Pain with nipple shield use

Why does it hurt when I use a nipple shield?

Mothers who use a nipple shield may feel mild pain if they have existing nipple pain or damage and are using the nipple shield to reduce pain or if they are just starting to use the nipple shield. Mild pain can also happen when a slightly inverted nipple or swollen nipple root is stretched as the baby latches and pulls the nipple deep into the cone. More severe pain may happen if the nipple is not centred in the nipple shield cone or if the nipple face is pulled into the holes at the tip of the cone. These situations usually settle within a week or so of correcting the problem. The mother may need to express occasionally to manage the pain until the nipple gets used to the nipple shield. The baby may clamp on the tip of the nipple shield, pinching the nipple. If this cannot be corrected, mothers should not use a nipple shield.

A) Mild pain

Mothers may feel milk discomfort with nipple shield use if they:

Mothers can generally continue breastfeeding with a nipple shield in this situation as long as the pain decreases steadily. This type of pain should be much better within a week or so.

B) Moderate or severe pain

1) The nipple is not centered in the cone

Pain may develop in the nipple and areola if the nipple is not centred in the nipple shield cone. The nipple and nipple root will be pulled to one side causing pain and even damage.

Look at how the nipple is placed inside of the nipple shield once the baby has let go to identify this.

To prevent this, make sure you have proper breastfeeding positioning and support. This is common when the breast is brought to the baby instead of the reverse.

2) Babies clamping on the tip of the nipple shield

Some babies clamp on the tip of the nipple shield, pinching the nipple. If this cannot be stopped, the mother should not use a nipple shield.

3) The nipple face is pulled into the tip of the nipple shield cone

Babies can produce varying amounts of suction (Perrella 2015). Occasionally, a baby sucks so strongly that the nipple face is pulled into the holes at the front of the nipple shield cone. This can also happen if the mother has longer or larger nipples than average.

Once the baby lets go of the breast, blisters or bumps appear on the nipple face in the same pattern as the holes on the nipple shield.

This is painful. The mother may need to express occasionally to manage the pain until the nipple gets used to the nipple shield. The nipple shield should be rotated such that the holes are in different places at each feed. Mothers can mark the rim of the shield to help manage this.

4) Other causes of nipple and areolar pain

Other causes of nipple pain that happen soon after the baby’s birth or after a period of pain-free breastfeeding can create or increase pain while using a nipple shield.

References

Perrella SL, Lai CT, Geddes DT. Case report of nipple shield trauma associated with breastfeeding an infant with high intra-oral vacuum. PBMC Pregnancy Childbirth. 2015 Jul;15:155