Nipple Shields: life-saver, supply -wrecker or just another tool for nursing mothers?

 by Jenny Thomas, MD, MPH, IBCLC, FAAP, FABM

I confess, I didn’t know what a nipple shield was back in the day when I was still a very smart but breastfeeding “knowledge- challenged” pediatrician. I did know that whatever they were, they were bad. Very bad. “Never” use them under any circumstances. Ever.

Later, when my niece was born, in a hospital hundreds, nay thousands, or millions of miles away from me, imagine my horror as I found out that she needed a nipple shield to latch. This was bad. I didn’t know why. But it had to stop. So, as unsupportively as I could imagine (in retrospect) I told my sister to stop using that thing! I hadn’t met my niece yet, but I knew that she was less than 5 pounds soaking wet and that nipple thingy was going to ruin her chances of getting into the Ivy League.

One of my dearest friends in the world needed to use a shield when her second child was born. She asked for one when her third was born and was told “no” by the staff caring for her in the hospital. To me, it just was further proof that their use was fraught with problems.

I’m smarter now, at least I’m less breastfeeding-challenged, and I know better than to use the words “never” or “always” and to deny to a request without providing education and informed consent. And I’ve heard too many stories of success to discount the benefits of nipple shields for some mothers and babies. But the fact remains that we have no guidelines for nipple shield use. We have few studies rigorously done that show they are effective.

A nipple shield is a gadget that is placed over the nipple and areolar area. It looks sort of like a nipple (sort of), or a sombrero, but is made of plastic and there are different types. You can get them online and over the counter. The problem with them stems from studies (with flaws in the method in which they were done) that concluded that the use of the shield could decrease milk supply, were associated with more supplementation, and lead to early weaning.

That meant that if they were to be used, the dyad using them would need to be carefully followed, but many mothers were getting them and no follow up was scheduled. I’m not sure the logical result of that should be a compete ban on their use, but, well, they were highly discouraged. Of course, those studies were with older versions of the shield, and other research (with flaws in the method in which they were done) with newer versions of the shield suggested this wasn’t as a big a problem as we thought. But many of those same concerns exist. We honestly don’t know the short-term or long-term effects of nipple shield use.

Nipple shields are often given out in the nursery for “flat” nipples. My guess (no data, so definitely flawed study method) is that the nipples are puffy. And if that’s the case, this might be something to try.

They are often given out for a poor latch as a quick fix to a more complex problem, but we need to remember basics: skin to skin, baby-lead latch, biological nurturing. And asking for help from someone who is board certified in lactation, an “IBCLC.” The shield should not be a first step.

If it’s given to you because your nipples are sore, then in addition to the shield, we need somebody to fix the underlying problem and be your cheerleader and you heal and transition back to the breast. (Find a Lactation Consultant!)

So, suggestions:
If you are given a nipple shield ask why. Informed consent for any intervention means that you are given the required information, in an understandable manner that allows your voluntary participation and that helps in making a decision for a course of action. Questions you can ask to help fulfill informed consent: Why am I getting this thing? How long do I use it? How will it help? Might it hurt? What other things might I try? What type of follow up do I need?

If you are given a shield, and it works, well, cool. You need follow up by somebody who knows something about breastfeeding so we can work on the underlying issue that initially caused the need for the shield.

If you were given a shield and don’t like it, well, let’s get you some assistance and fix whatever the issue is that requires a gadget to fix it so we can go gadget-less.

Shields are meant to be temporary solutions. If you are still using it when your baby is months old, we really should be able to help you stop using it, if you want us to.

If you are given a shield, it works well, you baby is growing and you’re happy but everyone around you is like “ooooooh, those things are bad’ you have my permission to hear everything that that person says after that in the voice of Charlie Brown’s teacher (you remember that voice, or am I showing my age?)

Resources:
Baby led- breastfeeding:http://www.geddesproduction.com/breast-feeding-baby-led.php
Biological Nurturing: http://www.biologicalnurturing.com/
Skin-to-skin http://massbfc.org/providers/SkinToSkin.pdf
Find a lactation consultant: http://www.ilca.org/i4a/pages/index.cfm?pageid=3432

Health professionals’ attitudes and use of nipple shields for breastfeeding women. http://www.ncbi.nlm.nih.gov/pubmed/20524842
Nipple shields: a review of the literature. http://www.ncbi.nlm.nih.gov/pubmed/20807104

 

 

 

Dr. Jenny Thomas, MD, MPH, IBCLC, FAAP, FABM is a general pediatrician and International Board Certified Lactation Consultant in southeastern Wisconsin. Find her sound, evidence-based and helpful advice on parenting at www.drjen4kids.com and Lakeshore Medical Breastfeeding Medicine Clinic.

Share

Comments

  1. Kayley M says:

    I was given a nipple shield by my lactation consultant because of a flat nipple, meaning it did not protrude and my daughter had nothing to latch on to. She also gave me a shell to wear right before nursing, which helped it “pop” out. I was able to wean her after about a month, but I had no issues with the shield itself. It was a thin silicone and I do not feel that it interfered in any way except to help her latch and pull my nipple out.

