Chances are good that you’ve probably heard of nipple shields. But what are they? A nipple shield is a thin, silicone device that goes over the mother’s nipple to assist with breastfeeding. Chances are also good that if your baby isn’t feeding well in the hospital, the nipple shield is a trick your lactation consultant might try.

There are many reasons a nipple shield may be used:

  • Inverted nipples, flat, or inelastic nipples: gives the baby something to latch onto
  • Tongue-tie: helps baby maintain seal to the breast
  • Preterm baby: helps baby maintain seal to the breast due to low oral muscle tone and minimal fat pads in cheeks
  • To get baby back to the breast: if primarily bottle feeding, feels similar to bottle nipple
  • Extreme pain due to damaged nipples: provides a small buffer if breasts very sore (this is a last resort)

Nipple shields are generally not used to prevent sore nipples and can cause soreness and damage if not used correctly.

This is because the front roof of the baby’s mouth is bone: the hard palate. Further back is the soft palate. In order to breastfeed without pain, your nipple needs to stretch back to the soft palate. Some mother’s nipples are not elastic enough, or long enough, or are inverted, or are flat and are unable to do this. If the nipple shield fits the nipple snugly, the nipple should be drawn into it and towards the back of the baby’s mouth early in the feeding. If the shield is too big, the nipple may end up in the front of the mouth getting pinched between the tongue and the hard palate, while the nipple shield is way back at the soft palate. Ouch! If it’s too small, the nipple will be pinched which causes pain and closes off the milk pores so less milk comes out. Also ouch!

What you need to know:

  • Size matters: the size needs to fit your nipple and the baby’s mouth. The nipple shield needs to fit snugly to the mother’s nipple. (The size of the nipple shield will not match the size of the flange of the breast pump.)
  • Type matters: the ultra-thin silicone nipple shields are the only type that should be used. Some manufacturers make thicker silicone nipple shields, but these have the potential of interrupting the message to the brain and negatively affecting the milk supply. The nipple shield should also come in full contact with the nipple and areola.
  • Shape matters: most mothers and babies prefer the shape with the cut out for the nose to touch the breast. This mimics natural breastfeeding and helps transition to breastfeeding without the nipple shield easier.
  • Generally, nipple shields are for short-term use. Occasionally mothers use them the entire time they breastfeed, but this is not their intended use.
  • You can begin weaning off of the nipple shield once breastfeeding is going well. This works best once your milk is in.
  • You should always follow up with a lactation consultant if discharged from the hospital using a nipple shield to ensure adequate milk transfer. Read here to learn more about the Lactation Consultant.

Summary:

  • many reasons for use: flat, inverted, or inelastic nipples, tongue-tie, preterm, or damaged nipples
  • size matters: must fit mother’s nipple snuggly and baby’s mouth appropriately
  • type matters: only use ultra-thin silicone nipple shield that is in full contact with the nipple and areola
  • follow up is important: if using a nipple shield, follow up with a lactation consultant is important

I generally recommend the Medela Contact Nipple Shields. They are made of the ultra-thin silicone and fit well to the nipple and areola. 20mm is the “average” size. Most mothers I see use the 20mm, but to be sure, see a lactation consultant. Click below to check them out.

Nipple shields are basically a last resort for lactation consultants for a baby who is having trouble latching. They’re a great tool if it enables the baby to breastfeed and transfer milk. However, nearly every mother I’ve seen after discharge can’t wait to stop using it. They say it’s a hassle to have to find it when the baby is ready to eat. Sometimes it gets knocked off when trying to latch if the baby is frantic. In most cases, this is a temporary tool. Work with a lactation consultant after discharge to wean from the nipple shield.

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