A nipple shield can be a wonderful tool to help an infant latch when they are struggling or may not be able to. Ideally, no nipple shields would be necessary, but we understand what a valuable tool they can be when required. It is important to work with a lactation professional to be sure you are using the correct size, which protects your supply and ensures adequate transfer of milk for baby.
What is a nipple shield?
A nipple shield is a thin cap or dome, usually made of thin silicone that is to be placed over the nipple during breastfeeding to aid in the flow of milk. The shield provides a larger surface for the baby to latch onto when they are struggling and may also be used for protection when the skin on the breast is tender or sore. Use of a nipple shield should always be closely monitored by an IBCLC (Internationally Board Certified Lactation professional).
Reasons a nipple shield may be needed:
If the the nursing parent has flat or inverted nipples. A nipple shield may offer more surface area when an infant is struggling to keep the nipple pulled out during a feed. In a “normal” breastfeeding scenario we would expect a baby with a deep latch and effective suck to maintain the shape of the nipple throughout the feed. A nipple shield can be of great assistance for infants who are struggling with that.
If the mother and/or infant have experienced birth trauma making it difficult to attach to the breast. This may be a situation where baby was separated from mother after birth, a vacuum or other type of assistance is required or if there was injury during the birth process. In these situations a nipple shield may be necessary to help keep baby feeding at the breast.
Premature or Late Pre-Term birth. When a baby is born pre-term, sometimes breastfeeding can be hard for them. They may be seperated from their parents early on and miss the opportunity to learn to latch right away. They don’t always have a lot of energy to expend, like a full term infant and feeding can be tiring. These infants do get better as they grow and their due date approaches, but inadequate transfer, sleepy feedings and troubles staying latched are not uncommon challenges. A nipple shield may be beneficial, help do some of the work for them, as they learn and grow.
Infant has an oral aversion. An oral aversion is “ Reluctance or refusal of a child to be breastfed…manifested as gagging, vomiting, turning head away from food, or avoidance of sensation in or around the mouth” (source: NCBI) Oral aversions can be present for various reasons, such as premature birth, birth trauma, birth defects or delays. A shield may be used to assist with latching and/or feeding in these circumstances.
Infant has a preference to artificial nipples. Bottles and pacifiers are introduced to infants for various reasons and most of the time do not interfere with breastfeeding. Occasionally a baby may develop a preference for the feel of these nipples. They can be longer and more firm than the breast. In these cases, short term use of a nipple shield can help baby learn to latch again.
Infant is born with oral structural problems. Tongue and lip tie, as well as other oral restrictions, can often benefit from the use of a nipple shield. They are not a solution to the restriction, rather a tool to keep the baby at the breast while they are waiting for revision of the restriction. A shield may also be suggested after a revision, while baby learns to use their new muscle movement.
The breastfeeding parent is experiencing extreme pain, discomfort or tissue damage. There are times when breast tissue may be damaged by an incorrect latch, poor flange fit, or other reason. A nipple shield creates a thin barrier between the nipple and infants mouth, which may aid in healing and give the breastfeeding parent relief so that they are able to continue offering the breast.
What are the disadvantages of a nipple shield for nursing?
It will not fix damaged nipples. While the nipple shield can aid in healing, it does not fix the root cause of the damage. It is important to determine what that is, and make an overall plan to heal.
It may pinch the nipple and areola causing nipple pain and damage. It is important to have the nipple shield fitted properly by a lactation professional.
Your baby may reject the breast without it. There can be a fine line to walk when using this tool. Proper support and supervision from an experienced lactation professional can help prevent this.
Weaning from the nipple shield can take time. You may have to spend a good amount of time practicing with the nipple shield, before your baby is ready to feed without. For some, this can be frustrating and be a downfall of breastfeeding. Going into the use of a nipple shield with proper expectations and understanding that you will need to take it one feed at a time, can be extremely helpful.
Does a nipple shield cause low milk supply?
Most recent studies have shown that use of a nipple shield for nursing, does not effect breastmilk supply, when responsive feeding is practiced and baby is given adequate time to remove milk. Some infants may need more time than others, it is important to watch your baby and work with your IBCLC to determine the best way to protect your supply, should you need to use a nipple shield.
These are just a few examples, and a nipple shield is just one part of the puzzle your lactation professional will help you put together. If it turns out you have to use a nipple shield for nursing, please do not feel defeated. Once breastfeeding is established, you can try weaning from the nipple shield. If you have more questions about using a nipple shield or other breastfeeding concerns, you can always reach an IBCLC and lactation Specialist.