How to use a nipple shield

How do I use a nipple shield?

To use a nipple shield, mothers first need to choose a breastfeeding hold. The cross-cradle hold or under-arm holds provide more control over the baby’s head and the latch. The nipple shield is placed so that the nipple is in the middle of the cone, It is gently held with the thumb and index finger on the outer edge of the rim. The breast is offered just as it would be without a shield; by gently tapping the baby’s upper lip with the nipple shield cone and waiting for the baby to open wide before bringing the baby onto the breast. When the baby is properly latched, the whole cone should be in the baby’s mouth and the baby should start contentedly sucking. Babies should be closely monitored when starting to use a nipple shield.

 

B) Choose a breastfeeding hold

Choosing the right hold is important to allow you to hold the baby and the nipple shield and ensure that the baby is properly positioned at the breast. Babies in a poor position can pull the nipple shield out of place, across the breast, so that the nipple is no longer centred in the nipple shield cone. This can lead to nipple pain and damage and the baby may take in less milk.

Consider using the cross-cradle hold or the under-arm hold as these provide more control over the baby’s head and the latch and you have one hand free to hold the nipple shield. The laid-back hold may result in excess milk leaking out from under the nipple shield and limit the baby's milk intake.

If you are using the cross-cradle hold, you may be able to switch into the cradle hold once the baby is latched and breastfeeding well with the nipple shield in place.

C) How to place and hold the nipple shield

When getting ready to breastfeed with a nipple shield, consider the following steps:

  1. Start the process when the baby is slightly hungry.
  2. Place the baby into the breastfeeding position.
  3. Place the nipple shield so that your nipple is in the middle of the cone.
  4. Hold the nipple shield in place.
    1. If you are using the cross-cradle hold, use the same hand as the breastfeeding breast (for example, use the right hand for the right breast) to hold the nipple shield.
    2. If you are using the under-arm hold, use the opposite hand (for example, the left hand for the right breast).
  5. Lightly place your thumb and index finger opposite each other at the outer edge of the rim of the nipple.
  6. Keep your fingers well out of the baby’s way.

You will notice that the nipple does not fill the nipple shield. This is normal.

Do not squeeze or press on the nipple shield rim; it will deform and the baby will not be able to latch. This might happen if mothers bring the breast to the baby instead of the baby to the breast.

Do not squeeze or press on the breast. This may change the breast into a shape that no longer fits the nipple shield.

Some mothers find that wetting the inside of the nipple shield with water helps it stay in place but very few of our patients have found this necessary.

D) Latch the baby

Offer the breast with the nipple shield the same way you would offer the breast without the nipple shield. That is, gently touch or tap the baby’s upper lip with the nipple shield cone and wait for the baby to open wide before bringing the baby onto the breast.

Resist the temptation to push the cone of the nipple shield into the baby’s mouth before it is open wide. If you do, the baby will likely clamp onto the tip of the cone and pinch your nipple. 

E) Watch the baby breastfeeding

When the baby is properly latched onto the nipple shield:

  • The whole nipple shield cone should be in the baby’s mouth and only a bit of the cone should be visible in the corners of the mouth.
  • The baby’s lips should be turned back slightly on the rim of the nipple shield.
  • The baby’s nose should just touch the rim.
  • There should be minimal to no pain.
  • The baby should be happy at the breast and feed normally.

Sometimes the rim flips over the baby’s nose. You can deal with it or, if the baby is breastfeeding happily, ignore it.

F) Keep the baby close to the breast

Some mothers worry about suffocating the baby. Babies breathe out of the sides of their noses while breastfeeding, so it is extremely rare for the nipple shield to block the airflow. Furthermore, the nipple shield consistency is firm enough to keep from creating a complete seal over the baby’s nose.

There is no cause for concern if your baby is happily breastfeeding. If the nipple shield is truly blocking the nose, the baby will immediately panic and let go of the breast. If the baby’s nose seems blocked, you can pull the baby’s nose away from the breast by pulling the baby’s body towards its feet.

G) After the feed

When the baby comes off the breast:

  • There should be a little milk in the bottom of the nipple shield cone.
  • The nipple should be in its usually shape. It should not be flattened or have a line across the face.
  • Your breast should be softer.
  • When held after breastfeeding, the baby should be happy or asleep.

If your baby is a newborn and breastfeeding with a nipple shield and your milk has not come in yet, it is best to express after each feed in order to maximize milk production. Expressing after feeds is not necessary once the milk is in and the baby is growing well.

If your baby is premature, you should express after all feeds in order to maintain your milk supply and have milk for the baby's supplement.

H) Long-term use

If the baby’s first few feeds are effective, mothers should continue using a nipple shield. Babies should be seen by their health-care providers within a few days of starting nipple shield use to ensure that the baby is taking in enough milk. A second visit should occur within two weeks.

If the baby continues to show all the signs of taking in enough milk at the second visit, it can be assumed that the nipple shield is working well and the baby is breastfeeding effectively. The baby can then continue using it for as long as needed. Babies should have regular visits to their health-care providers.