by Jack Newman

Here's What You'll Find Below:What are nipple shields?
Why nipple shields are not the answer when baby won't take the breast
Why nipple shields are not the answer when mother has sore nipples
Why nipple shields are not the answer when baby is born prematurely
Why nipple shields are not the answer when baby needs to learn to suck

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 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. With time, the mother's milk production would usually decrease if a mother used a nipple shield. Some studies will suggest that there is not a decrease; if one compares milk extraction on a nipple shield to a poorly latched baby, sure, there may be no decrease.

The point is to get a baby well latched. We believe a nipple shield does not allow for this. Unfortunately, it is still true in our opinion that it is often not best practice to use a nipple shield and it is the considered opinion of our clinic and institute that nipple shields need hardly ever, if ever, be used.

What are nipple shields?

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 bra, particularly when the nipple has trauma. Whether the shell actually succeeds in this purpose is debatable, but a breast shell is probably harmless; 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:

1. The baby will not take the breast.
2. The mother has sore nipples.
3. The baby is born prematurely.
4. The baby needs to "learn how to suck."

Nipple shields are not, in fact, the answer to 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 to mothers not getting help early and making fixing the problems 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; 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. 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 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. Furthermore, as mentioned above, when a baby feeds through a nipple shield, the milk supply can even decrease (see the information sheet Slow Weight Gain Following Early Good Weight Gain). Even worse, if the milk supply decreases, it becomes more difficult to get the baby to take the breast without using a nipple shield.

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.