helpful to just place the nipple shield over the nipple.

2. Make sure your baby is getting a good flow of milk.

  • You should hear swallowing every 1-2 sucks after your milk has let down.
  • If you start using a nipple shield before your milk has come in you won’t hear swallowing that frequently. It may be only every 5-6 sucks.
  • There should be milk or colostrum in the shield when the baby comes off your breast.
  • Before your milk comes in you should see colostrum in the end of the shield. If you just see bubbles that is probably saliva.
  • You want your baby to get a deep latch.
    • He needs to draw a lot of the areola into his mouth.
    • You shouldn’t be able to see the part of the shield that covers the nipple when he is sucking
    • He should not be bopping on and off the shield.

3. You should be using a breast pump after breastfeeding with a nipple shield.

The exception to this is if you are using a nipple shield for an oversupply of breast milk.

Too much milk can be overwhelming to some babies. They choke and sputter and sometimes won’t breastfeed.

If this is why you are using a nipple shield you do not want to pump after feedings. You wouldn’t want to do anything that is going to increase milk production.

If you use a nipple shield long-term chances are good that you won’t have to pump throughout your entire breastfeeding journey.

It’s best to be safe and pump after feedings when you first start using a shield. You should pump for ten to fifteen minutes. Pumping should start within twenty minutes of the end of the breastfeeding session.

You do not pump with the nipple shield in place. The nipple shield is only for breastfeeding.

There has been conflicting evidence about the effects of a nipple on milk supply and milk transfer (Source 1) (Source 2).

A mom is usually using a nipple shield for breastfeeding because there are problems. It seems wise to prevent the occurrence of a supply problem by pumping after feeding in the early weeks to ensure adequate emptying and stimulation.

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HOW TO AVOID NIPPLE SHIELD PROBLEMS

A visit with a lactation consultant is strongly encouraged.

  • She can ensure the latch is correct.
  • She can determine milk transfer by weighing your baby before and after breastfeeding with the nipple shield. This will let you know if your baby is able to get enough milk out with the nipple shield. If your baby can’t get enough milk with the shield then it will not be a good tool to use.
  • She can follow up and help you track your baby’s weight gain when you are using a nipple shield for breastfeeding. This is important.
  • Weekly weight checks are recommended. Normal growth lets you know that your baby is continuing to get enough of your milk with the nipple shield.

HOW TO WEAN OFF NIPPLE SHIELD

You only want to use a nipple shield for as long as it is needed.

In most cases, the shield will be a temporary solution.

However, some moms will use a shield the whole time they are breastfeeding.

To wean off the shield:

  • Every few feedings offer the breast with no shield.
  • If that doesn’t work offer the breast with no shield only every few days.
  • If your baby still won’t breastfeed without the shield then decrease your attempts to latch without it to every few weeks.
  • Still need it? Wait a month to try breastfeeding without it.

CAN I USE A NIPPLE SHIELD ALL THE TIME THAT I AM BREASTFEEDING?

This is a very common question. The answer is an unequivocal yes. If it is what you need to continue breastfeeding you absolutely can use a shield the whole time you are nursing.

I have talked to moms who felt constant pressure to stop using a nipple shield. Moms have told me that they felt like failures using it. Some even said they felt like they were cheating by using a nipple shield for breastfeeding.

Don’t ever feel bad for using a nipple shield if it is helping you have a good breastfeeding experience.

WHERE CAN I BUY A NIPPLE SHIELD?

A lactation consultant will have them. They also sell them at Target and Amazon.

Medela is the brand that I have used for 25 years. They are very thin. A nipple shield should look like a person’s nipple. It should never look like a bottle nipple.

Using a shield that is shaped like a bottle will result in almost no nipple stimulation and a mom could end up with a low milk supply or losing her milk altogether.

NIPPLE SHIELD TIPS

  • Get 2 or 3 shields. Nothing strikes fear in a woman’s heart like not being able to find her nipple shield when it is time to breastfeed.
    • Put them in the places where you will be breastfeeding. Put two! If one drops on the floor you want another to be ready to go.
  • Get a nipple shield case to help keep it clean.

HOW TO CLEAN A NIPPLE SHIELD

  • Your nipple shield needs to be washed after each use.
  • Wash it in soapy water.
  • Then rinse with warm water.
  • Allow to air dry.

LACTATION CONSULTANTS AND NIPPLE SHIELDS

It is best to work with a certified lactation consultant before you use a nipple shield for breastfeeding.

  • She can help you determine if it is the right tool for you.
  • She will show you how to properly apply it.
  • She can help you determine if your baby is getting enough to eat with a nipple shield.
  • She can show you how to tell if your baby is getting your milk out with a nipple shield.
  • She can help you monitor your baby’s weight.
  • She can help you figure out when you should try to wean off of it.
  • She can answer your questions about how breastfeeding is going.

