Scientific Article

Advantages of using Nipple Shields

Clare Byam-Cook SRN SCM

Nipple shields can be the brilliant answer to so many breastfeeding problems and yet many mothers have never even heard of them, let alone know how or when to use them. Moreover, many of mothers who have tried using them, have only done so on the recommendation of friends or family, rather than at the suggestion of their midwife or breastfeeding counsellor.

This secrecy about nipple shields is largely due to the fact that many (but thankfully not all) health professionals are totally opposed to their use and will therefore never discuss how or when they can be used. They claim that shields should not be used because:

  • The shield will create “nipple confusion”, which will cause a baby to lose his ability to suck correctly on the breast. 
  • Feeds will take much longer and the baby won’t be able to get as much milk through a shield as he would when feeding direct from the breast 
  •  A shield will reduce a mothers’ milk supply as her breasts will not be as fully stimulated and emptied as they would be with “normal” breastfeeding. 

Whilst I would agree that nipple shields are not suitable for everyone, this is no reason to prevent them ever being tried. I don’t think that mothers should worry about ‘nipple/ teat’ confusion because in my experience this rarely happens. In any event, it is better to try using a nipple shield than to give up breastfeeding completely - which is what often happens when a mother is finding breastfeeding too painful or difficult.

Because it is undoubtedly true that nipple shields will not work for everyone, each mother must experiment for herself to see whether they will work for her. Nipple shields will usually work really well if a mother has plenty of milk which flows quickly, but if she has a poor supply of milk and/or a slow let-down the baby may struggle to get enough milk through the shield.

Many breastfeeding problems (see below) can be helped by using nipple shields, but you need to work out how to use them and check that your baby can feed properly via the shield before relying on them as the solution to all your breastfeeding problems.

Nipple shields can be tried for any of the following problems:

  •  Sore nipples : This is the most common reason for using shields and a mother may only need to use them for a few feeds until her nipples recover. But if sore nipples continue to be a problem, it is important to realise that better positioning of the baby at the breast is the key to successful breastfeeding.
Note: I explain how to latch a baby on quickly and pain free in my books and on my DVD.
  • Difficulty in latching onto large or flat nipples : Some mothers, who have a combination of large nipples and a baby with a very small mouth, might find latching on extremely difficult. Shaping the breast (as described in my books) will usually resolve this problem, but some mothers find it hard to manage the technique and sometimes the baby really can’t get enough breast into his mouth to feed effectively. In these cases, a nipple shield provides something the baby can get hold of so he can feed from the breast in the same way that he would from a bottle. 
  • Primary Engorgement: When the milk first comes in, breasts can sometimes become so hard and engorged that the baby temporarily can’t latch on. In this situation, mothers are usually advised to express some milk until the breasts become softer - this works well but is time consuming and also involves sterilising pumps and bottles. A quicker and easier solution is to try using a nipple shield for the first few minutes and then put him direct onto the breast once latching becomes easier. 
  • Tongue-Tie: If a baby has a tongue-tie that is preventing him from sucking properly, a nipple shield may help him breast-feed until the tongue-tie is cut. 
  • Excessively fast milk flow: Some mothers have such a fast flow of milk that the baby simply can’t cope with the rush of milk. These babies will typically suck at the breast for a very short time and then start gulping and choking on the milk. If the baby then pulls away crying and appearing distressed, he is almost certainly being frightened by the sheer speed at which the milk is flowing and he will probably get more and more panicky with each subsequent feed. If this happens, a shield will usually solve the problem immediately, by slowing and containing the flow of milk so the baby can feed at his own pace.

These are my guidelines:

  • A baby will not be able to get colostrum through the shield so a shield should not be used until the mother’s milk comes in. 
  • Nipple shields come in several different sizes and it is important to use the one that best fits the size of your baby’s mouth. I most frequently use the MAM size 1 nipple shield for very young babies, but if the mother has large and hard ‘marble’ type nipples she might need to use the larger size.
  • Place the shield over your nipple and then latch your baby on quickly. If you bring him too slowly to the breast or don't hold him in close enough he will keep knocking the shield off and he won't be able to feed properly. He should be held in so closely that both his nose and his chin are touching your breast.
  • You will be able to tell whether he is getting the milk properly through the shield by the way he sucks. He should start off by doing some very quick sucks to stimulate your let-down. Then, if the milk starts flowing freely you will notice that he suddenly changes to slow, deep and rhythmic sucking. You might also hear him swallowing.
  • You can also check how well he is feeding by taking him off after a few minutes of sucking to see what is happening. If there is a pool of milk inside the end of the shield he will be getting the milk easily and you can continue to feed him through the shield. But if there is little or no milk visible it is likely (but not absolutely certain) that the milk is not flowing freely and he may be unable to get a full feed through the shield.
  • Ultimately, your best guide as to success or failure when using nipple shields is to see how long your baby feeds and how well he settles after each feed - the quicker he feeds and the longer he lasts in between feeds, the better the shields are working.

How long can/should I use them for?

If your baby is getting plenty of milk and feeds are not taking too long, you can carry on using them indefinitely. But if feeds become significantly longer, your baby is not settling after feeds because he is not getting enough milk through the shield and/or you notice that your milk supply is reducing, they are clearly not working and you should stop using them.

Case History

Sarah came to see me when her baby Joshua was three weeks old. Breastfeeding was proving to be very difficult because he kept pulling off the breast after only a few sucks and she was endlessly having to wind him and then re-attach him. It was obvious to me that the problem was that her milk was flowing so fast that Joshua was choking and panicking and this is why he kept pulling off. The problem was easily resolved with a nipple shield. As soon as I put it on, he was able to feed calmly and  happily thanks to the nipple shield slowing the flow of the milk and enabling him to drink at his own pace. Sarah continued to use the shield for many months because Joshua got really upset whenever she tried to latch him on without them. 

Despite the fact that Joshua was happy, settled and gaining weight, Sarah’s Health Visitor told her at his 4 month weigh-in that she should stop using the shield because ‘it will cause nipple confusion and reduce your milk supply’!

Clare Byam-Cook SRN SCM

Nurse and Midwife

Clare Byam-Cook trained as a nurse and a midwife. She worked for several years at Queen Charlotte’s Maternity Hospital in London before joining Christine Hill’s antenatal practice in Chiswick in 1989, where she taught the breast-feeding classes until 2013. Clare carries out home or hospital visits to any  mother who is having feeding problems and also sees clients at her house in Putney, London. All of Clare’s clients come to her through word-of-mouth referral from GP’s, obstetricians, paediatricians, Health Visitors, midwives and previous clients. Clare has written articles and been a guest expert for various baby magazines including Mother & Baby. She regularly appears on television and radio, including This Morning, BBC Breakfast, Sky News, Channel 5 News, BBC Radio London and Woman’s Hour. Clare is one of the main speakers at The Baby Show which is held three times a year at Olympia, the NEC Birmingham and Excel.

She is author of ‘What to Expect when You’re Breastfeeding…and What if you Can’t?’, ‘Top Tips for Breastfeeding’, ‘Top Tips for Bottle-feeding’ and presenter of the DVD “Breastfeeding without Tears”