In the past, nipple shields, or nipple guards as they are also known, have received harsh, and sometimes justified, criticism for how they have frequently created or worsened breastfeeding problems rather than for how they have remedied them.
The shields of old were made of thick rubber and were often used with little instruction concerning necessary precautions by mothers who were deficient in knowledge about the normal course of breastfeeding.
When I first started my work with breastfeeding mothers in 1993 the shield was considered taboo. Today, it can be a very effective tool to get baby to the breast when latching is difficult or just not happening at all. The modern-day shield is made of very thin silicone and therefore poses fewer risks when used appropriately and under the direction of a lactation consultant.
Nipple shields are a helpful tool to facilitate breastfeeding when:
• Baby is unable to latch-on due to mom’s flat or inverted nipples or due to baby’s prematurity, oral anatomy, birth trauma or other problems related to baby’s part in latching.
• Baby has become nipple confused due to receiving artificial bottle nipples or pacifiers and is resistant to latching onto the breast.
• Mother has an overabundant milk supply and the shield is necessary to help slow the flow of milk down to allow baby to feed more effectively and comfortably (only after lactation is well-established).
• In rare circumstances a nipple shield may be used as a bandage approach for sore nipples. However, it will not cure sore nipples. The cause of the nipples soreness must be identified or the problem will persist and other problems may arise.
Possible risks when using a nipple shield:
• Insufficient milk transfer to the baby since he is not able to compress the breast directly.
• A drop in mother’s milk supply since stimulation by baby is not direct and milk removal may not be optimal.
• Traumatized nipples when baby is allowed to only latch onto the teat part of the shield.
• Sub-optimal weight gain by the baby due to insufficient milk transfer and subsequent low milk supply.
Care plan when using a nipple shield (important to follow each part of the plan):
• Seek hands-on assistance from a board-certified lactation consultant to help you identify the cause of your breastfeeding problem. Often a nipple shield is not the best solution and can create other problems.
• Seek help from a lactation consultant in proper use of the shield. This will better ensure that your baby gets enough milk and your milk supply is maintained.
• When latching baby, pretend the shield is not there. The baby must open wide and take a large portion of the area behind the nipple shield teat. Consider pumping a minute or two before attempting latch with the shield. This will give baby an instant taste of milk. It will also help moisten the inside of the shield which should allow it to adhere to the breast better.
• If there is pain past the first 30 seconds of a feeding, the baby is most likely too far down on the shield. Break the latch and start again. Make sure baby maintains a deep latch throughout the feeding. If he slides down on the teat of the shield as the feeding progresses, start again and aim for him to get a mouthful of shield and breast. This is important for your comfort, his optimal milk intake, and maintenance of your milk supply.
• For one to two weeks after initiating nipple shield use, pump your breasts for five to 10 minutes after every feeding. This will ensure adequate drainage of the breasts and maintenance of your milk supply.
• For one to two weeks after initiating nipple shield use, have your baby weighed once or twice a week to ensure he is getting enough milk. Keep a daily log of his wet and dirty diapers, too.
• Choose a standard size nipple shield if you baby was full-term or is several weeks old. Choose a smaller shield if your baby was premature.
• Wash the shield with hot, soapy water after each use. Sterilize by boiling for five to 10 minutes once a day.
If you are using a shield and your baby is gaining well, be glad that he is at your breast! Better to be breastfeeding with a shield than not breastfeeding at all. Don’t feel the need to rush weaning from the shield. Most babies will give it up independently and with maturity once they realize where the milk comes from. A lactation consultant can offer tips for making the process easier once the time comes.
Becky Flora-Waterman, RN, CMSRN, IBCLC, is a registered nurse and board-certified lactation consultant. Email her at firstname.lastname@example.org