  2. Thank you for this. I had my daughter at 35 weeks and had flat nipples. She was losing so much weight and I didn’t want to supplement with formula. We were given a shield by the LC in the hospital and it was the only thing that got her to latch. I ended up stop using it 3 weeks later because i think it was affect my supply. The first day or 2 without the shield was hard but i decided going cold turkey was the best for us. I like to think of nipple shields as training wheels for breastfeeding. Sometimes you need them.

    • he was healthy egunoh to nurse. The best we could get were very painful shallow latches that resulted in disfigured, compressed nipples. My L&D nurse sister came to visit when my son was a week and a half old and thought that perhaps a nipple shield might help. I’d never heard of them until this.Seven and a half weeks later, they have greatly helped overall and have kept me going in working on that elusive pain-free latch. They’ve also caused problems of their own, which is greatly distressing. My nipple gets pulled through the shield holes and I’m left with little white raised stumps like grains of rice on my nipple. They’ve scabbed over a few times, but usually go away within the hour. I’ve even taken pictures to show to the LC’s I’ve been working with. This is happening with a 24mm shield and I use a 27mm flange with my pump, so perhaps this wouldn’t occur with a larger shield if I can ever get my hands on one. This seems to occur less or not happen as soon when my breasts are very full. It also helps to simply place the nipple shield over my nipple, instead of applying it as instructed.I feel the use of nipple shields have had a positive impact on my breastfeeding because they’ve kept my son at the breast at times when his extremely shallow shield-free latches are too painful to tolerate and he would be fed with a bottle if it weren’t for the nipple shield. My system is to latch without a shield and see if I can handle the pain. Even though my nipple always comes out disfigured, sometimes the pain is mild and I roll with it. If it’s too painful, then I try to see if I can handle nursing with the nipple shield. Usually I can, but if not, then my son will get a bottle of pumped milk using a haberman bottle to keep him happy with a slow flow. I’ve been working with three LC’s and am waiting on a cranio-sacral therapy referral to help my son to open his mouth wider (he’s not tongue-tied, just has a fairly tight jaw and a slightly inset/recessed lower jaw). I plan on continuing to use nipple shields until we are able to get a good deep latch that doesn’t disfigure my nipples and cause so much pain. Hopefully this will be soon!

  3. Elissa Winkler says:

    I have an eleven month old and believe it or not, we still use a nipple shield (we currently nurse 4 xs a day, once at night). He is a “big” kid, over 22 lbs, and I’ve never had a problem with supply. My son had a rough first week – pneumonia and in the NICU for seven days and I was forced to use formula until my milk came in and we were able to attempt nursing three days after I gave birth. I have very flat nipples and the shield was given to me by an LC.
    We tried at three and five months to wean from the shield, but it never happened. Perhaps if I’d been more persistent, gone to see an LC again, but to me, why fix what’s not broken? My son continues to thrive.
    Personally I am SO thankful for the nipple shield because it enabled me to nurse my son, form that bond with him and do what I felt was best for his health and our relationship. If/when I have another child, I do hope to not have to use a shield, but if it’s the only way to breastfeed my child, I’ll use it again. Thanks for the article!

    • Reneda Chittum says:

      I was given a shield in the hospital for flat nipples. My son is 7 1/2 months and we still use the nipple shield. He has never had an issue with growth (he doubled his birth weight by 1 month). I was told by a breastfeeding peer counselor with WIC that I needed to wean him from it. But I agree with Elissa, if it’s not broken, why fix it. it has been a life saver for us and if I am blessed with more children I won’t hesitate to use it again.

    • My son was born 3.5 weeks early and spent a week in the NICU because he couldn’t regulate his blood sugar levels (what that meant for me, in terms of breastfeeding, was that he was only allowed 30 minutes to ingest food because after that, he was losing more blood sugar than he was taking in. It was almost impossible to get him to wake up and put forth the effort to latch. Much of his feeding during that time was via IV or NG tube). Before we took him home, we met with an LC who recommended the use of a nipple shield to make it easier for him to latch (less effort meant it was more likely he’d nurse). It was the only way I managed to breastfeed, and we were able to wean him off of the supplementation within a week of being home. I made follow up appointments with the LC to try to wean him off the shield as soon as possible (because I’d previously also heard that nipple shields were to be avoided at all costs!) so imagine my surprise when they said that we could try to wean him if I’d like, but that if he was gaining weight and I felt like things were working out just fine, then there was no reason that we HAD to do so! I did want to wean him from the shield, but it turned out after a few months that even WITH the shield he didn’t have a strong enough suck to adequately gain weight, and we moved to exclusively pumping (so the whole thing was a moot point). The shield was a real pain to have to use, but it was the only way I was able to breastfeed at all, and for that I am grateful for it.

  4. Jeannette says:

    I had my baby in 2007 and the nipple shield was a life-saver for me. My baby could not latch properly, and within 24 hours he was getting blood, not milk. A lactation consultant was not available as we were in the middle of an ice storm (worst in our state’s history.) Someone had given me a nipple shield (I had never heard of them before, either) and a relative who is a nurse suggested I try it. It worked like a dream! We used it for six weeks, at which time I decided to try nursing without it. My six-week-old was able to latch almost immediately, and we never looked back! I did not notice any particular supply issues with the shield; when I had issues later on, I drank malted milk and presto!–no more issues! (Malted milk was a theory my husband came up with.) As far as weaning early, we are still breastfeeding at 44 months! Thanks for the Charlie Brown’s teacher image–that is useful sometimes with breastfeeding!

