Using a nipple shield with a newborn baby

Should I use a nipple shield for my newborn?

If a newborn baby does not latch onto the breast on the first attempts at breastfeeding, it is important to decide whether the baby is unable to latch because of sleepiness or sickness or is trying to latch but can’t. These aredifferent challenges with different solutions. If the baby cannot latch, it is reasonable to use a nipple shield. It is important to monitor the baby closely to make sure the baby is using the nipple shield effectively and getting enough colostrum. If not, the baby will be underfed and will need to be supplemented with milk. To establish a full milk supply, it’s important that the breast be stimulated by removing colostrum. For these reasons, we encourage all mothers of newborns using nipple shields to express after all feeds until the milk has come in and the baby does not require supplementation.

A) When to use a nipple shield to breastfeed a newborn baby

Most latching problems appear at the first attempt at breastfeeding right after the baby is born. Occasionally, they appear when the mother’s milk comes in and the breast is suddenly harder or engorged. Rarely, problems can start later.

If the baby does not latch right after birth, it is important to decide whether the baby is unable to latch because of sleepiness or sickness or is trying to latch but can’t (has a latching problem). These are different challenges with very different solutions. A baby who is too sleepy or sick to breastfeed will need medical attention and pushing them to breastfeed is not helpful.

If a newborn baby has a latching problem, it is reasonable to start nipple shield at that time.

B) How to know if a newborn baby is getting enough milk when using a nipple shield

If a newborn baby is hungry and cannot latch, it is reasonable to use a nipple shield. However, it may be difficult to know whether the newborn can use the nipple shield effectively and get enough colostrum or milk. That’s because:

  • Some of the typical signs of effective or ineffective breastfeeding with a nipple shield may be missing.
  • Underfed newborns may become sleepy and may be unable to communicate their hunger, unlike older babies.

The consequences of ineffective breastfeeding by a newborn are significant and can develop quickly. If a newborn is not taking in enough colostrum or milk, the baby will be underfed and will need to be supplemented with milk.

Newborns who are using a nipple shield need to show clear signs of getting enough milk, should not loose too much weight, and have normal pees and stools (poos). Premature babies and early-term babies are at increased risk of becoming sleepy and need extra-careful monitoring.

C) Ensuring that the milk supply is established when using a nipple shield

If the baby is not breastfeeding effectively with the nipple shield in the first few days after birth and mothers do not express well and regularly, the milk supply may be low in the long term. Mothers of premature babies are at higher risk of a low milk supply.

1) Before the milk comes in

To establish a full milk supply, it is critical that colostrum is removed effectively and regularly. Babies using a nipple shield may not be able to do this.

Therefore, mothers should express within one hour after birth and after each of the baby’s feeds. There should be least 7 expressions in 24 hours. Expression is best done by manual expression for ten minutes on each breast and then by double pumping with an electric breast pump for ten minutes.

2) Once the milk comes in

Once the milk comes in and the baby is growing well and breastfeeding effectively with or without a nipple shield, mothers can reduce and then stop expression. 

If a healthy, full-term baby who is breastfeeding with a nipple shield still requires supplements after the milk has come in, it is possible that the nipple shield is not effective or the milk supply is low.  

Some mothers of babies who are growing well are told that they should continue expressing for the long term to maintain their milk supply because they are using a nipple shield. We have not found this is necessary. It also creates a lot of work for mothers and may cause them to have an excessively large milk supply.