FINAL THOUGHTS ON NIPPLE SHIELDS FOR BREASTFEEDING

Nipple shields are an awesome tool for moms who have certain breastfeeding problems. Just like any tool, they are only useful in the right situation.

In the wrong situation, they will create more problems. And who needs that?

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14 thoughts on “What No One Tells You About Nipple Shields for Breastfeeding”

  1. Kari Matadobra

    Hi. I have done some research and am seeing that baby’s saliva sends a message to the Mom’s body as to what composition of milk baby needs and what antibodies. Is it possible that a nipple shield could interfere with this, or does enough get through the hole?

  2. Saliva does get into the shield. So a nipple shield should not hinder that communication if a baby is latched well and sucking adequately.

  3. What does it mean when the nipple is getting sucked through the holes in the top of the shield?
    I was given a 20mm Medela at the hospital and the nipple damage was not going away and I was in a fair bit of pain. A lactation consultant has since said it may be too small, I am currently on a 22 Avent and noticed the nipple comes out the holes in the end.
    Does this mean they are too small or too big?
    Also if I invert the shield it sucks up a fair bit of areola which I think is wrong?
    How do I know whether the shield is the correct size for my nipple?
    Thanks

  4. Hi Kim! Sorry for the delay in replying, I was on vacation. If the nipple is coming through the shield then it is too small. The shield should be able to hold the nipple with a bit of the areola as well. If the nipple rubs against the shield it is too small. You really should have a lactation consult to determine what is the best size.

  5. Hi Andrea,

    My little one is tongue tied I’ve been using nipple shields the last 2 days, 1st day was great 2nd day & today my little one seems to be feeding on me for longer & much more frequently is this due to the shields? Not sure if it’s effecting my milk supply cos he’s Feeding so much more so don’t feel as full. X

  6. Andrea Tran RN, IBCLC

    It is possible that your baby is not getting enough from the nipple shield. Did you watch the video that shows how to put it on? I always recommend a mom pump when she initially starts using a nipple shield to protect her milk supply. I would recommend that you work one on one with a lactation consultant while you figure out if the nipple shield is the right tool for your situation. Contct me via email if you would like to book an online appointment with me.

  7. Hi Andrea,

    My 18 day old has been feeding using the nipple shield from the beginning. She’s been gaining weight really well but is gassy of late. Could the nipple shield be a reason. I have been trying to wean her off it but it’s so hard and we have such a good thing going with the shield. My breasts don’t seem to have a milk supply problem given her weight gain. She has a strong suck and is able to get the milk she needs. Is there a strong reason I should keep trying to push to wean her off?

    Thanks a lot!

  8. Andrea Tran RN, IBCLC

    If the nipple shield is helping you do not have to worry about weaning off of it. Some moms use it the whole time they breastfeed. If it is applied properly it shouldn’t cause gassiness. That may be caused by something else. Do you have her finish the first side before offering the other side?

  9. Thanks for providing such great insights! My baby is 3 weeks old, and I’ve been using the medala nipple shield provided by the lactation consultant from the hospital. The problem is that my baby doesn’t nurse for very long. She’ll nurse for 5 minutes (10 if we’re lucky). Could that be caused by the nipple shield? I have very fast down if that info helps.

  10. Andrea Tran RN, IBCLC

    A nipple shield will usually help with a fast let-down. Do you hear lots of swallowing when she is nursing for those five minutes? Is it five minutes a side or total?

  11. Hi,
    My baby is 22 days old and I have been using the nipple shields from day 5 because of sore and cracked nipples.my lo who usually feeds for 20min every 3 hours is not feeding every 2 hours for 10-15min and needs both sides.Does continuous usage of them cause a decrease in milk supply?

  12. Andrea Tran RN, IBCLC

    Hi, Your baby is probably going through the 3-week growth spurt and that’s the reason for the more frequent feeding. I do recommend a mom pump when she first starts using a nipple shield. If she has a good supply then I will have her wean off pumping.

  13. Hi! I have a 2 month old son and since being in the hospital, we have been using a 24mm nipple shield. It’s been going well, and while I want to wean him off of it, I don’t see it happening as he can’t seem to latch on to my nipples without it as they are slippery/somewhat flat or inverted. The problem I am seeing now is he will not take a bottle (or pacifier for that matter), though when I experimented with putting the nipple shield over the bottle nipple, he did take it. Is it possible he won’t take a bottle or pacifier because he is used to the much larger size of the shield? And if so, are there bottles out there I could buy that have a much larger nipple similar to my shield, or am I better off buying a 16 or 20 mm shield?

  14. Andrea Tran RN, IBCLC

    Nipple shield size needs to match baby’s mouth and your nipple. If you have smaller nipples that will comfortably fit in a 20 mm shield you could try that. Most bottle nipples and pacifiers will not be as large as a 24 mm shield.

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