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A rough start to breastfeeding doesn’t necessarily mean breastfeeding won’t work for you. Have you considered Breastfeeding with a nipple shield? Learn who should and how to use it, plus nipple shield review and much more.

Breastfeeding confers tremendous benefits to both mothers and infants. Hence, it is necessary to promote breastfeeding and mitigate any barriers that may prevent its success or lead to early cessation of breastfeeding (1).

Breastfeeding in the first few days, specially when you have an infant who is reluctant to nursing is an overwhelming challenge to a new mom (2). The first month with newborn is both emotionally and physically tiring for many new moms. In this situation many women stop their breastfeeding efforts due to the absence of timely help or the resources. In such a situation, use of nipple shields may preserve and facilitate breastfeeding (1).

Regardless, you are a new mom or a veteran mom, all of us have faced one or more breastfeeding problems during our breastfeeding journey. Some problems are easy fix, while others take so much perseverance to overcome it.

Many mamas have turned to nipple shields when they’re having breastfeeding problems, caused by flat nipple or inverted nipples or latching issues.

Nipple shields are thin, flexible, silicone covers positioned over the nipple and areola prior to breastfeeding(1). Nipple shield provides SHORT-TERM solution to many latching issues when used properly.

While nipple shields have had bad reputation in the past, in some cases – such as preterm babies, latching issues, it becomes necessity to continue breastfeeding.

However, not every mom needs a nipple shield for breastfeeding! It is quite alarming to see many mommies bloggers recommending nipple shield in their “breastfeeding essentials” list.

Majority of mamas do NOT need a nipple shield. It should be used under the guidance of lactation consultant because improper used of it can actually cause more issues.

Here in this article, you’ll learn everything you need to know about breastfeeding with a nipple shield.

• Why and who should use nipple shield?
• Caring for Your Nipple Shield
• Types of nipple shield
• How do I choose a nipple shied?
• How to use a nipple shield?
• The Best nipple shield reviews
• How to wean baby from nipple shields

Its going to be a long discussion, so pin me for later,

Why and Who Should Use Nipple Shield?

Nipple shields are thin, soft, flexible piece of silicon worn over the nipple before breastfeeding.

Nipple shields have been used among moms, not only as a device to facilitate the infant’s latch on to the breast but also to help mamas with sore nipples. However, the benefits of using nipple shields have been debated. A several research studies (3,4) discovered a reduced milk transfer when nipple shield was used, while more recent studies (5,6) have discovered successful breastfeeding outcome when nipple shield was used.

It may help you take away some of the stress from breastfeeding problems but may not be right solution for you and your baby (6). Before deciding to use nipple shield, discuss it with lactation consultant. You can find a lactation consultant here if you are in USA and here if you are in Canada.

Ironically, so many mommies bloggers recommending nipple shield in their “breastfeeding essentials” list and use of it in certain situations is completely the wrong solution to the problem. The use of a nipple shield is not recommended for full-term infants (7) because of its negative impact on exclusive and any breastfeeding duration (8), and less optimal weight gain (9).

While every situation is different, here are few common reasons new moms use them for breastfeeding:

If you have a Premature babies

Premature babies may benefit from the use of nipple shield because of their immature suction pressure. Preemies often find it much easier to latch on and stayed latched on to the breast when nipple shield is used.

However, recommendation for nipple shield use in preterm infants are inconsistent. The standard set by the evidence-based expansion of Neo-BFHI (10) states that

“Nipple shields should not be used routinely in the neonatal ward. They should only be used after the mother has received skilled support in solving the underlying breastfeeding problem, and after the mother’s repeated attempts to breastfeed her infant without the shield”.

As a standard of care, some hospitals recommend nipple shield use in preterm infants (11), and others recommend that infant who shows sign of immature suction pressure could potentially benefit from using a nipple shield (12).

However, research article published in Acta paediatrica 2008 (13), reports that babies born as small as 26 weeks gestation and up to 31 weeks gestation have the capacity for early development of oral motor competence that it sufficient for establishment of full breastfeeding at a low post menstrual age.

With a Kangaroo mother care, early access to breast and oral stimulation exercises, preterm babies can breastfeed without help of nipple shield. Check out this video of mom Laura and preemie baby Adam showing tremendous benefit of kangaroo mother care for baby.

If you have a Flat or inverted nipple

Nipple shield is a popular device when moms have a flat nipple. But most of the time, flat nipple does NOT create any problem during breastfeeding. Remember that, babies BREASTfeed not NIPPLEfeed. As long as good portion of your breast is in your babies’ mouth, flat nipple will not cause a problem when breastfeeding. Click here to learn about 12 tips for breastfeeding with flat nipples

If nipple is truly inverted –if nipple pulls in instead of sticking out when you squeeze the areola- then baby can struggle to feed. In this case nipple shield is very useful. Overtime, baby’s sucking can stretch the nipple to facilitate breastfeeding without nipple shield.

