Using a nipple shield with a premature baby

Should I use a nipple shield for my premature baby?

Premature babies have unique breastfeeding challenges. They are smaller, weaker, and sleepier than term babies. Using a nipple shield may help them breastfeed better. Premature babies may need smaller nipple shield cone sizes. Until premature babies can breastfeed effectively, they need extra milk in addition to breastfeeding and mothers need to express to establish and maintain their milk supply.

A) Premature babies

Premature babies commonly have breastfeeding problems. Some benefit from using a nipple shield because it can help them:

  • Latch.
  • Suck longer or better.
  • Develop sucking skills.
  • Suck for comfort:
  • Get more milk when breastfeeding with it than without it (Clum 1996; Meier 2000).

The exact reason that nipple shields help babies is unknown.

Please work with your health-care providers if your premature baby has any feeding challenges.

B) Using a nipple shield with a premature baby

Use a nipple shield only if it is helpful. To use a nipple shield when the baby is premature:

  • Only offer the breast when the baby shows hunger signs.
  • Use proper nipple shield technique.
  • Stop once the baby is asleep or no longer interested in breastfeeding.

Given the limited breastfeeding skills of many premature babies, their mothers generally need to express colostrum within one hour after birth and then after each of the baby's feeds. Mothers should express at least 7 times in 24 hours. This helps to establish the milk supply and provides colostrum for the baby's supplement.

Expressing and supplementing continues after the milk comes in and until the baby can breastfeed effectively and no longer needs milk supplements. This often continues past the baby’s due date.

C) Estimating milk intake

Premature babies have limited strength and often peter out while feeding and go to sleep. This makes it hard to know how much milk a baby takes in. This is in contrast to healthy term babies who will show clear hunger signs if they have not taken in enough milk.

For this reason, hospitals that care for premature babies usually have breastfeeding scales. This allows you to weigh the baby before and after a feed (before-after-feed weights). The difference in weight is the amount of milk the baby has taken in.

Before-and-after weights can be helpful in seeing how well a nipple shield is working. Mothers can do a few before-and-after weights using the nipple shield and a few times for feeds without it. If the baby gets more milk with the nipple shield, continue to use it. If the baby takes in the same amount of milk or less, stop.

D) Nipple shield size when the baby is premature

You may also use before-and-after weights to determine the best nipple shield size for you and your baby. Use the size that results in the baby taking in the most milk at each feed.

For premature babies, we usually recommend the largest nipple shield that comfortably fits a baby’s mouth and accommodates the mother’s nipple. These are rough guidelines for starting out:

  • 16-mm nipple shield for the smallest babies
  • 20-mm nipple shield for babies born at 33 to 36 weeks
  • 24-mm nipple shield for babies born closer to full term

Mothers should try bigger nipple shield sizes as the baby grows. This often results in less nipple pain and in the baby taking more milk from the breast and breastfeeding more quickly.

A small number of mothers have very large nipples and may need a 28-mm nipple shield. Their baby baby may not be able to latch onto either their nipple or the nipple shield until they have grown a little.

E) How long to use a nipple shield

Nipple shields are often used with premature babies to help them latch and extract milk from the breast.

Stop 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. Some premature babies never learn to breastfeed without one. The reason for this difference is unknown.

F) The difference in nipple shield use between premature and full-term babies

1) Premature babies

Successful use of a nipple shield is defined differently for premature babies, who have trouble latching, sucking, and getting milk from the breast.

With the nipple shield, babies may not be breastfeeding very effectively and often need to be supplemented with milk, but they can do more at the breast with the nipple shield than without it. If this is the case, use a nipple shield.

2) Full-term babies

Full-term babies who cannot latch or stay latched or who do not get enough milk with using a nipple shield, should not rely on it. It is unlikely they will develop any further skill using a nipple shield. In these cases, mothers should use other tools instead.

References

Clum D, Primomo J. Use of a silicone nipple shield with premature infants. J Hum Lact. 1996 Dec;12(4):287-90
 
Meier PP, Brown LP, Hurst NM, et al. Nipple shields for preterm infants: effect on milk transfer and duration of breastfeeding. J Hum Lact. 2000 May;16(2):106-14