Sample FAQ: Nipple shields

 

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What is a nipple shield?

A nipple shield is a silicone device that covers the mother’s nipple and part or all of the areola. It has a cone that holds the nipple and goes into the baby’s mouth, and a rim that lies on the areola. The cone has holes at the front to let the milk out. Nipple shields are used mostly to help babies latch, suck, and get milk from the breast. They are especially useful for premature babies. Some mothers use nipple shields to reduce nipple pain. Mothers who are using a nipple shield need to make sure their baby gets enough milk. They should see a health-care provider when they start using one and again in a few days and within two weeks to make sure the baby is not underfed. Not all babies have the ability to use a nipple shield.

A) Describing nipple shields

A baby breastfeeding with a reguar-style 24-millimeter nipple shield.

Nipple shields were first described in the 16th century. They were made in various shapes from materials such as wood, lead, wax, pewter, animal hide, and rubber (Chow 2015).

A modern nipple shield is a silicone device that covers the mother’s nipple and part or all of the areola. It is clear and has two parts: the cone that holds the nipple and goes into the baby’s mouth, and the rim that lies on the areola. The cone has several holes at the front that allow the milk to enter the baby’s mouth.

Cone size varies, the cone shape can vary slightly, and rims come in different styles. The cone size can change the effectiveness of the shield. The rim style is more a matter of personal preference. We encourage mothers who are using a nipple shield to have more than one as they are clear in colour and easy to misplace.

Nipple shields are relatively cheap, easy to use and clean, and can prevent early weaning (Chertok 2009). They are used until they are no longer helpful.

Nipple shields are not the same as breast shields, which are used when pumping. They are also different from breast shells, which can be used to treat nipple damage.

B) Purpose of a nipple shield

While it is easy to understand how nipple shields decrease nipple pain and decrease the rate of milk flow, the exact mechanism of how nipple shields help babies latch is unclear. 

Nipple shields are used for numerous reasons:

1) To allow a baby with latching problems to breastfeed

Nipple shields are mostly used to help babies latch when they cannot latch or stay latched onto the breast without one. Premature babies in particular tend to have difficulties latching and nipple shields can be very helpful. 

Babies are more likely to learn to breastfeed if they have been using a nipple shield than if they have been bottle-fed. 

2)To help a premature baby get more milk

Premature babies can have difficulty taking in milk when breastfeeding. Nipple shields can not only help them latch, but also increase the amount of milk they take in when breastfeeding.  

3) To control nipple pain

Some mothers use nipple shields to decrease nipple pain, but our clinic has found they are not always effective for this. It is very important to treat the cause of the nipple pain instead of just masking it with a nipple shield. Furthermore, our patients have frequently reported that they have just as much pain when using the nipple shield as when not using it. Using a nipple shield for pain can also result in the baby becoming used to it and not being able to breastfeed without it. 

4) To slow the milk flow when a mother has a very large milk supply

On rare occasions, babies really struggle to feed when their mothers have a very large milk supply. Using a nipple shield can reduce the amount of milk that they need to swallow.

5) To create a barrier when mothers feel emotionally uncomfortable with the closeness of breastfeeding

Some mothers may not be comfortable sharing their body with a baby. A nipple shield can provide enough separation to make breastfeeding acceptable.

C) Precautions

When using a nipple shield, it is important to ensure that it is effective:

  • The nipple shield is an appropriate size.
  • The baby can latch and suck on one.
  • The baby is taking in enough milk and is closely monitored for good growth.
  • It does not cause moderate or severe nipple pain.
  • The baby does not clamp on the tip.
  • The baby is premature and the nipple shield is helping the baby get more milk from the breast.

If the nipple shield cannot meet these criteria, it should not be used.

Every mother and baby should be seen by their health-care providers when starting to use a nipple shield and again within a few days to ensure the baby is getting enough milk and not showing signs of being underfedA further visit should take place within two weeks.

Newborn babies who use a nipple shield should be especially closely monitored and their mothers should express after all feeds until the milk comes in so they can establish a good milk supply. Premature babies also need close monitoring as they grow and develop their breastfeeding skills.

Nipple shields can flip against the baby’s face and mothers may notice milk leaking from under the nipple shield. These are not signs of a problem.

D) Likelihood of a nipple shield working

There are a range of opinions on when and how to use nipple shields, which can make their use frustrating.

Our clinic estimates that about 60% to 70% of babies can breastfeed using a nipple shield. Their ability becomes evident the first few times it is tried. The problems of a baby who cannot latch onto the nipple shield in the first few days of trying or is always hungry after using a nipple shield are unlikely to go away unless the baby is premature.

If a baby is not offered the nipple shield as a newborn, it is less likely the baby will be able to use it. This makes using a nipple shield less helpful for breastfeeding strikes and breast reluctance, as these typically happen in older babies. Mothers of these babies can offer the nipple shield once or twice each day and see if the baby has learned to use it. Offering it more often can waste a mother's valuable time.  

References

Chertok IR. Reexamination of ultra-thin nipple shield use, infant growth and maternal satisfaction. J Clin Nurs. 2009 Nov;18(21):2949-55
 
Chow S, Chow R, Popovic M, et al. The Use of Nipple Shields: A Review. Front Public Health. 2015 Oct 16;3:236

 

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