All about nipple shields

A nipple what?! Nipple shields can be a lifesaver in some breast/chest-feeding situations! But how do I know when to use it?

A nipple shield is basically a layer of flexible silicone that’s shaped like a nipple and you apply directly to your nipple. Reasons for use include:

Tongue or Lip Tie

• Finn had an undiagnosed tongue tie after his NICU stay. We were mostly bottle feeding formula and the very small amount of breastmilk that I was producing at the time. During the last day, we tried exclusively nursing and continued when we got home.
• We had a 48 hour check up and Finn had lost 0.5 pounds – I was also showing signs of major engorgement and mastitis – which were all signs that Finn was not transferring enough milk from my breasts. My nipples were also RAW and had a lipstick shape to them when Finn unlatched – more signs of TT!
• Luckily, I had an amazing LC who diagnosed the TT and showed me how to use a nipple shield. In this case, I needed to exclusively pump to decrease my engorgement, treat my mastitis (with antibiotics as well) and most importantly, make sure that Finn was getting enough milk (the chunker took 4-5 oz every 3 hours at a week old…). He was only transferring about 30mL from me due to the TT.
• SO: I used a nipple shield for two reasons in this case:
  • To help my extremely torn up nipples to heal
    • Along with APNO! And breast rest – see my BF4 highlight for more info.
  • The shield prevented the extreme pain I was having when Finn latched. (BURNING AND CRYING!!!)
  •  To keep Finn associated with the breast.
• My goal was to breastfeed from the breast, and our ENT appointment to assess need for a tongue tie revision wasn’t for 4 weeks. 
• I fed Finn 1-2 times a day from the breast with the nipple shield to keep him familiar with the breast and make the transition to breastfeeding at the breast smoother. I exclusively pumped and bottle fed for the remainder of the feeds.
• Lip ties can wreak just as much havoc.
  • You can read more about lip and tongue ties here.
• If your baby has a TT or LT, you may need to pump more often to keep supply up. Unsure of how to do this? Book an appointment with Kate, Lauren or Natalie (breastfeeding counselors and NICU RN’s).

Prematurity 

• Preemies are still learning the “suck, suck, swallow, breathe” method that come naturally to term babies.
• They also have smaller MOUTHS! Which makes it very hard for them to latch appropriately, deeply, or at all.
• The nipple shield allows some structure for baby to learn how to latch properly and helps with milk transfer.
• Preemies are often bottle fed first to keep track of intake, so the silicone may feel familiar to them as well.

Small anatomy of baby

• It’s simple! Teeny babies have teeny mouths!
• Breasfeeding Finn (10 lbs) vs Bee (6lbs) was a WHOLE different ball game. Bee’s mouth was just SMALLER! It took a bit of a learning curve to feed her and latch her appropriately without causing nipple damage.
• Make sure that baby is always TUMMY TO MUMMY! And their whole body is aligned with the level of your nipple. Use lots of pillows!

Short, Flat, or Inverted Nipples

• These three scenarios don’t allow for baby to latch deeply and remove milk properly. Baby may get frustrated at the breast or loose interest after a few sucks, even if they are able to latch.
• The nipple shield, when applied correctly helps EVERT the nipple if applied properly, allowing proper latch and milk removal.
• This nipple everter may be of use to you as well! You can train your nipples to evert more.

Poor latch

• High palates from anatomy or long intubations during NICU stays can affect the way that baby latches, causing a poor latch and poor milk removal, as well as frustration at the breast. A nipple shield can help with proper latch and milk removal in these situations.
• *SOMETIMES* nipple shields can actually worsen latch. Always feed your baby to cues and make sure baby is gaining weight if you are breastfeeding and using a shield!

Can I always use a nipple shield?

Sure! If you want to! Less moving parts if you don’t, but if it’s not broke, don’t fix it!

How do I wean from a nipple shield?

• You can try introducing one feeding a day without the shield. It’s best to do this from the beginning (making sure you supplement with cues after if needed) so baby can be associated with the bare breast.
• Slowly increase the amount of times you breastfeed without the shield. Make sure baby is still transferring milk well and gaining weight along the way!
• Another suggestion is to cut the tip of the shield bit by bit. Please be careful with this method as pieces could come off or be pointed. 
• The earlier, the easier!
•  Skin to skin at your breasts/chest will help baby reassociate with the bare breast.
• Catch your baby at a good time – don’t go too long between feeds.
  • Catch the cues early to avoid baby being over-hungry – then they really won’t latch without the shield!
• If you have flat or inverted nipples try:
  • A nipple everter or latch assist will be helpful for you
  • Pumping for a few minutes before latching baby to evert your nipple
  • Use an ice cube or a cold washcloth to harden your nipple before latching
• Make sure your breasts aren’t too engorged. 
  • This makes it harder for baby to latch to bare breast.
• Create a positive association with the bare breast. 
  • Do not allow baby to get upset while trying to latch to the bare breast. If they get upset, move on and try again at the next feed. This will help create a positive association.
•  Hand-express a few drops of milk onto your nipple before trying to latch to bare breast.
• Use your hand to compress your breast with a C shaped hand, so that the breast tissue around your nipple is shaped like a sandwich. This helps baby latch.
• The bait and switch! 
  • Latch baby with the shield for a few minutes. Unlatch and relatch without the shield to see if baby will take it!

How To Apply A Nipple Shield

1. Measure your nipple. Use the same size nipple shield as you do flanges (make sure your flange size is correct!)
2. Choose shield size according to measurements.
3. FLIP/INVERT the nipple shield like so:
4. Place on your nipple while shield is still inverted.
5. POP your nipple out while applying pressure. The suction will evert your nipple, ensuring latch success and minimal pain.

   

   

   

   

   

   

   

   

   

   

   

   

   

6. Latch baby. Watch for swallowing and feel for emptying of breasts. When you unlatch, there should be milk in the shield. You can hand express into the shield before latching or drip formula in the shield to help baby latch and stay interested.
7. Wash with warm soap and water + air dry between feeds.
8. Sterilize once a day.

Have more questions? Schedule a text or video chat consult with Kate, Lauren or Natalie (NICU RNs) and they can help answer any questions that you have!

Download our free nipple ruler to make sure you’re using the correct flange size.

Other helpful blog posts:

• 6 signs of oversupply
• 5 signs it’s time to wean
• How to store breastmilk
• How to supplement with formula
• Breast rest
• Common breastfeeding complications explained

**This post is educational and not meant to take the place of your provider. Bumblebaby makes a small commission on some of the items listed above.