A nipple shield is a soft protective cover that can be worn over the nipple and areola during breastfeeding. A nipple shield is shaped like a tiny Mexican hat with a high crown and a wide brim that fits against the breast. Made of thin and flexible silicone, nipple shields have a number of holes in the tip through which a baby can receive breast milk. Some breastfeeding helpers think nipple shields can be useful sometimes and others strongly disapprove of them. Are nipple shields OK to use or not?! This article looks at the situations where nipple shields may be suggested to help keep breastfeeding going, and discusses their pros and cons.
When might a nipple shield be used?
#1 Flat nipples, short nipples or inverted nipples
When a baby feels a firm nipple against the roof of his mouth it will usually trigger even a sleepy baby’s sucking reflex and help to focus a baby’s latch. It follows that if a mother has quite flat or inverted nipples, her baby may find it more difficult to latch on the breast properly if he does not feel this trigger. Locating a flatter nipple may be even more difficult for a baby who is very sleepy after a stressful or medicated birth. In this situation, a well fitted nipple shield can provide that firm touch or trigger to the baby’s palate to get breastfeeding going.
Seek specialist help
Given a little time, plenty of skin-to-skin, and some skilled help with latching and positioning, many babies can breastfeed with flat or even inverted nipples without a shield. Try contacting your IBCLC lactation consultant for help and support before reaching for nipple shields.
Avoid shields in the first few days
Jack Newman (Canadian paediatrician and breastfeeding specialist) is not a fan of nipple shields. In particular he cautions against the practice of using them for a baby who won’t latch in the first few days before a mother’s milk has come in:
A nipple shield started before the mother’s milk becomes abundant (day 4 to 5) is bad practice; in fact, I believe it should never be done. Starting a nipple shield before the mother’s milk “comes in” is not giving time a chance to work. Furthermore, used improperly (as we see it often being used), a nipple shield may result in severe depletion of the milk supply, and the baby refusing to ever latch on to the breast without it.
#2 Premature babies
Arriving in the world early can present feeding challenges for premature babies, some of whom may find it difficult to latch at first. Skin-to-skin or kangaroo care can be particularly helpful for these little babies to help stabilise their body systems and prime their instinctive feeding behaviour so they can concentrate on learning to suckle. A well fitted nipple shield is a possible tool to provide a firm sucking trigger to help a premie to maintain their latch and suck 1. But not all premature babies will need one, seeking good skilled help may be all that you need to get breastfeeding off to a good start.
#3 Sore nipples
If breastfeeding is very painful or a mother’s nipples are sore or cracked, a well fitted nipple shield can act like a glove protecting the nipples and allowing mum some pain relief until she can get some help with the latch or while her nipples heal. Used this way, shields can help to keep breastfeeding going for mother and baby. However it’s important to solve the cause of the original nipple damage and not just use the shield as a quick fix. See Why Does Breastfeeding Hurt? for ideas to solve painful feeding or find a good breastfeeding helper. If your baby continues to latch on the nipple (or tip of the shield) rather than the breast, your baby may not be able to get enough milk and breastfeeding will likely still be painful. With good positioning and a corrected deep latch, breastfeeding will be more comfortable, even with a sore or damaged nipple.
#4 Nipple confusion
If your baby has got used to bottle teats and become confused about latching to a breast, or is refusing to latch at all (sometimes called a nursing strike), a nipple shield can help to transition your baby back to the breast because the shield feels, smells and tastes more like a bottle teat. How to Get Baby Back to the Breast has more ideas to help you.
#5 As a tongue exercise
Sometimes a nipple shield can be useful as a type of training exercise for a baby who isn’t using his tongue properly—for example if your baby is retracting his tongue (holding it back instead of extending it to wrap around the breast). Contact your IBCLC lactation consultant to assess your baby first; babies with high palates or a tongue tie can have a sensitive gag reflex which may be stimulated by the shield and they may need different exercises or treatment 2.
Why do nipple shields get a bad press?
Nipple shields can reduce the milk available to your baby
Some nipple shields (especially the earlier thicker versions) can make it much harder for your baby to get enough milk and can reduce your milk supply. After all it is an extra layer or barrier between you and your baby. And the silicone shield is not as soft and flexible as skin—so it can be more difficult for your baby to reach all the milk with a nipple shield in place. To avoid this;
- Check that your baby is latching deeply on the shield with a wide open mouth and isn’t just on the tip of the shield
- Make sure the shield is big enough, if it is too small it can restrict the milk available to your baby
- Try breast compression during a feed to help your baby get more milk
- Keep a count of your baby’s dirty nappies and check their weight gain regularly to make sure he is getting enough milk
- If there is a problem, try hand expressing or pumping after a feed and topping your baby up with the expressed milk. This will protect your milk supply and help to keep your baby well fed. There are more ideas for making more milk in How to Make More Breast Milk.
