It is surprising that the nipple shield, the use of which we had seen decline rapidly from the 1970’s and before, would once again be thought in the 2000’s, and especially in the last 10 years or so, as an appropriate treatment to cure many breastfeeding problems! It was generally thought to be a mistake to use nipple shields as their use resulted in babies seeming to be stuck on these gadgets and usually, with time, the mother’s milk supply and flow would decrease. And with a decrease in milk supply and flow, it would become more and more difficult to stop using the nipple shield.
The problem with nipple shields is that they are too easy to use, a quick fix that the hospital staff do not need to be concerned about once the mother and baby have left the hospital. A quick fix “good for every problem”. It is sometimes difficult to get a baby well latched on, from day 1. But if it is not possible on day 1 (because mother has been overhydrated with intravenous fluids, for example), then reverse pressure softening (see video), may help. As well, expressing the mother’s milk by hand will help prevent a decrease in milk production (a pump may increase the swelling at the front of the breast). And early followup with a qualified, experienced lactation specialist will almost always result in the baby latching on and breastfeeding well. On the other hand, one of the most difficult problems in lactation is to get the baby off a nipple shield.
The fact that some mothers can “breastfeed successfully” and exclusively while the baby is on a nipple shield, only means that that mother had an abundant milk supply. An abundant milk supply and good “breastfeeding management” would have succeeded in getting the baby off the nipple shield relatively easily, if help were initiated early enough.
It is the considered opinion of our clinic staff that nipple shields need hardly ever, if ever, be used. Not for a baby not latching on, not for sore nipples, not for any reason!
A nipple shield is different from a breast shield or shell. The breast shell is not used while feeding the baby, but rather in between feedings, and its purpose is to make the nipple more prominent, so that the baby will take the breast better, or, to protect the nipple from contact with the mother’s clothing, particularly when the mother has sore nipples. Whether the shell actually succeeds in this purpose is debatable, but a breast shell is probably harmless, if it, in turn, does not aggravate nipple pain as it sometimes can; on the other hand, a nipple shield is not harmless.
Nipple shields are flexible artificial “nipples” put over the mothers nipple and areola. They are made of silicone nowadays and come in various diameters and sizes. They are used generally for the following reasons:
Nipple shields are not, in fact, the answer to any of these problems. They give the illusion that the problems have been dealt with, but in fact, the problems have not been dealt with at all. The illusion that things are now going well leads many mothers not getting help early with the result that fixing the problems becomes more and more difficult as time goes by. Let’s look at these questions more closely.
1. The baby will not take the breast.
A nipple shield is not usually the answer. In fact, a baby who sucks at the breast through a nipple shield is not latched on to the breast, not at all; he is latched on to the nipple shield. Does this matter? Yes, because a poor latch is still a poor latch and baby on a nipple shield has, at best, a poor latch, though in truth the baby is not latched on at all. This means the baby will depend on the mother’s having milk ejection reflexes (letdown reflexes) in order to get milk. If the mother’s milk production is abundant, then the baby actually may gain weight well. Even then, however, we believe that it is problematic to use the nipple shield (see below).
Many mothers have a good milk supply but not all have what one would call an abundant milk supply. In that case it is very possible that the baby will not gain weight adequately with a nipple shield especially after the first few weeks after birth. Furthermore, as mentioned above, when a baby feeds through a nipple shield, the milk supply can decrease (see late onset decreasing milk supply and flow). Even worse, if the milk supply decreases, it becomes more difficult to get the baby to take the breast without using a nipple shield. A typical “vicious circle”.
Even if some justification can be found for using a nipple shield, starting one before the “milk comes” in is, in our opinion, not best practice. So many babies who do not latch on in the first few days, will latch on without trouble, even easily, when the mother’s milk “comes in”, especially if the mother gets good help. If the mother believes that the nipple shield has dealt with her problem, she may not get help until it is too late. Here is just one email (identifying information deleted) of hundreds we could have included:
“My baby was born on xxx weighing 2.5 kg (5lb 8oz). I started using a breast shield when the baby was a few days old because my baby would not latch on; everything seemed to go okay, but somewhere around 3 weeks I began to notice she didn’t seem to be sucking properly and by her one month check up she’d only gained an ounce.”
So what now? After a month feeding on the nipple shield, it may be extremely difficult to get the baby to take the breast directly especially if the slow weight gain was due to the milk supply decreasing rather than the baby not getting milk well because of the nipple shield (both are, in fact, possible). The mother may have been asked to supplement. The mother needed a lot of support.
We believe it is better that a mother express her milk and give it to the baby by cup (or, if absolutely necessary, by bottle) rather than use a nipple shield. At least expressing milk will usually maintain the milk supply. See the blogs/information sheets When the Baby Does Not Yet Latch, Finger & Cup Feeding and Expressing Milk.
2.The mother has sore nipples
Using a nipple shield for sore nipples results in the same problems as using it for a baby who will not latch on. Milk supply is likely to decrease, and the baby may not want to take the breast directly again. Furthermore, a nipple shield is not a good way to treat sore nipples, oftentimes it will make the problem worse and cause more trauma. True, we have heard from some mothers that using the nipple shield helped them get past the pain and they were able to get the baby to take the breast again without pain; this is not always the case and there are better ways of dealing with sore nipples (prevention being the best of all). See the blogs/info sheets What is a good latch, Latch quiz, Sore Nipples, The All Purpose Nipple Ointment, Candida Protocol.
3. The baby is born prematurely.
If the baby is not restricted to starting breastfeeding at 34 weeks gestation (as in most of special care units or neonatal intensive care units in North America and Western Europe), if the mother is helped get the best latch possible and shown how to know a baby is getting milk, then nipple shields will hardly ever be necessary for the premature baby. See these blogs Premature Baby 1, 2, 3.
4. The baby needs to learn how to suck
A baby learns to suck and suck well by breastfeeding, not by sucking on a nipple shield. If a baby “sucks better” on a nipple shield it’s only because the baby is not latching on to the breast. A baby who latches on and gets milk will suck just fine. The problem is that the baby is not latching on well and using a nipple shield does not teach a baby how to do that.
The information presented here is general and not a substitute for personalized treatment from an International Board Certified Lactation Consultant (IBCLC) or other qualified medical professionals.
This information sheet may be copied and distributed without further permission on the condition that it is not used in any context that violates the WHO International Code on the Marketing of Breastmilk Substitutes (1981) and subsequent World Health Assembly resolutions. If you don’t know what this means, please email us to ask!
©IBC, updated July 2009, 2021
Questions or concerns? Email Dr. Jack Newman (read the page carefully, and answer the listed questions).