  5. Personally, the nipple shield saved my breastfeeding relationship with my son. I was given one by the LC in the hospital 2 days after my son was born because my son would not latch on the right side. I was in tears every time I tried to nurse and many times told my husband that I wanted to formula. My husband and the LC supported me in my desire to nurse, so he called the LC every time I was nursing and one time she came back with the nipple shield. BINGO – my son latched! Now we are going on 4.5 months of exclusive breast feeding and my son and I love it! I know that without the nipple shield, when we left the hospital he would have been on formula.

  6. We used a shield from 6-9 weeks. I had overactive letdown and pour latch in the beginning (probably because I was drowning my poor little one). The shield allowed me to finally heal and nurse pain free! We are still nursing now at 19m. I think in addition to protecting my skin while it healed, the shield also slowed down milk transfer just enough while my DS was figuring it all out. For us it was a lifesaver!

  7. I was offered a nipple shield in the hospital when I was struggling terribly to feed my son. I had tried the shells to no avail, and I was mortified that I couldn’t feed my baby. THANK GOD for the shields!! We used them for 1 1/2 months before my son could latch without it. He nursed for 9 months before weaning on his own. Again, with son #2 I needed a shield, also for roughly 1 1/2 months. My second son nursed for 19 months, up to my 5 th month of pregnancy with my 3rd son!! My third boy latched immediately and hasn’t let go yet, so my trusty nipple shield went unused.

    I am pro-breastfeeding all the way, but I am pro-mom first and foremost. I had no issues with the idea of a nipple shield…it was the only thing that allowed me to be successful in the first place! I needed it and was ok with it. They were a pain to have to use (keeping them clean, and good god, do they have to be clear?!? The first time it hits the ground during a night feeding was the last time I depended on having just 1…I bought a few and had them close at hand!!), and I would try regularly to nurse without the shield. I have told all new moms that the shield is another tool if needed, and they are not evil!!

  8. I used a nipple shield because my daughter was tongue tied and the latch was unbearable. After it was released she used it for a few weeks and then refused it one day and latched on by herself.

  9. I used a nipple shield from when my daughter was about 2 weeks to about 2 months off and on. I was instructed to purchase one under the guidance of a lactation consultant because my nipples were so sore and messed up that I would CRY thinking about nursing and the pain, and was seriously considering giving up. The nipple shield helped me to nurse without excruciating pain, and as my nipples healed, I would use it less, and if they got sore I would bring it back out again. it got to a point where I didn’t need it anymore, but in the beginning it was a lifesaver. It never affected my supply, and we never supplemented. I exclusively breastfed until almost 7 months and we are still going strong nursing at a year.

  10. We used a nipple shield for the first day and a half in the hospital at the nurses’ recommendation because our daughter refused to nurse from my left breast. I didn’t realize until the next day that most of my nurses who were helping me nurse were not putting the shield on correctly. The nurse that initially helped me inverted the shield, laid it over my nipple, and then flipped it so that my nipple was drawn into it – the way it’s supposed to be used. All of the other nurses we had simply had me lay it over my nipple (no inverting) and nurse like that, and I listened because I was sure they knew more about them than I did. I experienced terrible pain when she initially latched (felt like she had glass in her mouth) for weeks because the nipple shield was not on correctly for that little bit of time we used it. My nipple was not far enough into the shield, therefore my daughter was not far enough back on my nipple when she nursed with the shield.

    Luckily we ended up with a very helpful LC (the nipple shield was before we met her) who spent a good 30-45 minutes with me just trying different nursing positions and different tricks to get our little one to latch without the shield on both sides. After that she became more and more willing to nurse on the left, and I was glad to not have to go home with a nipple shield.

    So… we didn’t have the best experience with the nipple shield, and I’m glad to not have to use one, but I’m sure it’s a lifesaver to others.

  11. Michelle says:
  12. I was given a nipple shield by the LC. I was struggling to feed without pain. My nipple was bleeding and at 6 days, I had given up. The LC checked my latch and attachment. All was good, but my LO kept slipping off because she was so small. The shield gave instant relief. I used it till 9 months, when I got up the courage to get rid of it (i didn’t want that nipple pain again). My LO was breastfed for over two years after that. I never had a problem with supply either. They saved my breastfeeding relationship!!!

  13. If it weren’t for a nipple shield, my daughter would have been formula fed. Plain and simple. She had no clue how to latch onto my nipple. She latched exactly once (and proceeded to chew my poor nipples) in the first 10 days of her life. An LC gave me a nipple shield and it worked like a charm. In less than a week, we were able to completely ditch the formula supplementation and she was fully on breast milk. Just before she turned 3 months old, I used the shield at the beginning of a feeding, unlatched her, took it off, and relatched. She had no problems latching onto my nipple. Over the next couple of days, we stopped using the shield and had a wonderful BF’ing relationship that ended just before she turned 2. I am eternally grateful for that nipple shield! It was a pain to deal with, to clean it, etc. but it saved our BF’ing relationship!

  14. I am another nipple shield success story!! I’m a mom of two preemies and with each we discovered that by day two or three (once my milk came in) that my nipples was so small and they didn’t have enough muscle tone to latch on. We used them for about six weeks and consider them to be the saving grace to breast feeding for us. We were given one by a LC with our older child when she would simply sit at the boob and scream in frustration. I am thankful that I had enough confidence to ask for one early with our second when he started experiencing the same issues. I was mortified that I couldn’t feed my tiny little girl who desperately needed my milk. The nipple shield saved me! I make sure all of my pregnant friends know about their existence so they can explore their use should they have any difficulties.

