Using a nipple shield with a breastfed baby 

ABM > Specific need/experience > Using a nipple shield with a breastfed baby

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What is a nipple shield? 

A nipple shield is a flexible silicone nipple that is worn over the mother’s own nipple during breastfeeding. 

Why would I consider one? 

Nipple shields can help establish breast-feeding with some babies who seem to have difficulty achieving and/or maintaining attachment to the breast. 

Most mums don’t need to use a nipple shield 

Please consult a breastfeeding counsellor or health professional for one-to-one support before you use a nipple shield. 

A nipple shield can be a temporary solution but not a permanent fix to an underlying problem. 

What might cause my baby to have difficulty with attachment? 

  • labour events
  • delivery 
  • drugs – opiates, Fentanyl 
  • use of dummy/teat 
  • physical abnormality 

Other reasons a shield could be used: 

  • flat or inverted i.e. non protractile nipples 
  • soft nipples
  • tongue tie
  • breast refusal 
  • sore, cracked bleeding nipples 
  • weaning a baby from bottle to breast. 
  • re-lactation or induced lactation (adoptive breastfeeding). 

Before using a nipple shield, consider: 

  • prolonged skin contact and ‘biological nurturing’ i.e. laid back breastfeeding techniques. 
  • hand expressing drops of milk onto the nipple to tempt the baby to attach. 
  • regular (2-3 hourly) hand expressing of colostrum to protect milk supply. 
  • regular (2-3 hourly) feeding of expressed breast milk (EBM) via syringe/cup to maintain baby’s condition. 
  • trying different positions/techniques e.g. cross cradle hold and exaggerated attachment, lying down feeding, underarm hold. 
  • applying cold to a soft nipple to firm it. 
  • use of nipple massage or gentle use of breast pump to draw nipple out. 
  • if milk is in, deal with any engorgement to soften areola to facilitate attachment. 

Caution 

Nipple shields should be used with caution under the supervision of a skilled breastfeeding practitioner. Unless used properly, they may affect transfer of milk to the baby which may contribute to poor weight gain. 

  • incorrect fitting and fit of shield = poor milk transfer and/or damage to nipple 
  • milk transfer to baby may not be as efficient = long feeds, very frequent feeds, unsettledness, colicky behaviour slow weight gain 
  • slower milk transfer = greater risk of blocked ducts/mastitis 
  • lower milk supply due to poor milk transfer from breast 
  • barrier between mother and baby 
  • baby gets used to the shields and will not feed without them 

How to use a nipple shield 

It’s often helpful to place your baby in skin to skin contact well before you attempt a feed. 

This will stimulate baby’s instinctive feeding behaviours and make attachment to the breast more likely to be successful. 

When shields are introduced, first try latching the baby without the shield. Or you can start each feed with the shield and then try removing it after a minute or two of breastfeeding. Or try latching the baby without it later in the feed. (This may not be appropriate if the nipples are very damaged.) 

Fit 

Nipple shields are sized according to the diameter of the base of the mother’s nipple. A poorly fitting shield can cause problems including reduced milk transfer and pain. In the U.K., the standard sizes are 16mm (small), 20mm (medium) and 24mm (large). A larger 28mm size is available online but can be difficult to find.

A ‘contact’ nipple shield (recommended) has a cut away piece that allows baby’s nose or chin to remain close to mum’s breast. So baby smells mum and not plastic

Preparation 

A warm wet shield sticks to the breast better – run the shield under warm water prior to use. Roll the wet, warm shield back about halfway down the shank of the shield. It may adhere to the breast better if you apply a little water, breastmilk or lanolin cream around the edge. Roll the shield back onto the breast so the nipple is drawn into the teat of the shield. 

Attachment 

Attachment technique is still important with a shield. Don’t just poke the shield teat centrally into baby’s mouth. Baby should be held close, mouth wide open and chin in contact with the breast. 

Your baby should draw your nipple into the shield teat and be able to compress the ducts in the areola with his jaws and actively draw milk out of the breast. Look for signs of effective milk transfer. 

Towards the end of the feed (when baby’s swallowing slows) it is a good idea to use breast compression while baby suckles to increase the milk and fat transfer to the baby. 

Offering baby both breasts at each feed will mean baby gets more milk. 

The nipple shield is a projection of the nipple so, when the baby unlatches, it should look well rounded, just as though she had a good latch directly at the breast. You should see milk in the shield when baby comes off . 

After feeding the baby using a shield, it’s a good idea to express both breasts, for just a few minutes only, using an electric breast pump. Doing breast compression while you are expressing will cut down the amount of time you need to express. 

Monitor feeding progress when nipple shields are used. Your baby’s weight will need to be monitored regularly too. 

It’s a good idea to keep an eye on baby’s bowel movements and urine output while you’re using a nipple shield as these give an indication of milk intake. Baby should have about three tablespoon-sized yellow, grainy stools in 24 hours (after the fifth day) and have at least six wet nappies. 

If baby is discharged from hospital using nipple shields, his progress should be closely monitored by the community midwife or health visitor. She will support the establishment of breastfeeding without the shield, or refer to a breastfeeding clinic if there are any problems. 

Try to attach your baby to the breast without the nipple shield. Continue to do this at each feed until your baby is able to latch on without the shield. 

Some babies need only one or two sessions with the nipple shields, while others may need more. 

Care 

Wash the shield with hot soapy water, rinse with clean water, dry carefully and store in a clean container. 

Weaning from a shield 

Be sure not to make this a battle with your baby, or he will resist more. Don’t obsess with weaning off the shield to the point that you are unhappy with breastfeeding. 

As long as your baby is gaining weight well, there is no need to rush into trying to wean him from the shield. 

Don’t cut down a shield to wean a baby off it — this practice is no longer recommended. 

Keep trying as often as you can, and give it some time. Some mums continue to use a shield for the duration of their breastfeeding experience, but most mums take anywhere from two days to about four to five weeks to completely wean from the shield. 

Other ideas 

‘Re-birthing’ via co-bathing can help to stimulate instinctive feeding behaviours in a baby that is not attaching. 

Some families find that cranial osteopathy can be an effective intervention for babies with attachment difficulties. 

Be patient while you work through this time of transition. Breastfeeding with a shield is still breastfeeding. 

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