1) Describing babies who cannot take in enough milk when using a nipple shield
Some full-term babies can latch and suck well on a nipple shield but cannot get enough milk, even when the mother has a full milk supply.
The reason for this disconnect is unknown. It is possible that some mothers have a weaker let-down when using a nipple shield. Nipple shields have been reported to decrease levels of a mother’s oxytocin, the let-down hormone (Amatayakul 1987; Chertok 2006).
It is also possible that:
- The baby is a premature, sleepy newborn, or weak, sick baby, as all may prevent the baby from breastfeeding well both with a nipple shield or without one.
- The mother has a low milk supply.
2) How to help the baby get more milk when using a nipple shield
If the baby is not latching or getting enough milk, you can try the following:
- If you are using a 16- or 20-millimetre nipple shield size, your baby may do better with a 24-mm nipple shield.
- If you have very large nipples, you may require a 28-mm nipple shield.
- On rare occasions, babies get more milk when using a smaller nipple shield.
- Ensure that the baby is not clamping down on the end of the nipple.
3) Using a nipple shield along with supplementing
You have three choices if your baby can latch and breastfeed with a nipple shield but does not get enough milk:
They are, in order of our patients’ preference:
- Express milk and supplement to feed the baby. Once the baby is done feeding, you can breastfeed with the nipple shield to settle the baby or breastfeed the baby to sleep.
- Express and supplement exclusively without breastfeeding.
- Breastfeed with a nipple shield for some, most, or all of the feeds and then express and supplement to “top up” the baby’s milk intake.
The first approach will provide your baby with breast milk and give you a tool to settle your baby. Both of these benefits are lost with the second approach.
We generally discourage the third approach, as it is time consuming for mothers and can be stressful for the baby. Also a premature, sleepy newborn, or weak, sick baby may waste precious energy breastfeeding ineffectively using a nipple shield.