    My advice to anyone who decides to use one–make sure you have at least two or three on hand. There is nothing like loosing one in the middle of the night!!!

  15. Nipple shields are tools that can come in handy! I would also add that an “IBCLC” is not the only professional lactation adviser. I hold a “CLC” credential and there are also LLL advisers that are able to help!

  16. A very experienced breastfeeding advisor advised a nipple shield for me and I know for surethat if it wasn’t for that, I wouldn’t have still been breastfeeding 12 months later. I never managed to wean my daughter off the shield but she put weight on nicely and I had no supply issues at all. Used at the right time and with the right advice they can be a lifesaver!

  17. We used shields from day 3-13, my son was tongue tied at birth and physically not latch on, he was syringe fed less than 1ml of expressed milk every 3 hours until he was 68 hours old. After a small mental breakdown on my part, we finally got the suggestion to try shields, he latched immediately.

    We got rid of themas soon as the tongue tie was clipped, it took him a couple goes to learn to rematch, but we got there, and at 31weeks today, are still nursing happily, no intentions of stopping soon.

    Our shields kwere a very thin silicone also. They were a pain to keep in place though, think I have awkward shaped boobs

  18. I have used a nipple shield with all 3 of my children. I was given one in hospital with my oldest because I had flat nipples, large breasts & just couldn’t get him latched. We did have some supply issues, but I used Blessed Thistle & that was enough to make a difference. I never could get him weaned off it. I nursed him until he was nearly 3 and he used the shield every single time.

    I then used it with my 2nd after finding myself in severe pain every time he nursed, especially on one side. Turns out he was severely tongue tied. We had that clipped at 6 weeks and gradually weaned off the shield by about 5 or 6 months. He nursed until I weaned him at 3 1/2.

    My third had a tiny mouth that he just would not open wide enough. I used the shield with him for a few weeks until he was bigger and learned to open wider. I weaned him off it around 3 months. He’s still nursing at 2 1/2.

  19. Erin Clark says:

    I found the nipple shield to be helpful for my daughter because she was so engorged that her nipple was flat on both breasts when she was finally able to try breastfeeding her premature late term baby. I was kind of wondering what the deal was because I don’t really know what was said about it, as I wasn’t allowed to see her latch her baby on for the first time cause her husband and the ICU wouldn’t let me see her breastfeed. Too many people in the ICU rules and all. I was super upset about this as they kept giving her the wrong information and not enough information that I felt would not be met with the follow up care she needed. I woke her up and made sure she pumped every three hours or four depending on the amount of sleep she had in the week her baby was in NICU. She had enormous amounts of milk when I left after a week. The ICU gave them all the milk she pumped as they didn’t have enough room in the refrigerator for it all. But unfortunately her husband thought that meant that instead of her waking up and feeding her baby in the middle of the night when the baby came home, he should just give the baby the stored milk in a bottle. He unfortunately contributed to her low milk supply. She had a really low milk supply after a week of them not knowing this. I don’t know if she continued to use the nipple shields or not but I think I told her that she probably didn’t need them and was horrified when she mentioned them two weeks later and how her milk supply had dwindled. She hasn’t spoken to me since because of all the drama associated with overcontrolling/ alcohol binging/bipolar (before baby) hubby and my speaking to the social worker and NICU nurse about how I did not feel comfortable leaving them without any support. I explained that it was one of my silly dreams as a parent and former LLL leader that I be able to see my daughter latch on for the first time especially after raising her as a LLL toddler and tandem nursing and my overactive letdown and all the lovely mastitis episodes I lived through with her plus waking up all week to help her latch while her baby was in NICU. She told me that unlike twenty years ago 90% of the Mamas they work with are now BF. I thought to myself, yes but what about aftercare? And what are they doing in six weeks, six months, a year? Her hubby kept saying he would help her wake up after the first four days I was waking her up but then would sleep through the night. She was drugged at the time on Vicodin and always a heavy sleeper her whole life. How do I know this, because of the family bed? The social worker told them erroneously under no circumstances to sleep with their baby. I was never able to correct this information either. I am sure it would have helped her to wake up had her baby been next to her. Because hubby’s mother is an ER nurse and he wasn’t BF he felt it was an unnecessary luxury to BF even though he gave lipservice to wanting to support her. He was appalled that I was helping her with the breastpump and saw her breasts. Apparently he owns them or something. I being the zoology major I am, am familiar with the mammaries of many mammals and am comfortable around them. Apparently US military personnel are not. I had never met a Dad who was jealous of his wife’s breasts and thought they really did not exist (kind of like unicorns) in all my LLL work, 24/7 for seven years, I had never heard of this actually happening. But now I know it s true and now am not allowed to see his child because my daughter wants to please him at all times. Keeping bipolar people ( and not on meds) from going off can be a full time job apparently.

