While a lot of moms look forward to a positive breastfeeding experience, not everyone goes through it smoothly. Breastfeeding moms are often faced with a wide range of challenges, and at some point, they will need a technological intervention to make sure they can still provide for their babies’ nutritional needs. This is when some breastfeeding tools, like nipple shields, come into the picture. I did my own research about nipple shields and it turns out, there is a lot more to learn about this seemingly simple nursing aid.
What do experts say about breastfeeding with nipple shields? The La Leche League and the Australian Breastfeeding Association recognizes the temporary use of nipple shields to help establish breastfeeding or address certain breastfeeding concerns when no other options are available. Further recommendations coming from The HSE National Infant Feeding Policy for Maternity and Neonatal Services states that nipple shields should not be advised unless there is a clinical reason for its use and this reason must be discussed to the mother and properly documented. Mothers considering the use of nipple shields should be educated with the potential risks and she must use it under the care of a skilled practitioner who will also help her to discontinue its use as soon as possible.
So if you’re a mother considering a nipple shield to help with your breastfeeding journey, it’s important to be aware of its proper usage and other important considerations in relation to its use.
What are Nipple Shields?
A nipple shield is a thin, flexible silicone teat that can be placed over the mom’s nipple and areola while breastfeeding. Nipple shields appear like a wider bottle nipple or a hat with a brim. The brim or the flat part can be attached to the mom’s areola and the tip usually has many holes where breast milk can pass through. Some varieties have “cut-outs” over the brim to facilitate more skin to skin contact while nursing. Basically, its primary purpose is to help address certain breastfeeding concerns either to assist in initiating or continuing breastfeeding.
When do you need a Nipple Shield?
Experts suggest that nipple shields can only be advised for certain clinical reasons and if other measures have become unsuccessful. If ever indicated, it is more likely to be a temporary relief while the underlying condition is being treated or managed.
So for what reason will you need a nipple shield?. Nipple shields can help mothers attach baby to the breast. Nipple shields can be indicated for the following conditions or concerns:
Breastfeeding premature babies
Breast milk is particularly beneficial for premature babies especially in the first few weeks of life. Using a nipple shield can facilitate breastfeeding for premature babies who have difficulties latching and withdrawing breast milk from their mothers. The mechanism is not that clear but it is thought that the firmer texture of the shield which extends deeper into the baby’s mouth may trigger more active sucking. This results to the preemie staying awake longer during a feed and getting more breast milk.
Flat or inverted nipples
If a mother has flat or inverted nipples and having difficulty with breastfeeding, using a nipple shield is one method to help your baby draw milk from the breast. When feeding, your baby needs a firm nipple to work as a trigger against the roof of his mouth to initiate his sucking reflex. The loss of a firm trigger is particularly the problem among mothers who have flat or inverted nipples. In this case, a nipple shield will help initiate sucking and get a better latch, so that breastfeeding can be facilitated more easily.
Infants with special needs
Infants who have anatomical variations, such as a high palate, or have high and low muscle tone can have troubles in getting a good latch and a nipple shield can be recommended to facilitate breastfeeding with these babies.
Flattened nipples due to breast engorgement
When the breasts get engorged with milk, the swelling could harden and flatten the mom’s nipples. In this case, a nipple shield can be used temporarily while other measures are being done to relieve breast engorgement.
Transition from bottle feeding to breastfeeding
When your baby gets used to the bottle teat and refuses the breast, a nipple shield can be helpful in the transition. It can help get baby onto the breast as the shield has a more similar texture to a bottle nipple. Then, it can be gradually removed as the baby get used to breastfeeding.
Sore nipples are pretty common among breastfeeding moms and some find comfort into using a nipple shield to temporarily protect their sore or cracked nipple while the healing process is taking place.
Disadvantages of using Nipple Shields
Using nipple shields are not without their risks. The mother who will be advised or who are planning to use them should be aware of these concerns.
Impact on milk supply
This is the primary concern why mothers should consult a health professional prior to using a nipple shield. Experts suggest that nipple shields may potentially put a mom’s milk supply at risk due to:
Ineffective emptying of the breast
Some nipple shields, especially the older and thicker versions, can act as an extra barrier between you and your baby. This makes it harder for him to get enough milk from the breast.
Even the newer silicone varieties can’t match the flexibility of bare skin so it can become more difficult for your baby to suckle all the milk from your breast.
Slower milk flow
Another issue to consider is that with a nipple shield over your nipple, the process of getting the milk is obviously slower when compared to directly placing your baby at the breast.
Misuse of the shield
Using a nipple shield before the milk comes in, usually between 3 to 5 days after giving birth, may deprive the mom and her baby a chance to establish breastfeeding. It can also interfere with the proper stimulation of the nipples to encourage milk production and let- down. Same thing happens if the nipple shield is improperly fitted or sized.
