Navigating the World of Nipple Shields: Making an Informed Choice
People have been using nipple shields for centuries. They are often introduced for latching issues or nipple pain/trauma and can often be the reason that breastfeeding remains possible. While they have their place, they can also be a right pain to wean from.
Let’s start at the beginning. A nipple shield is a thin silicone device that is placed over the nipple/areola area and used to help baby latch on. They come in different shapes and sizes and are introduced for a variety of reasons.
Nipple shields can:
-Offer oral stimulation when a baby can not latch or transfer milk
-Create a nipple shape in the baby’s mouth
-Compensate for a weak suck
-Be a stable nipple shape that remains in the baby’s mouth during pauses whilst suckling
-Keep the nipple in a protruding position
-Affect the rate the milk flows
Nipple shields can’t:
-Correct milk transfer problems or weight gain if your milk supply is low
-Fix damaged nipples if the cause of the damage is not found and corrected
-Replace skilled support
Just as people’s nipples can vary in size and length, so can nipple shields. They can range in size from 16mm to 28mm with the most common sizes being S/16mm, M/20mm, L/24mm. There are no agreed-upon guidelines for fitting nipple shields however. Some people size to baby’s mouth and others use nipple size. The height of the nipple portion of the shield should not be longer than the baby’s mouth otherwise the baby’s jaw closure and tongue compression will be over the protruding bit of the shield only and not over the breast/chest. If the nipple shield is too small, it can pinch the nipple, increase the vacuum in the teat, and contribute to persistent nipple pain if the nipple swells during suckling. If the nipple shield is too long, a baby with a small mouth can gag, whereas if the shield is too short, the baby might not have a deep enough latch and decrease the amount of milk they can transfer.
When you are using a shield, make sure that you are still getting a deep latch and that baby isn’t just sucking on the teat part. Look for the same signs as if the baby was latched directly on to the breast/chest (chin and cheeks touching, slightly looking up) and that the teat isn’t moving in and out of the mouth.
The shape of the shield can vary from perfectly straight teats to cherry-shaped and even bottle-like.
Different nipple shield shapes
Conical: The most common shape. Often used in hospitals. Slightly thicker at the base of the cone.
Cherry: Mimics the natural shape of a nipple, with a wider base and a more narrow tip. Appears to be particularly helpful for baby with sucking difficulties, tongue tie, etc. Rounded with indentations that can help baby “catch” onto nipple rather than sliding down shaft of smaller conical shield.
Bottle shaped: Useful for getting a baby with a bottle preference back to the breast but really not ideal as a long term solution as a baby does not latch on to them like a breast/chest meaning that supply will decrease.
They can also come with different cut outs around the edge such as a butterfly shape.
How to use them correctly
The typical application of a nipple shield is to turn it almost inside out, centre the teat over your nipple, then pull up the teat so that your nipple is drawn up through the teat. Some people find that a bit of milk or nipple balm on the base helps them to stick. The cut out bit goes where the baby’s nose will be if there is only one or if it is butterfly shaped, where the nose and chin will be. Some people also find that warming the shield will encourage your milk ejection reflex.
The shield should be washed with hot soapy water and rinsed well after each use.
Weaning from a shield
There is no set time to wean from a shield. Some people (like myself!) use a shield throughout their entire feeding journey. To be able to wean, the original reason for introducing the shield needs to have resolved if possible (i.e. prematurity). There are many ways to wean from the shield and not all will work for everyone. Remember that this is a two-way relationship and you both need to be ready.
Some people start the shield-weaning process by keeping it simple with skin-to-skin. Encouraging contact next to the nipple, making the bare breast/chest a relaxing place to be.
You could try starting the feed with the shield and then once let-down has occurred, quickly de-latching and whipping the shield away. Gradually trying feeding without the shield at all.
It is often more likely your baby will latch without the shield when they are sleepy or at night.
Don’t be discouraged. Keep feeding your baby a relaxed experience and try again in a couple of days. Keep persistent and don’t give up if you desperately want to feed without them but also know that it is possible to use them long term. Seek expert support from an IBCLC so that you are not alone.
It used to be common advice to chop off the tip of the shield, but this was for rubber shields and the rough, cut edge on a silicone shield can scrape baby’s mouth.
Remember that many people have found that a nipple shield saved their nursing journey and that like any other breastfeeding tool, they should be used cautiously, appropriately and with support so that your goals can be met.