Nipple Shields

By Leva

Breastfeeding has many challenges, including establishing and maintaining a secure latch and dealing with cracked and sore nipples. Nipple shields have been used for centuries to assist in latching and providing a barrier to prevent discomfort. Historically, nipple shields were made from pewter, tin, wood, silver, ivory, horn, glass, and even lead. However, with the discovery of softer materials, nipple shields have been made from rubber, latex, and, more recently, silicon. 

The use of nipple shields has been regarded as a controversial practice. There is evidence that using nipple shields decreases milk supply because of the reduced sensory input during breastfeeding, which reduces oxytocin production, resulting in less milk production. However, the nipple shields used in the studies that produced this data used thick silicon or rubber.

Recent studies have demonstrated that thinner nipple shields do not interfere with the feedback system of sensory stimulation, hormone production, and milk production. In the case of premature babies born at 33 to 39 weeks gestation, nipple shields have been shown to increase breast milk consumption.  The theory is that maintaining a firm nipple shape with a nipple shield compensates for the preterm infant's less mature feeding mechanisms and helps them latch on easier.  Additionally, infant weight gain did not appear to be compromised by using nipple shields.

Several breastfeeding mothers who might otherwise have given up breastfeeding due to difficulties such as flat nipples, sore nipples, latch problems, prematurity, oversupply, upper airway disorders, breast refusal, oral anomalies, and transitioning an infant from the bottle to the breast have been able to continue nursing with the use of a nipple shield. However, it is important to note that concerns and unknowns are associated with nipple shield use. Therefore, it is advisable to contact a lactation specialist to establish whether using a nipple shield is the solution to the feeding difficulties you may be experiencing.

Like all synthetic interventions, some issues may arise from using a nipple shield.  These include:  

• The hindrance of the baby's oral sensory processing.  Oral sensory seeking behavior, or mouthing items, is normal in babies and infants. They use sucking to help to calm themselves and self-soothe. This self-soothing can also be called self-regulation.  Some evidence shows that the use of nipple shields may stunt this development. 

• The mother may be more at risk for plugged ducts and mastitis (if the shield causes reduced milk transfer). Some evidence suggests that using nipple shields may cause the ingestion of silicone polymers, which can negatively affect your baby's health.  That said, most nipple shields are produced by companies that know the dangers to a baby's health and ensure that nipple shields meet the highest health standards.  

• Incorrect size, shape, stiffness, and thickness of the nipple shield cause further feeding problems.   Nipple shields are not one size fits all. It is important to find one that is the right size for you. A nipple shield that does not fit properly may block the milk flow from your breasts. 

• It can be difficult to wean from the shield.

If a nipple shield is going to be used, it is advisable that:

• A clinician assesses and ensures that the circumstance necessitates shield use.

• A clinician tries various shields to ensure the best size and fit for the mother and baby.

• The smallest nipple shield that yields the best results is used.

• The shield is warmed before use. 

• The mother massages her breasts during feeding.  If the breasts are not well-softened after each feeding, mothers may need to pump until they are soft to ensure adequate supply. This will also lessen the risk of a plugged duct. 

• Baby will also need to be weighed frequently – at least every two weeks (make sure you use the same scale) – until it is clear that they are gaining enough weight.

Although nipple shields have proven helpful for many breastfeeding mothers, there are some contradictory data regarding the long-term effects of their use and the best method for weaning off the nipple shield and introducing the bare nipple.

Overall, it is best to consider all options and consult a lactation specialist before using a nipple shield.

Resources

• Chertok, I. R., Schneider, J., & Blackburn, S. (2006). A pilot study of maternal and term infant outcomes associated with ultrathin nipple shield use. Journal of Obstetric, Gynaecological and Neonatal Nursing, 265–272.
• Hanna, S., Wilson, M., & Norwood, S. (2013). A description of breastfeeding outcomes among U.S. mothers using nipple shields. Midwifery, 616–621.
• Meier, P. P., Brown, L. P., & Hurst, N. M. (2000). Nipple Shields for Preterm Infants: Effect on Milk Transfer and Duration of Breastfeeding. Journal of Human Lactation, 106-114.
• Walker, M. (2016). Nipple Shields What We Know, What We Wish We Knew, and How Best to Use Them. Clinical Lactation, 100-107.
• Maastrup, R., Walloee, S., & Kronborg, H. (2019). Nipple shield use in preterm infants: Prevalence, motives for use and association with exclusive breastfeeding—Results from a national cohort study. PLoS ONE, 1-13.
• McKechnie, A. C., & Eglash, A. (2010). Nipple Shields: A Review of the Literature. Breastfeeding Medicine, 309-314.
• Deng, Y., Huang, Y., Ning, P., Ma, S.-G., He, P.-Y., & Wang, Y. (2020). Maternal Risk Factors for Lactation Mastitis: A Meta-analysis. Western Journal of Nursing Research, 698-708.