Risk for plugged ducts and mastitis
As discussed, nipple shields may sometimes cause reduced milk transfer and incomplete emptying of the breast, which may lead to milk stasis in the long run. The milk that remains within the milk ducts can cause a blockage and become infected. This has the potential to lead to mastitis which, if infected needs urgent medical treatment.
Impact on baby’s nutrition
Using the nipple shield incorrectly may result to your baby getting less milk than what he supposed to need. If your baby’s attachment is still poor, less milk will be consumed. This is why your baby’s weight gain as well as the urine and stool output should be carefully monitored while using the shield.
A difficult habit to break
It may be difficult to wean from a nipple shield if your baby get used to nursing with this thing on. Mothers need to be properly guided on how to wean their baby off the nipple shield.
Nipple Shield Sizing
Nipple shields come in a variety of shapes and sizes. Getting the right fit is essential to make breastfeeding successful with the shield. Several factors that should be taken into account with regards to nipple shield sizing include:
- Baby’s mouth size
- Mother’s nipple size
- Nipple variation from each breast (sometimes, one nipple is larger than the other)
In most cases, it is advised to seek help from hospital staff or your lactation consultant with regards to getting nipple shield sizing. Getting the right fit might be tricky, and some moms may need to test out a few first before they finally discover the size which will work best for them. Nevertheless, here are some important considerations when selecting your nipple shield size:
Go for the largest, most comfortable size
The sizes of nipple shields often reflect the diameter of their base and they vary from one manufacturer to another. For example, Medela has small (16mm), medium (20mm) or large (24mm), while Mamivac has small (18mm), medium (20mm) and large (28mm). Most experts recommend the you go for the largest size which perfectly fits your nipple and works well for you and your baby.
Avoid nipple shields that are too small
Nipple shields that are too small can be painful and restrictive on your milk flow. When choosing a nipple shield, make sure its tip has enough room where your nipple can stretch while breastfeeding.
Individual sizing for each nipple.
Nipple shield sizing isn’t a one size fits all. In some cases, you need a different size to each of your nipples to make sure you are comfortable breastfeeding on both sides.
Take shape into account
As with sizes, nipple shields vary in shape. For instance, Mamivac offers both the conical shape and the cherry-shaped nipple shields. Other varieties like those of Baby Ono have a more rounded or dome-shaped tip which can give a little more room for your nipples to stretch.
Cut-outs vs. full shields
Some moms prefer nipple shields with cut-outs which enables more skin to skin exposure helping their baby feel and smell the scent of the breast to trigger feeding instincts more easily. However if this variety tends to slip off your nipple during a feed, it’s better to use a full shield.
How to use a Nipple Shield
Apart from the appropriate sizing, the key to using a nipple shield effectively lies in its proper placement over the nipple. This is another good reason why it is very helpful to have a face-to-face consultation with a breastfeeding counselor. Here are some experts’ tips with regards to the application and use of nipple shields:
Run some hot water over the nipple shield prior to use
An optional tip to warm the shield and make it extra flexible.
Express and add a few drops of breast milk on the inside part of the nipple shield
This will improve its seal unto your breast and helps prevent chafing. Some also make use of lanolin over the brim or flat part of the shield to help with the seal.
Express a few drops of breast milk over the tip of the nipple shield.
This will help encourage your baby to latch.
Stretch the brim partly outwards, place it centrally over the nipple and smooth down the edges.
To create a suction and draw nipple and part of the areola into the shield.
The “cut-out” parts should be placed where your baby’s nose and chin would usually touch the breast.
To promote skin-to-skin contact while breastfeeding.
Check if there is a small space between your nipple and the tip of the shield
This indicates that you’ve got the right nipple shield size. If your nipple touches the tip, the shield will be too small for you and you’ll need to try a larger size.
With the nipple shield on, point the tip towards your baby’s nose
To encourage your baby to open his mouth wide and get a good latch.
Once attached, the tip of the shield can be guided towards the roof of your baby’s mouth. Make sure he latches the breast and not just the nipple
This stimulates the sucking reflex and helps your baby to get breast milk more effectively.
Cleaning your Nipple Shield
Keeping your nipple shield clean is as simple as to how you clean any of your pumping equipment. Here’s how to do it:
- Wash your hands.
- Rinse your nipple shield with cold water to remove any breast milk debris.
- Wash the shield using hot soapy water.
- Rinse it using hot water.
- Allow to air dry and store in a clean and covered container.
When to Replace your Nipple Shield
There is no current recommendation about the time of nipple shield replacement but according to reviews, most shields are sturdy enough to last the whole time they needed to use them. Of course, just like any other child-feeding materials, you’ll need to replace the nipple shield if its surfaces have any breaks, cracks or abrasions that may put your baby at risk. Nevertheless, nipple shields are only meant for temporary usage, so it is more likely that you’ll use the same set until such time that you’ll wean your baby off the nipple shield.