  20. When my son (second baby) was born, I requested a nipple shield from the lactation consultant so I would have it on hand at home if I needed it. I was worried about a repeat of the problems I had with my first baby (flat nipples – really flat, not puffy – and oversupply) which led to cracked, bleeding, and excruciatingly painful nipples. The LC was very reluctant to give me one and tried to talk me out of it, telling me I probably wouldn’t like it and it would hurt, yadda, yadda. Finally she gave in and gave me one. She also failed to address any of my worries about my flat nipples, instead just pushing me to try laid back breastfeeding techniques, which did not help in the least. When my nipples got cracked and started bleeding (surprise, surprise) I used the shield on just the worst side for 2 days, while also working on my own to correct my son’s latch. The shield let the cracks heal, and after those 2 days we were nursing with a lot less pain. I still had a while to go before nursing was pain free, but the shield was a huge help. Unfortunately, the LC (and yes, she was IBCLC) was not helpful at all.

  21. Linda Cheston, IBCLC says:

    As a 24-year LC in private practice, I see a great many problem issues. By the time people get to me, the problems are severe and often difficult to solve. Shields are a short-term or long-term solution depending on the problems mothers and babies are working through.

    If baby is unable to latch and has been given bottles and/or soothers, I often use a shield to get the baby feeding from the breast in breastfeeding positions–and I mean optimal breastfeeding positions that have nothing to do with mothers’ hands on the back of baby’s head or whamming the baby on. If any baby has latch issues, slamming the baby into the breast will not work.
    With tongue and mouth anomalies, a shield often buys time and builds milk supply while we wait for baby to out-grow the basic problems.
    With babies less than 38 gestational weeks, the baby has both maturational and physical limitations where the shield again buys us time.
    I have problems with mothers given shields that are smaller than 24mm. Small shields teach the baby to open his mouth small and will not result in a good latch to the shield or to the breast in later days.
    Nothing substitutes for perfect positioning and mother in a leaned-back, relaxed position.
    My teaching methods are not the same of those of the rest of the world, but they are highly successful with happy mothers and babies who have a good understanding of why we position the way we do, an understanding of how the breasts function with the ebb and flow of milk within the feeding, and an understanding of the predictable frequency days and their management in the the first three months of breastfeeding.

    • My favorite post of all the ones I’ve seen. I’m glad it helped, delighted that someone else has made the same transition (from “evil” to “tool”) and just happy you read the piece :) Thanks!

  22. Linda Cheston, IBCLC says:

    I also use shields when a mother is too hurt to continue without damage. If she is able, I ask her to feed on one shielded nipple and one bare at each feeding if that is possible. If it isn’t possible today, it may be possible tomorrow. Baby’s position at breast must be corrected so the baby’s legs are tucked high enough to be tucked into the mother’s opposite armpit. No football position!! No transverse position!!
    Those dreadfully sore nipples are almost all caused by bad positioning with the baby’s legs dragging. Legs one or two inches down create a drag like hanging a ten pound weight on that tender erectile tissue.
    As a last-resort coping mechanism, I often leave a sore mother with an unopened shield that can be returned if she doesn’t need it. Of ten left, I get 6 or 7 returned because I was able to solve the problems without its use on one visit.

  23. Thank you so much for this article; the ensuing thread of comments has been very informative, too. Over the many years that I have been helping moms as a LLL Leader my understanding of the usefulness of shields has changed. Initially I was definitely swayed by all those stories I heard, I’m sure the same ones you had, Dr. Jen, about how awful they were. I was certain that knowledgeable breastfeeding support people would avoid them like the plague. 

    As time went on I met one or two lactation professionals who were more positive about breast shields, with the caveat that moms should be taught to wean off shields immediately after they learned to use them, and my absolutely-no-way mindset toward them began to change. I admit, though, to a continuing bias against them. 

    This whole converastion has given me much to think about, to the benefit of the moms I will help with breastfeeding in the future, I’m sure, though I still hope to prevent the hint of a need for shields by, as you said Dr. J, sharing the benefits of the wonderful biological nurturing / baby-led latch knowledge which has “revolutionized” our field in recent years. 

    So, thanks to you all for sharing your experiences and adding to my understanding of breast shields. I am going to share this post on the LLL page I started for groups in my area. :)

  24. I, like many who commented, used a nipple shield. My daughter was 7 weeks early but was determined to nurse (she and I both!). She was in the nicu for 3 weeks and for most of that time I refused a nipple shield (hearing all the “bad” things about them). We wanted to take our daughter home however, and the only way we were allowed to do that is if she was feeding frequently. I consulted an outside lactation consultant (not from the hospital) and she said we wouldn’t leave the hospital only bf-ing. We would have to use a bottle and/or nipple shield. So a few days before we went home I asked for the nipple shield. My daughter was able to leave the hospital nursing (she wouldn’t take a bottle–and I was ok with that.) I think because I had been pumping so much while she was in the nicu I had a great supply and the nipple shield didn’t affect that. I was able to wean her from the shield at about 3 months and she’s still nursing (without it) at 16 months–she’s a pro! I think the nipple shield should be used with caution, but as many people have commented above, it definitely seems helpful in difficult situations.

