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.