Special Considerations when Breastfeeding with Nipple Shields
When using a nipple shield, there are a couple of things to carefully look at to avoid any future problems.
Use after your milk comes in
Unless specifically indicated for your condition, using a nipple shield is often advised to be used after your milk comes in at around Day 3 to 5 after giving birth. This will give the mother and her baby a chance to work things out during their first few days and to minimize the risk for further complications.
Check for signs of a good latch.
Your lactation consultant or breastfeeding counselor can help you determine if your baby is getting breast milk effectively while you are using the shield. You may also check some signs indicating a good latch for example if his jaw is moving as he sucks. He will also pause mid-suck and open his mouth to swallow or you can hear him swallowing.
Check for the effectiveness of breastfeeding with a nipple shield.
- Your nipples are not flattened or distorted after a feed.
- Your nipples are not rubbed or sore.
- The tip of the nipple shield has traces of milk.
- Your breasts are well-softened after the feeding.
Assess for your baby’s adequate intake.
A reliable indicator of your baby’s intake is his urine and stool output. As a reference, here is the data from the Australian Breastfeeding Association, in accordance with WHO’s guidelines.
For baby’s urine output:
- If baby is more than 5 days old, he must have at least 5 heavily soaked disposable diapers, or 6 to 8 cloth nappies over a 24-hour period.
- Your baby’s urine is pale yellow. (dark and smelly urine indicates poor breast milk intake)
For baby’s stool output:
- If your baby is less than 6 to 8 weeks old, he should have 2 or more runny stools, about the size of your baby’s palm.
- For older babies, it is normal to pass out stools even once every 7 to 10 days, as long as the stools are soft and of a larger amount.
With the help of your health care provider, you can also monitor these indicators of good breast milk intake:
- Weight gain (every 2 weeks or can be as frequent as every 3 days for premature babies)
- Good skin color and muscle tone
- Reaching developmental milestones
Try breast compression
Breast compression is a technique used to maximize your baby’s breast milk intake whilst using the nipple shield. To do this, La Leche League suggests you’ll need to do the following:
- Support your breast using your thumb and fingers on one hand.
- When your baby starts to nurse actively and stops swallowing, gently but firmly squeeze your breast. Hold it while your baby is nursing actively and then release once he stops.
- Rotate compression on several areas of your breast.
Do you have to pump when using nipple shields?
If your breasts are not fully emptied during a feed or if your baby isn’t effectively nursing with a shield, you’ll need to pump your breast milk so that you can maintain your milk supply and also have extra breast milk to feed your baby.
Does baby get more milk without the nipple shield?
Your baby may get less milk if the shield is used improperly. This is the reason why prior to deciding to use one, you and your baby need to be properly assessed by a health care provider so they can decide if you need to use a nipple shield. Remember, nipple shields are only considered as a last resort and it is considered as a temporary measure. Once the underlying problem is addressed, your baby is more likely to get more milk without them.
How do you wean off a Nipple Shield?
Some mothers find it a bit challenging to wean their baby off a nipple shield, especially when they have been using it for several months. This is why it’s important when it comes to weaning, seeking support from a breastfeeding counselor or a lactation consultant can help. Experts shared these tips to wean your baby off a shield:
Your baby will most likely resist a sudden change in his routine, so doing weaning little by little can ease out the transition.
- Use the nipple shield at the beginning, then remove it part way through the feed.
- In some of the feeds, try latching without the shield.
- Simply put back the shield if your baby starts to get cranky.
- Be patient to try all over again.
Maximize skin-to-skin contact
Remove your upper clothing and undress your baby to his diaper. Try a laid-back breastfeeding position and place baby on your chest. Allow ample time for your baby to locate your breast using his instincts and breastfeed without the shield.
Try several breastfeeding techniques.
Nurse while in motion (rocking, walking around or swaying).
Try several breastfeeding positions.
Breastfeed as soon as he wakes up from sleep.
Nurse as soon as he shows hunger cues (sucking his fist, sticking his tongue out or rooting) and before your baby cries.
Try to nurse when your baby is not yet fully awake.
Add a few drops of milk on your nipple before nursing.
Pump before your breastfeed.
You may pump until you feel your milk let down before you try to latch your baby on your bare nipple. This way your baby won’t struggle much to draw out breast milk. This will also help elongate your nipple so that your baby might be more willing to accept it without the nipple shield.
Overall, breastfeeding with nipple shields isn’t for every mom, but it can be helpful for many who have a particular breastfeeding concern that needs to be addressed. If ever you feel the need to use a nipple shield, Don’t hesitate to seek advice from your nearest health care provider so that appropriate assessment and proper guidance can be given.