If baby has a difficulty latching

Despite frequent efforts of latching babies on to the breast, if babies struggle to latch on, nipple shield becomes very useful. It helps baby to latch on well and helps continue breastfeeding until underline problem is addressed.

Latching and sucking can be difficult for baby if they have physiological abnormalities such as cleft palate, lip tie, tounge tie or any other abnormalities.

In such cases, the connective tissue present in babies mouth prevents the babies from fully extending their tongues or flanging lips, causing problems in latching. Use of nipple shield allows babies to breastfeed in spite of a shallow latch.

If you have a Sore Nipples

Continuing breastfeeding when you have a sore or cracked nipple is agonizing. Sore or cracked nipples are number one reason among mothers to not continue breastfeeding. Nipple shields are frequently used in this situation to protect nipples. However, use of nipple shield for these reasons is not justifiable. Usually sore or cracked nipple is a sign of something that needs to be fixed such as baby’s latch.

If nipple shield is used without addressing underling issue then it can lead to other issue such as clogged milk ducts, mastitis, low milk supply, poor weight gain.

Nipple shield can be used for temporary relief of pain while addressing initial cause of sore or cracked nipples.

If baby prefers the Bottle over the Breast

Sometimes early introduction of bottle before breastfeeding was established can create a ‘nipple confusion’ for the babies meaning baby’s preference of the bottle over the breast.

If you are planning to transition back your baby to the breast than nipple shield can be used. Nipple shield feels more like a bottle in baby’s mouth for smooth transition.

If you have overactive let-down

Some babies choke and splutter while breastfeeding when mom has overactive letdown. Use of nipple shield in this case can greatly help in regulate milk flow.

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Types of Nipple Shield

There are mainly two types of nipple shield.

Circular Nipple Shield

As seen in picture, this type of nipple shields has a thin circular base with a thicker nipple. This type of nipple shield is very useful for women with a larger breast and nipples. Thin circular base provides full grip to the breast while breastfeeding. Circular nipple shield is also preferred by women with flat or inverted nipple as thin circular base provide area of suction when baby feeds.

Contact Nipple Shield

The contact nipple has a dipped cut out area. The cut-out part should line up with baby’s nose once they are latched. This ensures you are skin-to-skin with your baby during feeding.

How do I Choose a Nipple Shield?

Nipple shields come in a variety of sizes. Choosing a right size is trial and error process. It is advisable to talk to your lactation consultant or breastfeeding counselor to get a help for choosing nipple shield that is right fit for you and your baby.

If your nipple and the shield covering it fits in to your baby’s mouth, then you know that you are using correct size.

If your baby has difficulty maintaining a proper latch, then it indicated that nipple shield is big.

The nipple shield is too small, if your nipple touches the top of the raised portion of the shield.

How to Use a Nipple Shield?

• Dip the Nipple shield in hot water to make it more flexible
• Apply little breast milk or water under the flat part of the shield to help the shield stay in place on the breast
• Express a little milk into the tip of the shield before latching to encourage your baby for breastfeeding with a nipple shield.
• Turn the shield partly inside out before placing over the nipple and then smooth down the ends to draw nipple into the shield
• The cut away part of the shield should line up with baby’s nose once they are latched
• The shield should be deeply into baby’s mouth to ensure proper latch
• Your nipple should not be rubbed or feel sore during the feed and after feeding your nipple should not look flattened or distorted.

Cleaning a Nipple Shield

You should follow manufacturer’s cleaning instruction given by brand of your choice. General instruction for cleaning are as follows;

• Wash nipple shield in running water to remove breast milk
• Then wash in hot soapy water
• Rinse well with clean water after each use
• Sterilize once a day by boiling it in water for ten minutes

The Best Nipple Shield Review 2020

There are lots of nipple shields available to choose. Finding the perfect size for you and your baby is trial and error most of the time. To get you started, we’ve selected our top 5 favorite nipple shields, for you to choose from.

Medela Contact Nipple Shield

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When it comes to breastfeeding accessories my first choice is Medela and so many other moms would agree to this. Medela contact nipple shield has a unique cut-out part allowing skin-to-skin contact between mom and baby.

Medela website has lots of help for breastfeeding moms. They have free app -My Medela- and if you upgrade it, you will have access to lactation specialist 24/7.

It is recommended by Medela to contact lactation consultant to pick right size of nipple shield as correct size is determined not only by size of nipple but also by baby’s mouth.

The brochure recommends applying a bit of cream around the edge of the shield to keep it in place. I have applied few drops of breast milk when I used Medela contact nipple shield and it worked out good for us.

Let’s look at pros and cons of using Medela contact nipple shield.