  25. Life saver. Preemie was around 3# when she could go to breast. Couldn’t get anything w/o it.

  26. I used a nipple shield when my son was born because of latch problems. The lactation nurses were wonderful and discovered quickly that he was tongue tied. We had his tongue fiixed and only used the shield for a few weeks. Milk transfer was greatly increased when I stopped using it and his weight gain increased dramatically. I am thankful for the tools I had, but definitely think that there needs to be education behind it. If we weren’t going to the BF clinic for regular weights checks and talking a lot I would not have known that the shield was causing decreased milk transfer. I am very thankful for the nurses at the BF clinic, if it weren’t for them I would not have been successful, they were always positive whereas the floor nurses wanted me to supplement with formula because he was losing weight. I stood my ground and agreed to supplement, but on my terms, with a syringe. I took a BF class before delivering and utilizied the BF clinic many times, taking advantage of resources available to me was key. They knew what they were doing and what I needed to do when I didn’t have a clue. I have several friends who pumped and gave breast milk in a bottle, but very few woman who actually nursed. Most claimed latch problems in the hospital. I am glad that we were able to make it work and are still happily nursing at almost 5 months…..now if I can just keep my milk supply up! :)

  27. Thank you for writing this! I could not have breastfed my children if I had not used a nipple shield. I had problems from the start and got the help of a lactation consultant. After I tried other solutions with no success, she offered the option of the nipple shield and provided pro and con information about it. Eventually (I don’t recall how long), the nipple shield wasn’t needed. With the next child, I briefly tried without it, but started using it again and couldn’t have continued without it. I breastfed both my children to age two.

  28. I had a late term preemie. Luckily he came out latched on and fed for over an hour; the pediatrician had never seen that, at that gestational age. Unluckily after another 2 beautiful feedings about 12 hours after birth I was not allowed to breastfeed due to a medication (they were uncomfortable with it but not I, had already fed one on that med). 24 hours after my last dose I would be allowed to continue, but like they often see at that age, my child then had “forgotten” or gotten to tired to nurse. In came an NG tube. After nurses over feeding his poor little tummy and my trying to preemptively gently stretch his tummy (think lots of thanksgiving dinners!) He started to show interest in the breast again (I had continued to try to nurse during ever feed as I wanted him to associate breast with content tummy.)

    Alas after my milk came in, nipples swelled, and flatness to overcome they FINALLY convinced me to try a nipple shield. Saying, “think of it as training wheels”, I still thought of all the women I have met online that still use one months later. At first he hated it. We eventually got him to feed with it a couple of times, but he started to latch normally around the same time. Always being checked on they wanted to know if I used the shield, but I felt as though it was hindering more that helping. He didn’t seem to like the texture and would get angry and tire himself out before getting a feed in. So I jsut stopped with them. I know they can be a useful tool, but I felt they were being pushed on me. I knew we had done it before, so I knew it was just a matter of time and we’d do it again.

    I wish they hadn’t pushed so much to use it but for us it wasn’t a big deal in the end. But again, what about the women that never unlearn how to use them!

    We are now 2 weeks out of the NICU and home and nursing fine. He is gaining between 2-3oz/day. Which as many of you know is insane! No matter what w/or w/out shield perseverance is the key.

  29. When my son was born, the hospital LC tried for about five minutes to get him to latch on. He wasn’t showing the least interest. When it didn’t work right away, she look at my nipples and said, “They’re flat. You’ll never be able to nurse with those.” Out came the nipple shield. I wanted to protest, because my nipples aren’t flat, just a little on the small side, but you know how it is when professionals tell you things … it can be hard to get up the guts to ask a question.

    Once he was nursing on it, she told me that it would destroy my supply unless I pumped after every feeding, and I would have to go down to their lactation store and buy a pump for over a hundred dollars! I was furious that she hadn’t told me this before. I couldn’t afford that.

    The next day a different LC was able to get him to latch without the shield — once — but then I was discharged and didn’t get any more help. I wasn’t able to duplicate what she did, so he stayed on the shield. I didn’t bother pumping because I just had so much else to do, and I seemed to have plenty of milk.

    The dang thing was a huge hassle, though. I was always misplacing it. One night I woke up to feed the baby, only to find I hadn’t put the shield back on my nightstand after the last feed. I had no idea where it might be! The baby cried for an hour and my husband was on the point of running to the store and getting formula when finally we found the shield in the bed. After that we got some extras so we wouldn’t have that problem, but still I never seemed to have one to hand when I needed one. It made me embarrassed to nurse in public, and I felt like a failure because I wasn’t “really” nursing him.

    After three months he finally weaned off it. My supply rocketed up (I hadn’t known it was low, but it got a big boost) and I finally felt like a success. But I was left with a baby who never nursed for comfort, and who went on strike after strike, even though I never gave him a bottle. The whole thing was frustrating. I’m proud to still be nursing him at 16 months, and he finally does nurse to sleep and for comfort, but it was a long road.

    If I had to use one again, I would. But I’d try a lot more other things first. In addition to any supply problems, it also stops nursing from being a “grab and go,” easy thing and makes it complicated. I wish it had not been offered to me so readily.

  30. The nipple shield saved my breastfeeding relationship. I think it is important to distinguish between the older, thicker latex shields that impacted milk transfer and the newer, thinner silicone shields that usually have minimal (if any) impact on supply (though there are always exceptions). We used a shield for about 6 months (flat nipples) when, suddenly, he just started taking the breast. I gave them up because it was a pain to wrestle with them in the middle of the night or to ensure that I always had a clean pair on hand, but could have gone on using them until he weaned.