A difficult habit to break
Once a baby has got used to using a shield it can sometimes be difficult to stop using them. To avoid the extra complications that nipple shields bring it’s worth trying to get problems sorted out early by getting expert help from an experienced IBCLC lactation consultant.
Where can I get nipple shields?
Most baby stores will sell nipple shields or you can also find them online (e.g. Amazon). Different brands have slightly different shapes and usually come in several sizes. For example:
- Mamivac sell conical shaped small (18mm), medium (20mm) and large (28mm) or cherry shaped small (18mm) or medium (22mm)
- Ardo’s Tulip shields are available as medium (20mm) and large (24mm)
- Medela sell shields that are small (16mm), medium (20mm) or large (24mm)
Check reviews on nipple shield brands carefully before buying and avoid any with consistently bad reviews, some nipple shields are poorly designed and can rub a mother’s nipple.
Which size or shape do I need?
It can be trial and error to find the right shape and size that works for you and your baby.
A nipple shield handout from Lactation Education Resources recommends using the small 16 mm size for premature or very small babies, a 20 mm shield for small term newborns and the 24 mm size for normal and large newborns, or older babies 3. Baby’s individual mouth size and mother’s nipple size will also need to be taken into account. To accommodate nipple variations, a mother may need different sizes for each breast.
- Choose the largest size that works well for you and your baby
- Avoid a shield that is too small which can rub your nipple and restrict milk flow, there needs to be enough room for your nipple to stretch during feeding.
Rounded nipple tip or dome shaped
Some nipple shields have more of a rounded nipple tip than popular brands Medela or Ardo, for example Baby Ono is more rounded. As above, choose a style that allows enough room for your nipple to stretch during the feed, otherwise it may be uncomfortable and slow milk flow.
The largest shield that I am aware of is the 28mm Mamivac shield, sold by Onceborn in Ireland.
Cut away shields?
Shields that are more of a half circle shape have a cut away area in the silicone so that your baby’s nose can be skin to skin and he can smell the breast—helping his feeding instincts. If this style keeps falling off however, try a different one.
Using a nipple shield
Applying a shield
Tips for using a nipple shield include:
- Warm the shield first in hot water to make it more flexible (optional)
- A little breast milk (or lanolin) under the flat part or brim of the shield can help the shield stay in place on the breast and prevent chaffing
- Expressing a little milk into the tip of the shield and initiating the let down before latching can encourage your baby with an instant reward of milk
- Turn the shield partly inside out before placing centrally over the nipple and then smooth down the edges so that the nipple is drawn into the shield
- The cut away part of the shield should line up with baby’s nose once they are latched
- Latch baby as normal ensuring they take the shield deeply into their mouth and are not just on the nipple.
- Your nipple should not be rubbed or feel sore during the feed and after feeding your nipple should not look flattened or distorted.
Step by step instructions for applying a shield can be found in Nipple Shields, by the Australian Breastfeeding Association, 2016 and there are photographs in Using a Nipple Shield, Lactation Education Resources (no date). A photograph of a good and a poor latch with a shield can be found in Nipple Shields by Barbara Wilson Clay.
Cleaning the nipple shield
Medela recommend shields be rinsed in cool water to remove breast milk, then washed in hot soapy water and rinsed well with clear water after each use. Shields can be sterilised once a day if required e.g. by boiling in water for ten minutes 4 or follow manufacturers’ individual recommendations.
Not all bad
In a Breastfeeding Today article Nancy Mohrbacher explains that modern shields are much thinner and less detrimental to breastfeeding than previous shields and when used correctly may preserve the breastfeeding relationship for short or even longer term use.
A mother can feel at ease about using the shield as long as it helps the baby breastfeed more effectively. In general, as the baby matures, his coordination increases, and as he develops more practice and positive associations at the breast, the easier it will be to wean him from the shield. A baby may need the shield for one feeding, a few feedings, a few days, a few weeks, or very rarely, a few months. If the baby is unable or unwilling to breastfeed without the shield, chances are the problem that caused the baby to need the nipple shield in the first place is not yet completely resolved. A mother who wants to wean from the shield should take her cues from her baby but keep trying to offer the breast without the shield every few days.
Weaning from a nipple shield
Some babies switch happily between breast and bottle and some will switch easily from a nipple shield back to a breast. However some babies develop a preference for the familiar feel of the nipple shield. If your baby refuses to latch without the nipple shield after a period of using one, see our article Weaning From A Nipple Shield.
Nipple shields can be helpful to keep breastfeeding going sometimes. It’s not the end of the world if you have to use one but it might be an early end to your milk supply if they are not used correctly. If you are wondering whether to use them, or whether your problems could be solved another way, seek out an experienced breastfeeding helper such as an IBCLC lactation consultant for help and support.