Assessing nipple shield effectiveness

How do I know the nipple shield is working?

If a nipple shield is working, the baby will latch and feed effectively and show all the signs of getting enough milk. It is important to weigh the baby when starting to use a nipple shield, within a few days, and again within two weeks. Nipple shields should not cause nipple pain or damage.

A) Signs that the nipple shield is working

It is important to make sure the nipple shield is working and the baby is getting enough milk and is not underfed as not every baby can extract breast milk while using one (Brigham 1996). Breastfeeding with a nipple shield can also cause nipple pain and damage.

If the nipple shield is helping the baby breastfeed, the baby will:

Mothers using a nipple shield should find that they can express significantly more milk before the baby breastfeeds, compared to the amount expressed afterwards. This shows that the baby can access the milk in the breast.

In addition:

  • There should be minimal or no pain during or after breastfeeding.
  • The baby should not clamp on the nipple shield cone.
  • The nipple should remain in its normal shape after breastfeeding and not have a line across its face.

Successful nipple shield use in premature babies is defined somewhat differently.

The video below shows a baby breastfeeding well using a nipple shield.

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B) Monitoring nipple shield use

If there are problems using a nipple shield, they will develop soon after starting to use one.

Accordingly, 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 underfed. A further visit should take place within two weeks. 

Assessing milk intake in a newborn who is using a nipple shield before the mother’s milk is in is be more difficult. These babies need close monitoring as they can quickly become sleepy and underfed and their mothers should express after all feeds until the milk comes in in order to establish a food milk supply.

Premature babies also need close monitoring as they grow and develop their breastfeeding skills. 

References

Brigham M. Mothers' reports of the outcome of nipple shield use. J Hum Lact. 1996 Dec;12(4):291-7