The Nipple Shield Question
When and how to use a nipple shield can be a confusing topic for healthcare providers and for parents. For any who may not know, a nipple shield is a thin, usually silicone cover that goes over the mother’s nipple and breast when she is breastfeeding. It is shaped like a nipple with a tip that has several holes in it over the nipple to allow milk to flow through.
Some reasons you might use a nipple shield include: flat nipples, failure of baby to latch to breast, sore/damaged nipples, engorgement, disorganized infant suck and transition from bottle to breast. There are cases where a nipple shield can be helpful for breastfeeding but there is a right time and reason to use one. It’s also important to be aware of the potential complications to breastfeeding when you introduce a nipple shield. So how do you know when it’s the right time to shield?
Before using a nipple shield these conditions should be met:
- Mom’s milk is “coming in”. This means that there has been a significant increase in milk production and milk flow. This won’t be until at least day 3 or 4 after birth or later.
- Attempts to latch and feed at the breast should be made once milk is in BEFORE the shield is used.
- The potential problems with breastfeeding when using a nipple shield have been explained to the parents.
- There is a support system (i.e. lactation consultant, public health, nurses, doctors) in place and a plan for transitioning baby off the shield and back to breast.
Why all the fuss? Here’s a bit more detail.
- There should be good milk production and flow before introducing a nipple shield.
It is more work for a baby to breastfeed and get milk through a nipple shield. Until a mother’s milk “comes in” they will not be able to get any significant amount of colostrum (the early breast milk) through a shield. Therefore, there is no point in them latching to a shield at the breast. They should be given this time to attempt to latch and get used to a mother’s breast, even if she has flat nipples or inverted nipples.
2. Attempts to latch and breastfeed should be made once milk is in and flowing BEFORE the shield is used.
There is always a chance that a baby who has not yet latched to a breast will do so once there is good milk flow. They should be given the experience and chance to try latching and breastfeeding from a breast with milk flowing before a shield is used. Unless the shield is being used for damaged nipples that are healing a baby should usually be offered the breast without the shield at some point during a feed to see if they will latch and suck without it.
3. The potential problems for breastfeeding when using a nipple shield have been explained to, and understood by, the parents.
This is important so that the parents understand how using a nipple shield could potentially impact breastfeeding. Nipple shields can be used in the proper way to help breastfeeding along in certain situations.
The risks associated with using a nipple shield can be explained this way:
When a baby latches to a nipple shield it is usually a shallow latch which is not as effective for breastfeeding. It is more work for a baby to remove milk when using a shield and the breast does not get the full stimulation and emptying that it needs to support and build a full milk supply. Over time this may impact milk supply and the baby’s growth. Therefore it is important to make sure that the breasts are being fully emptied at feeds and that the nipple shield is only temporary until breastfeeding without a shield can be established. Mothers using nipple shields may need to do some extra milk expression (i.e. pumping) while using nipple shields depending on their individual situations.
If a nipple shield is being used to protect sore and damaged nipples the baby was likely not latching on well in the first place as this is usually what causes nipple damage. Therefore it’s important to be very careful when using a nipple shield as this can further change the baby’s latch. If you have sore or damaged nipples a shield may help temporarily but it’s also important to get help and figure out how to better latch your baby to avoid further damage and pain to your nipples!
4. There is a support system and a plan in place for transitioning baby off the shield and back to breast as soon as possible.
As explained above, there can be longer term problems with milk supply and baby’s growth when nipple shields are used. If you need a nipple shield, that usually means there are breastfeeding concerns that need to be addressed. You should have a plan and supports in place to help with breastfeeding and removing the nipple shield when it makes sense to do so. This will look different for each individual situation and there are lots of different ways to work at removing a nipple shield, so help from someone who is experienced in breastfeeding management is key.
Hopefully this answers the shield or not to shield question a little bit better. If you’re still not sure what to do, then ask! Make sure to get all the information so that you can make the best decisions that will work for you and your family.