Pros:

• The shield is made from a BPA free silicon material.
• Designed to provide a skin-to-skin contact between mom and baby.
• Nipples shield comes in three different sizes- 16 mm, 20 mm, 24 mm with a carrying case to keep nipple shield clean.
• Medela has an active online community and online lactation consultant to answer your questions.
• Users of this shield report less pain and greater enjoyment with breastfeeding.

Cons:

• Few moms experienced lots of leaking while using the Medela Contact Nipple Shield.

Lansinoh Contact Nipple shield

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Lansinoh is my second choice for breastfeeding accessories. Lansinoh makes only contact nipple shield -cut out model- and is only available in two sizes.

Just like Medela, Lansinoh also has a free app to help moms tracking feedings and diaper changes. Also, subscription to this app will provide you breastfeeding help 24/7.

Let’s look at pros and cons of Lansinoh contact nipple shield,

Pros:

• The shield is made with 100% silicone and is BPA/BPS free.
• It comes in two sizes: 20 mm and 24 mm.
• It is sold in pair with a convenient hygienic carrying case.
• It is favorite among mothers with flat nipples.

• The cut-out part of nipple shield provides skin-to-skin contact between mom and baby.

Cons:

• Some mothers complained about its design not working for them.

Purifyou Premium Nipple Shield

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Purifyou does not specialize in breastfeeding products but do have good quality nipple shield. Purifyou premium nipple shields are also favorite among breastfeeding moms.

Like most shield, Purifyou premium nipple shield is made of silicon and comes in a set of 3.

The Purifyou shields also has cut-out part above and below the nipple to allow skin-to skin contact between mom and baby.

Let’s look at pros and cons of Purifyou premium nipple shield,

Pros:

• It is made of silicon and is free from latex, phthalate, lead, BPA’s, BPS’s or other toxins.
• It comes in a pack of three with a soft cotton bag with a drawstring.
• It is available in two sizes: 20mm and 24mm
• Purifyou offers a 30-day money back guarantee on this nipple shield.
• The oblong shape of the shield allows skin-to-skin contact between mom and baby.

Cons:

• You need to purchase a case separately if you want to keep your nipple shield clean.
• Many moms complained about its size being small causing pinching while feeding.

Philips AVENT Nipple Protector

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The Philips Avent nipple protector is designed to provide maximum skin-to-skin contact between mom and baby. This nipple shield has top and bottom cut-out part to facilitate lots of exposed skin while feeding.

The nipple protectors are sold in a twin pack. The company website offers some online help for breastfeeding moms and they also have baby care app called uGrow.

Let’s look at pros and cons of Philips avent nipple protector;

Pros:

• It is made from a BPA free silicone
• Top and bottom cut out part allows maximum skin-to-skin contact between mom and baby.
• The nipple protector is available is two sizes: small (15mm) and standard.
• 15mm nipple shield is great for women with small breast and nipple.
• It comes in a pack of two.

Cons:

• The Philips Avent Nipple Protectors do not come with a carrying case to keep them clean.
• Some moms complained about nipple shield not sticking to breast because of less surface area in contact with the breast so you really have to hold it until baby is latched on.

Haakaa Breastfeeding Contact Nipple Shield

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The Haakaa Breastfeeding Contact Nipple Shield has the most unique shape to fit all nipple sizes. So if you are tired finding right fit for you, then this might work for you. The Haakaa Breastfeeding Nipple Shield is made of silicone, with an extended nipple that puts space between your nipple and your baby’s mouth.

This nipple shield is for moms who’s little one bites down or pulls away while feeding. It also helps moms with inverted or cracked nipples.

If your baby prefers bottle over breast and you are trying to put back baby to the breast, the Haakaa Breastfeeding Nipple Shield can be very useful because of its unique design.

Let’s look at pros and cons of the Haakaa Nipple Shield;

Pros:

• It is made of 100% silicone and is BPA, PVC and Phthalate-free.
• It is available in two shapes: round and butterfly
• It comes in pack of one with premium carrying case.
• This Nipple Shields suction onto your breast, so you do not need to worry about holding it while feeding.
• Space between mom’s nipple and the nipple shield prevents baby from biting the nipple.
• Anti-colic and variable flow nipple allows baby to drink continuously without gasping for air.
• Its anti-flatulence design prevents baby from milk choking when milk flows too fast.

Cons:

• Do not allow skin-to-skin contact between mom and baby because of its unique design.
• A couple of moms have complained that their babies have to work too hard to be satisfied because it doesn’t allow enough milk flow.

