Nipple Shields

Nipple Shields (aren’t cheating)

Getting Started with A Nipple Shield

We recommend the Medela Contact Nipple Shield. You should be using a size Medium unless specifically directed otherwise. Shields are fitted based upon your nipple diameter, not based upon the size of the baby’s mouth. Hint: If you pump with a size 24 mm (M) or larger flange, you should be in a size Medium nipple shield.

  1. Applying the nipple shield: Partially invert the nipple shield and center it on your nipple. The cut out of the shield should be placed where the baby’s nose will land. Sometimes the plastic flips back on the baby’s face. That’s ok. If the cut out is in the right spot, there is no worry that the plastic will block baby’s nose.

  1. Checking placement of the shield: Before latching baby on, make sure your nipple is centered in the shield. It shouldn’t be squashed off the one side (that will hurt when baby latches!)

  1. Latching baby onto the shield: Utilize the same techniques to achieve a deep latch as you would without the shield, but align the baby’s mouth with the shield rather than placing the nipple on the baby’s nose. Wait for baby to open wide and then push him on quickly and assertively from the shoulder blades. Baby should start sucking right away. If he pulls his head back, let him, then try again.

Once the baby is latched onto the shield, check the latch:

  1. You should feel a strong tug, not a sharp pinch. If you are feeling a sharp pinch, the shield may be crooked on your nipple or the shield may be too small. Adjust and try again.

  2. Both lips should be flayed out like a fish. With the shield, it is acceptable to manipulate baby’s mouth to make this happen or unlatch and re-latch.

  3. Baby’s lips should be touching breast tissue and you shouldn’t see the nipple portion of the shield popping in and out of the baby’s mouth. If this is happening, pull baby’s body in closer to you and angle the baby’s head so his chin is in deeper and his nose falls slightly away from the breast like he is drinking from a glass.

Make Sure Your Shield Is Working

  1. After nursing, you should see a little milk left in the nipple shield.

  2. Once your milk is in, you should hear and see baby swallowing.

  3. Your breast should feel softer after feeding.

  4. Baby’s weight gain and diaper count should be within normal limits.

  5. You should not feel pain while nursing.

  6. The baby should seem satisfied after nursing on one or both breasts (remember to always offer the second breast!)

How to wean from the nipple shield

There is no particular time you must get off a nipple shield. Some women need it for a few days, others for a few weeks. When you are ready to start trying, follow these suggestions.

  • Attempt at a time when both you and baby are feeling patient and in a good mood (not 3am!).

  • Try Nursing with the shield first, then taking the shield away and attempting a latch.

  • Try before baby gets very hungry, right when you see early hunger cues.

  • Spend lots of time skin to skin. Try bathing together and letting your baby try to find the nipple on his own.

  • Get a crash course from a Lactation Consultant before getting too frustrated.  If your first few attempts aren’t going well, or the latch is really painful without the shield, schedule an appointment with the LC.  Nursing with a shield is quite different than nursing without and there are a few techniques that have become second nature that now need to change.  Don’t feel like you have to do this alone!

When to Seek Help with Your Nipple Shield

  1. If you have a persistently painful latch with or without the shield

  2. If baby isn’t gaining weight well or having adequate diaper output

  3. If you are trying to stop using the shield and you cannot obtain a comfortable latch or get baby to latch at all

Lastly, here are some times when nipple shields are appropriate:

  1. Nipple confusion: If we have a baby that was exposed to another nipple and can’t seem to figure out how to get on the boob (think angry trout on a fishing line). This baby shakes his head, rooting uncontrollably with the nipple in his mouth, but he just won’t suck! This baby is waiting for something to hit his sucking reflex in the roof of his mouth and the breast just can’t do that. Here, a nipple shield will elicit his sucking reflex and get him right on. This will teach him to trust that milk comes from the breast again and give mom the confidence that she can feed the baby again. Once the two of them have nursing with the shields down pat, she can consider weaning off the shield when she is ready.
  2. Flat or inverted nipples: I mean, I know babies breastfeed, not nipple feed, but how is a baby supposed to latch onto a bowling ball? Even if the baby can get on a little in the first few days, once mom’s milk comes in that nipple is going to get even flatter and her breast tissue firmer making latching virtually impossible. Slap a shield on that booby.
  3. For a premie that needs extra oral support when learning how to nurse.
  4. SOMETIMES for nipple pain. Shields are not meant to fix nipple pain. If you try to use a shield on top of busted up nipples, it may help a little at first but isn’t going to fix the problem. So if you are using a shield because you have sore nipples, it is time to see an IBCLC.