  31. Hello. Another reluctant shield mother here. My baby would not latch and it took a whole week to get him on the shield even. At six weeks his growth was poor and we needed to supplement. I started pumping like a mad woman and taking domperidone. He went on a nursing strike when the pumping started. As my supply came up he came back to the shield and weaned at 9 weeks. It took until 10 to loose the formula supplements. My experience is that there are negative things about the shield. However my son would have never nursed at all without it. It impacted my supply but it did help him learn that the breast is for nursing. He is twelve weeks now and I am grateful whenever he nurses.

    • that this is not usually when they romcmeend them, but that Milo might benefit from some stimulation to help him latch. (In addition to everything else, let’s just say that my nipples are not exactly ideal for nursing. Small in every way.) Every other time we’d been to visit one of our local LC’s at the hospital, it seemed like the new strategy we worked out would be great. Everything worked in the magic chair in their magic office. But until then, nothing had really worked well for us at home. It’s so much easier when you have an expert (and calming influence) there to help. This time, what worked in the magical LC’s chair worked at home. Milo could latch every time, without a problem. My nipples were able to heal. (Right before this last visit, I had a wound on the side of one of my nipples so bad that I swear I thought the thing would fall right off. There is a big nasty bulging purple scar there, still. Thank god it doesn’t hurt!) I gave all this background because I don’t think the nipple shield or Milo’s latching problems are responsible for my low supply. To some extent, I think they are the result of a very frustrated and starving baby who was desperate to get milk out of me. The shields have been so wonderful for me. Yes, they are a pain to bring places. I don’t like that I can’t just put my child to my breast without planning in advance. I don’t like that it’s more difficult to nurse in public, though having to supplement almost every feed when an unfulfilled baby pops off your breast in hunger makes it even harder to nurse in public, so having to use the shield isn’t the primary factor in making me reluctant to nurse outside of my home. I have very occasionally been able to get him to latch on without the shield. At first it was just as painful as before, but in the past week or so I’ve had some success with non-painful latches. He can only do it when he’s so tired that he doesn’t know he’s doing it, or if I trick him by sticking my finger in with my nipple, so he has something longer and harder to sense. (I then pull my finger out. This works about 1/3 of the time I try it.) I would love to be able to nurse my son until he’s satisfied and full, without a shield. I don’t think either of these things is a reality. But I relish being able to nurse him at all, and I relish the times I’m able to do it without a shield. Even with a shield, I find it a beautiful experience, and I will continue using the shield as much as is necessary. If I am lucky enough to still be able to nurse him to a year, or two years, or beyond, I will be so grateful. After all we’ve been through, I can’t complain much about being stuck with the shield. Without it (and the support of the wonderful LC’s at my hospital), I’m sure I would no longer be nursing.

  32. I used a nipple shield for the entire year I breastfed each of my boys – now ages 3 1/2 and 16 months. I had flat/inverted nipples, and it was the only way I was able to breastfeed. After feeling like I was “cheating” by using a shield with my first and vowing not to use one with my second, I ended up caving once I was in tears trying to get my second baby to latch on – afraid to let him do it because I was in so much pain, but feeling guilty because I knew he was hungry.

    The shield helped my nipples heal, and I began to embrace the it, because it allowed me to breastfeed without the inconvenice of pumping and feeding each time. In fact, I embraced the nipple shield so much that I actually developed a case to store it in. Since the launch of http://www.shieldshell.com in December 2010, I’ve done my part to help over 250 mothers breastfeed their baby a little more conveniently, and also gotten the word out about nipple shields in general.

    • that this is not usually when they remecmond them, but that Milo might benefit from some stimulation to help him latch. (In addition to everything else, let’s just say that my nipples are not exactly ideal for nursing. Small in every way.) Every other time we’d been to visit one of our local LC’s at the hospital, it seemed like the new strategy we worked out would be great. Everything worked in the magic chair in their magic office. But until then, nothing had really worked well for us at home. It’s so much easier when you have an expert (and calming influence) there to help. This time, what worked in the magical LC’s chair worked at home. Milo could latch every time, without a problem. My nipples were able to heal. (Right before this last visit, I had a wound on the side of one of my nipples so bad that I swear I thought the thing would fall right off. There is a big nasty bulging purple scar there, still. Thank god it doesn’t hurt!) I gave all this background because I don’t think the nipple shield or Milo’s latching problems are responsible for my low supply. To some extent, I think they are the result of a very frustrated and starving baby who was desperate to get milk out of me. The shields have been so wonderful for me. Yes, they are a pain to bring places. I don’t like that I can’t just put my child to my breast without planning in advance. I don’t like that it’s more difficult to nurse in public, though having to supplement almost every feed when an unfulfilled baby pops off your breast in hunger makes it even harder to nurse in public, so having to use the shield isn’t the primary factor in making me reluctant to nurse outside of my home. I have very occasionally been able to get him to latch on without the shield. At first it was just as painful as before, but in the past week or so I’ve had some success with non-painful latches. He can only do it when he’s so tired that he doesn’t know he’s doing it, or if I trick him by sticking my finger in with my nipple, so he has something longer and harder to sense. (I then pull my finger out. This works about 1/3 of the time I try it.) I would love to be able to nurse my son until he’s satisfied and full, without a shield. I don’t think either of these things is a reality. But I relish being able to nurse him at all, and I relish the times I’m able to do it without a shield. Even with a shield, I find it a beautiful experience, and I will continue using the shield as much as is necessary. If I am lucky enough to still be able to nurse him to a year, or two years, or beyond, I will be so grateful. After all we’ve been through, I can’t complain much about being stuck with the shield. Without it (and the support of the wonderful LC’s at my hospital), I’m sure I would no longer be nursing.

