Nipple shields

What is a nipple shield?

A nipple shield is a thin flexible silicone cover which a mother places over her nipple prior to breastfeeding. A nipple shield is like a hat with a brim and a crown. Some nipple shields have cut-out sections around the brim that allows the baby’s nose and chin to be in contact with the mother’s skin rather than the nipple shield. 

When is a nipple shield used?

A nipple shield may be suggested to a mother with certain types of breastfeeding problems and when other options have not worked to fix these. A nipple shield should not usually be used before a mother’s milk has ‘come in’ — typically around day 2–6 after the birth of her baby. Refer to our article on engorgement for more information.

In most cases, use of a nipple shield is temporary. Some mothers find they only need to use the nipple shield in the early days while their baby is learning to breastfeed. When using a nipple shield, it is important to seek follow-up from a breastfeeding counsellor or lactation consultant to assess how breastfeeding is going and when the time might be ‘right’ to cease using the nipple shield.

There are differing opinions even amongst experts when it comes to when/if nipple shields should be tried. Some of the reasons why nipple shields have been used by breastfeeding mothers include when:

  • a baby is having trouble attaching to his mother’s breasts (eg due to prematurity, a mother’s flat or inverted nipples or infant variations such as a high palate)
  • the mother has sore nipples
  • an infant who has been fed with a bottle is learning to feed at the breast.

Some mothers find that skin-to-skin contact and letting her baby find her breast using his instincts and other techniques to help improve positioning and attachment can help with the above.

Concerns with the use of a nipple shield

Some of these concerns come from the past because the older type of shields affected how well a baby could get the breastmilk from his mother’s breasts, thus reducing the milk supply. The newer thin silicone (as opposed to older hard plastic or latex rubber) nipple shields seem to be better in this regard. However, feeds may take a little longer than they would without it, as the nipple shield will still slow the flow to some extent. If the baby’s attachment is still poor, then milk intake may be reduced. The baby needs to be checked for all the usual signs of adequate intake. See our articles on baby weight gains and low supply for more information on this.

How to use a nipple shield

When using a nipple shield, it is important to learn how to use it properly. This usually involves a face-to-face consultation with a health professional such as a lactation consultant or breastfeeding counsellor. This will assist you in making sure that your baby is well attached with the nipple shield and give you information on how to tell that your baby is getting enough breastmilk through it. Nipple shields come in different shapes and sizes and so seeing someone face-to-face can help to ensure that a nipple shield is the right one for you and your baby.

Tips for using a nipple shield:

  • Express a few drops of your breastmilk onto the inside of the nipple shield. This will help prevent chafing and help to improve the seal that the nipple shield makes with your breast.
  • Express a few drops of your breastmilk into the tip of the nipple shield, where the holes are. This will help encourage your baby to attach.
  • Stretch the brim of the nipple shield somewhat outwards.
  • Keeping the brim stretched, place the nipple shield centrally over the nipple, onto the breast, to help draw some of the nipple and areola into the crown of the shield as you release the stretch. Position any ‘cut-outs’ where the baby’s chin and nose will touch the breast. Flatten the ‘brim’ of the shield over the breast. Hold the nipple shield in place with your fingers on the outside edges.
  • There should be a small space between the end of your nipple and the end of the crown of the nipple shield. If your nipple touches the end of the crown of the nipple shield, then the nipple shield is too small for you.
  • Point the crown of the nipple shield at your baby's nose and encourage your baby to open his mouth wide. As he attaches, the nipple shield can be directed towards the roof of your baby’s mouth.
  • A lactation consultant or breastfeeding counsellor can help you make sure that your baby is attached to your breast well and that he is getting your breastmilk through the nipple shield. The following points will help you to recognise if your baby is attached well:
    • His mouth is open wide.
    • His chin is in pressed into your breast.
    • He has a good mouthful of your breast, with his lips over the brim of the nipple shield, not just the crown portion.
    • His lips are flanged outwards.
    • His tongue is forward over his lower gum and cupping the nipple shield. (This may be difficult to see when he is attached well. Don’t worry about pulling his lip to check or he may come off!)
    • You may notice his whole jaw moving as he sucks. He should not be sucking in air or slipping off the nipple shield.
    • You can tell if he is swallowing milk when his lower jaw pauses slightly in mid-suck when his mouth is wide open. You may also be able to hear him swallow (soft ticking sound).
  • At the end of the breastfeed, your nipple should neither be rubbed nor sore. If it is, the nipple shield is the wrong size or shape.
  • The crown of the nipple shield usually has milk in it at the end of the breastfeed if your baby was getting your breastmilk through the nipple shield.

Let-down reflex

Making sure your let-down reflex happens will help ensure that your baby is getting your milk through the nipple shield.

Signs of baby getting enough breastmilk

It is important that you know the signs of your baby getting enough breastmilk through the nipple shield. See our articles on baby weight gains and low supply for more information on this.

How to clean a nipple shield

A nipple shield can be cleaned in the same way as you would clean any equipment involved with expressing your breastmilk. See our article on electric breast pumps for more information. You don’t need to sterilise the nipple shield. With clean hands, you can just rinse it in cold water after use, then wash it in hot soapy water and rinse under hot running water. Drain, dry (eg with paper towel) and store in a clean covered container that has been cleaned in the same way.

Weaning off a nipple shield

When it comes to weaning off a nipple shield, many mothers find it helpful to seek the support of a breastfeeding counsellor or lactation consultant. Some mothers find that weaning off a nipple shield can be a bit tricky. Some tips that can help when it comes to weaning off a nipple shield include:

  • Remove the nipple shield part way through the breastfeed.
  • Have as much skin-to-skin contact between you and your baby as possible when breastfeeding.
  • Allow your baby to use his instincts to find your breasts.
  • Offer your baby a breastfeed as soon as he wakes from a sleep.
  • Offer a breastfeed while walking around.
  • Express a few drops of your breastmilk onto your nipple just before a breastfeed.
  • Try to feed your baby when he makes feeding cues such as turning his head from side to side, sticking his tongue out, wriggling, bringing his hands to his mouth.
  • Have patience. Make an attempt to attach your baby without the shield at as many feeds as possible. If it doesn’t work, don’t persist until your baby is upset. Simply use the nipple shield again and try again later.

References

English A, Ziemer AL, Chevalier A, 2010, Health professionals' attitudes and use of nipple shields for breastfeeding women, Breastfeeding Med, 5(4):147–151.

Chevalier-McKechnie A, English A, 2010, Nipple Shields: A review of the literature, Breastfeeding Med, 5(6):309–314.

 

© Australian Breastfeeding Association March 2012

The information on this website does not replace advice from your health care providers.