Duration of nipple shield use

When do I stop using a nipple shield?

Some babies use nipple shields the whole time they are breastfeeding as they never learn to breastfeed directly from the breast. Using a nipple shield requires some effort but is less work than expressing, and nipple shield use appears to allow mothers whose babies have latching problems to breastfeed for longer. Babies with latching problems can be encouraged to learn to breastfeed without a nipple shield, but they should not be forced to do so. To encourage the baby, offer the breast without the nipple shield at most feeds, whenever the baby is calm and ready to try breastfeeding. Put the nipple shield on and try another time if it doesn’t work within 30 seconds or as soon as the baby is upset. Premature babies need to grow stronger and breastfeed well without a nipple shield before stopping its use. Mothers who are using a nipple shield to control nipple pain can simply stop using it as the pain allows.

A) The effort needed to use a nipple shield

Mothers are often anxious to stop using a nipple shield as it requires effort to:

  • Remember where you put it.
  • Bring it along when you go out.
  • Use it.
  • Clean it. 
  • Store it.

However, breastfeeding with a nipple shield is a lot less work than expressing.

There is nothing wrong with using a nipple shield if it works for you and your baby and you should not feel pressured to stop. Indeed, nipple shields can be essential for breastfeeding success. Among mothers whose babies have latching problems, the mothers who use a nipple shield can maintain breastfeeding for longer than those who don’t (Chow 2015). Nipple shields are also very helpful for premature babies. 

Some health-care providers do not support the use of nipple shields. 

B) Stopping nipple shield use when using one for the baby’s latching problems

Babies who have latching problems are likely to learn to breastfeed without a nipple shield. They can be encouraged but should not be forced through this process.

1) Offering the breast 

Try different breastfeeding positions and holds and other tools to settle any latching problems. The baby may be able to latch without help in the laid-back hold or may benefit from help with latching. 

Offer the breast without the nipple shield at most feeds. You can do this at the beginning, middle, or end of a feed — whenever the baby is calm and ready to try breastfeeding. 

Most efforts last less than 30 seconds. Never push the baby to the point of frustration. If the baby can’t breastfeed without the nipple shield, put it back on and try again another time.

2) When offering the naked breast is not necessary

Most mothers do not try to breastfeed during the night without a nipple shield. This allows them to get a little more sleep.

The older the baby, the less likely the baby will learn to breastfeed without a nipple shield. This is especially so after three months of age. Accordingly mothers of older babies will generally offer the naked breast less often.

3) Learning to breastfeed without a nipple shield

Some babies will learn to breastfeed without a nipple shield from one feed to the next. Others may take up to one month to manage the transition.

If your baby suddenly learns to breastfeed without a nipple shield, your nipples may get tender. You may still use the nipple shield now and then if you need to control your pain. You can slowly decrease the use of the nipple shield as your pain allows and the nipple adjusts to breastfeeding. The baby does not have to set the pace.

If the baby is slowly learning to latch, try to latch the baby without a shield every time you breastfeed and at each breast. The baby needs these opportunities to practice now that the baby’s skills are developing.

Some babies will start breastfeeding better on one side than the other. This is normal. Within a few days most babies will be able to latch equally well onto both breasts, as long as there are no major differences between them.

Once your baby learns to breastfeed effectively, you no longer need a nipple shield. Without the nipple shield, you will probably notice that the feeds are shorter and the baby is more likely to choke. Both are normal.

Please do not cut away the tip of the nipple shield to teach your baby to breastfeed without one. This creates a sharp edge that may injure you or your baby. Also, there is no evidence that this approach helps babies learn to latch. 

4) When the baby doesn’t learn to breastfeed without a nipple shield

A few babies need a nipple shield long-term, which is rarely a problem (Hanna et al 2013).

We have cared for many mothers whose babies never learned to latch and who used a nipple shield for years without problems. Studies have estimated that 7% to 33% of mothers need to continue using a nipple shield for their entire breastfeeding time (Kronborg 2017; Powers 2004)

Our only concern with long-term use is that in very rare cases a baby suddenly loses the ability to use the nipple shield and is still unable to breastfeed without one. This is similar to a breastfeeding strike. It tends to occur when the baby is between three and five months of age. In this case, the mother would need to give the baby replacement feeds. If she wished to give the baby breast milk, she would need to express.

C) Stopping nipple shield use when the baby is premature

Nipple shields are often used with premature babies to support their breastfeeding efforts as they grow and develop. Nipple shields can help premature babies both latch and get more milk.

Stop using a nipple shield when the baby can latch and suck effectively and get as much milk without the nipple shield as with one. This usually occurs around 42 to 46 weeks of gestation, but it may be earlier or later. As with term babies, some premature babies never learn to breastfeed without one.

D) Stopping nipple shield use when using one for other reasons

Mothers who use a nipple shield to control nipple pain can simply stop using it as the pain allows.

Mothers who use a nipple shield to minimize choking should be able to stop using it within one to two months as the baby becomes more able to handle the milk flow.

References

Chow S, Chow R, Popovic M, et al. The Use of Nipple Shields: A Review. Front Public Health. 2015 Oct 16;3:236
 
Hanna S, Wilson M, Norwood S. A description of breast-feeding outcomes among U.S. mothers using nipple shields. Midwifery. 2013 Jun;29(6):616-21
 
Kronborg H, Foverskov E, Nilsson I, et al. Why do mothers use nipple shields and how does this influence duration of exclusive breastfeeding? Matern Child Nutr. 2017 Jan;13(1).
 
Powers D, Tapia VB. Women's experiences using a nipple shield. J Hum Lact. 2004 Aug;20(3):327-34