  33. When I was first suggested to use a nipple sheild by the LC in the hospital for flat nipples, I felt the same way. Those things are bad! But then learned that it is more like a crutch. I was at a point of crying every time my DD would latch because I had one flat nipple and one inverted nipple. She brought them out but it ended up cracking when it came out. I was so determined to bf that I just took the pain until giving in to the nipple sheild! I only used it until my nipples healed and she went right back on afterward! I am soooo thankful for that thing!

  34. Nipple shields saved us. By week 2, my nipples looked as though someone took a cheese grater to them. I was bleeding at the very first latch at the hospital and things went from bad to worse.

    I took one week off breastfeeding, pumping every two hours while my partner bottlefed her my expressed milk. While there was an improvement with the cuts and cracks and scabs, the thought of my daughter coming near my destroyed nipples terrified me. So we introduced a nipple shield despite my lactation consultant’s advice.

    I used it for about a month. It was very inconvenient and my daughter developed a dependence on it. There was a weaning process which was pretty stressful. I thought she would always need it. I offered her my breast without the shield at every feeding until one day, she just accepted it!

    Now she won’t take anything else. And I’m okay with that. There’s no way we’d be breastfeeding 6 months later if we didn’t start using the shield.

  35. I had one flat and one inverted nipple with my first and needed a shield for the first month or so in order to allow her to latch. It was actually suggested by some LLL leaders when I went in to a meeting when my daughter was 5 days old and had only latched successfully a few times. Thankfully, I was able to wean her off it on my own fairly quickly. And with pumping and continued nursing my nipples are not at all flat! In fact, with my son I never needed the shield.

    The worst thing though is the utter sense of failure using it invoked in me. Breastfeeding is supposed to be “natural” and “easy”, at least, that’s how my mom (who nursed 7 kids) made it seem. I also wasn’t nearly as educated when I had my first, so I didn’t know how important skin to skin and establishing breastfeeding in the first hour is to the whole relationship.

  36. There’s nothing wrong with using a nipple shield. I used the Medela silicone one with both of my babies because of flat/inverted nipples. They latched on their own later, and I’m still nursing my second, who’s 14 moths old. So ladies, go with your instincts and do not listen to the ‘professionals’ who think they know everything. It depends a lot on the situation.

  37. My let down wasn’t overactive per se, but my wee guy was a 34 weeker so took a little while to catch on. Same deal as you though; prevented the poor boy from being drowned! Used it until he was 6ish weeks old…wow was that ever a different feeling the first time without it!

  38. I was given a nipple shield at the hospital due to a flat nipple (or that was my assumption.) To this day (my daughter is 6 months old) we are still using it. I am one of the fortunate ones that it did affect my milk supply, in fact I believe that it helped us as I do have over active letdown. I just want moms out there to know that not all moms experience a decrease in milk supply. However it is possibility. It just worked for us.

  39. My baby was full term, but she was refusing the breast all together at the hospital and it was only with the introduction of the shield that she actually started to breastfeed. I got super worried around week 6 when she showed no interest (and screamed) when I tried to offer the boob sans shield, but she was gaining steadily and the shield didn’t seem to affect my supply in the slightest. We finally weaned off the shield at around 4 months and she feeds like a champ now without it. I just know that without the shield, I wouldn’t have been able to breastfeed and giving myself permission to ignore the naysayers and the pressuring people who said I had to get off it immediately allowed me to get to the point where I could wean and still continue to breastfeed. She’s 5 months now, 27 inches and almost 17 pounds. The shield certainly didn’t adversely affect her growth any. I will say that nursing with a shield takes twice as long as nursing without a shield. With a shield, she’d nurse for probably 30 to 40 minutes. Without the shield, she does it in about 10 minutes, if that. So, if you’re nursing with a shield, you can’t really rush them. Certainly, I got a lot of ebooks read while I was nursing her as a newborn.

  40. I’ve been breastfeeding full time my 6 month old son, til couple of days ago my right nipple started hurting everytime he nurses. I checked my nipple today and there is a crack. This same breast I had undergone surgery (removed a walnut size pus) because of an infection way back when I was breastfeeding my now 2yr old other son. My husband told me to stop breastfeeding til the crack heals coz we dont want another infection to happen. I’ve been putting lanolin today on my nipple nd have not used it to nurse my baby the whole day (been nursing only through my left breast), but I feel sogorged and its more painful. I dont have a pump, I dont wanna buy one. I heard about this nipple shield and I wonder if I can use this temporarily til my crack heals. I know I can deal with the painbut its the infection imtrying to avoid…

  41. I have 3 kids and I have had to use a nipple shield with both of my boys, I got them from one of the LC in my area. I had to use them for about 1-2 weeks.

  42. Thank you thank you thank you for posting this! I’m a new LC in a hospital, and I’ve never been a fan of nipple shields, but the nurses hand them out like candy, and I have ended up using them several times with moms because it was either that or baby was going to get formula (we obviously need some staff education…). I can’t wait to read the links you posted and share info. with staff and moms!