How to Wean Baby from a Nipple Shield

A nipple shield is temporary solution to your breastfeeding problem. Once you figure out solution to your initial problem, you want to wean baby off it. If you’re lucky, it will be as easy as latching on baby without shield. Like most moms if you’re not lucky, here are few tips to help you start weaning process:

• As a first attempt, you can gently but quickly unlatch your baby before baby is almost done feeding, take off nipple shield and latch baby again. It may take several days for baby to latch on without nipple shield. Try this for several days.
• Wash your breast with plain water before feeding. Baby may like water (silicone) flavor over your skin flavor. This strategy worked well for me when I was trying to wean my baby off nipple shield.
• Apply breast milk to nipple and areola to make baby interested in feeding.
• Increase skin-to-skin time with you and baby.
• Do not cut the tip of nipple shield.

Takeaway

Breastfeeding for some mamas is an easy process, while for others, including me, it is (or was) a most difficult journey. But congratulations to you for continuing breastfeeding with a nipple shield!!

Let’s look at some important point that we have discussed here;

• Nipple shields are greatly helpful for premature babies when they have latching problem. I highly recommend Medela contact nipple shield.
• When baby prefers bottle over breast, and you are trying to put baby back to the breast then I would try Haakaa contact nipple shield.
• Nipple shield are not recommended for sore nipple. You can still use temporarily but you need to address the initial cause of the pain.
• Always take advice from lactation consultant before deciding on to use nipple shield.

Here’re few useful articles related­­ to breastfeeding:

Breastfeeding in the first few days: Make it a positive experience

Natural remedies to treat clogged milk ducts

19 most common breastfeeding problems and how to fix them naturally

How to increase milk supply for breastfeeding: Natural Remedies

The first month with  newborn: How to Survive Emotionally and Physically

How About You?

Have you used a nipple shield to address any breastfeeding problems? Do you think it was useful for your breastfeeding journey? Which brand of nipple shield worked for you? Please leave your comment below.

 

 

References:

1. Chertok IRA. Reexamination of ultra-thin nipple shield use, infant growth and maternal satisfaction. J Clin Nurs (2009) 18:2949–55.10.1111/j.1365-2702.2009.02912.x
2. Wilson-Clay B. Clinical use of silicone nipple shields. J Hum Lact (1996) 12(4):279–85.10.1177/089033449601200412
3. Woolridge MW, Baum JD, Drewett RF. Effect of a traditional and of a new nipple shield on sucking patterns and milk flow. Early Hum Dev (1980) 4(4):357–64.10.1016/0378-3782(80)90040-7
4. Auerbach KG. The effect of nipple shields on maternal milk volume. J Obstet Gynecol Neonatal Nurs (1990) 19(5):419–27.10.1111/j.1552-6909.1990.tb01661.x
5. Nicholson WL. The use of nipple shields by breastfeeding women. Aust Coll Midwives Inc J (1993) 6:18–24
6. Chertok IR, Schneider J, Blackburn S. A pilot study of maternal and term infant outcomes associated with ultrathin nipple shield use. J Obstet Gynecol Neonatal Nurs (2006) 35(2):265–72.10.1111/j.1552-6909.2006.00028.x
7. World Health Organization/UNICEF. Baby-Friendly Hospital Initiative. Revised, Updated and expanded for Integrated Care. Sections 1 to 4.; 2009. from: http://www.who.int/nutrition/publications/infantfeeding/bfhi_trainingcourse/en/
8. Kronborg H, Foverskov E, Nilsson I, Maastrup R. Why do mothers use nipple shields and how does this influence duration of exclusive breastfeeding? Matern Child Nutr. 2017. January;13(1). 10.1111/mcn.12251
9. Ekstrom A., Abrahamsson H., Eriksson R.-M., Martensson B.L. Women’s use of nipple shields-Their influence on breastfeeding duration after a process-oriented education for health professionals. Breastfeeding Medicine 2014; 9 (9):458–466. 10.1089/bfm.2014.0026
10. Nyqvist KH, Maastrup R, Hansen MN, Haggkvist AP, Hannula L, Ezeonodo A, et al. Neo-BFHI: The Baby-friendly Hospital Initiative for Neonatal Wards. Core document with recommended standards and criteria. Nordic and Quebec Working Group; 2015. Available from: http://www.ilca.org/main/learning/resources/neo-bfhi.
11. Meier P.P., Patel A.L., Bigger H.R., Rossman B., Engstrom J.L: Supporting Breastfeeding in the Neonatal Intensive Care Unit. Rush Mother’s Milk Club as a Case Study of Evidence-Based Care. Pediatric Clinics of North America. 2013; 60 (1):209–226. 10.1016/j.pcl.2012.10.007
12. Froh EB, Hallowell S, Spatz DL. The use of technologies to support human milk & breastfeeding. J Pediatr Nurs. 2015. May-Jun;30(3):521–3. 10.1016/j.pedn.2015.01.023
13. Nyqvist K. Early attainment of breastfeeding competence in very preterm infants, Acta Pædiatrica 2008;97:776–781