IN THIS ISSUE
- Would you benefit from using a nipple shield?
- A closer look at when nipple shields can be useful
- Selecting a nipple shield
- How to use a nipple shield
- How to wean off of a nipple shield
- Support through CLS
WOULD YOU BENEFIT FROM USING A NIPPLE SHIELD?
A nipple shield is a soft, flexible silicone cover that was developed to cover the nipple and the areola of a breastfeeding mom. The tip of the shield has a number of holes in the tip that allows for breastmilk to flow through it. It was developed to aid those moms who were experiencing a variety of breastfeeding challenges from nipple pain to difficulty with latch.
The frustrations that accompany these breastfeeding hurdles can make breastfeeding very challenging for some women. If you are experiencing some of these challenges, then you may want to consider trying a nipple shield to help you get over these hurdles and maintain a breastfeeding relationship with your baby.
It is important to note that this is a temporary tool. In this handout, we will cover the pro’s, con’s, proper use of, and how to wean off of a nipple shield.
WHO MAY BENEFIT FROM USING A NIPPLE SHIELD?
- Women with flat, short or inverted nipples experiencing latch difficulties.
- Women who have sore or cracked nipples.
- Premature babies.
- Babies who were offered bottles and have developed a preference to bottle teats.
Furthermore, if using a shield, it is recommended that you seek help from a lactation consultant to help you identify what the root cause of your breastfeeding challenge is and how to best correct it before deciding if a nipple shield is the best choice for you. Sometimes, a little fine-tuning and extra help with latching or how you position your baby at the breast can be just the thing that you need to overcome your breastfeeding hurdles.
A CLOSER LOOK AT WHEN NIPPLES SHIELDS CAN BE USEFUL
POOR OR DIFFICULT LATCH DUE TO FLAT, SHORT OR INVERTED NIPPLES OR A TONGUE-TIE
The roof of a baby’s mouth acts as a trigger point for the sucking reflex. When your nipple is drawn into your baby’s mouth during latching, and reaches that spot between the junction of the hard and soft palate of the roof of the mouth, it sparks an interest in sucking and breastfeeding. But sometimes, when a mother has flat, short or inverted nipples, it may be difficult to get the nipple to reach that sweet spot that helps remind the baby to stay interested in latching and staying on. A well-fitted nipple shield may be able to provide that firm touch that acts as a trigger for breastfeeding.
This can also be the case, if a baby is identified to have a tight frenulum, where the tongue is attached to the baby’s mouth in such a way that it is unable to move freely, making it difficult remove milk from the breast. A tight frenulum can also cause a poor latch and/or sore cracked nipples, and use of nipple shield may help to ease the breastfeeding complications associated with this condition until you can get it further evaluated by a Ear-Nose & Throat specialist or Pediatric Dentist.
SORE OR CRACKED NIPPLES
A nipple shield will act as a barrier between your nipple and your baby’s mouth and likely reduce some of the pain involved with breastfeeding when the condition of your nipples is sore or there is damage to the skin.
However, sore, cracked, bleeding nipples are often a result of an improper or shallow latch, and it is very important to address this issue. Using a nipple shield during this time may help maintain the breastfeeding relationship between you and baby while you work on correcting and establishing a deeper latch.
Occasionally, there may be some additional feeding challenges for babies born prematurely (born before 37 weeks). Many of the reflexes needed for breastfeeding may not be fully developed in a baby born before 37 weeks. These reflexes include extending the tongue to grasp the breast, the rooting reflex, and a coordinated suck, swallow and breath pattern.
A nipple shield can be used as a tool to provide extra milk flow and the extra firm touch to roof of the mouth to give these babies a boost in their instincts for breastfeeding.
If your baby was introduced to a bottle, teat or pacifier before positive breastfeeding habits and a good latch could be established, it is possible that your baby may develop a preference to the feel of a firm pressure from this teat/pacifier and then go on to refuse your very own nipple. Use of nipple shield may be a good tool to help you transition your baby to the breast.
SELECTING A NIPPLE SHIELD
A nipple shield can be purchased in some stores that have a focus on baby supplies or can be purchased online. There are several brands and a variety of different shapes and sizes for nipple shields on the market.
One must take into account the baby’s mouth size as well as the mother’s nipple size when considering which size nipple to purchase. Sizes tend to range from 16 mm all the way up to 28 mm, but will oftentimes also be marketed as small, medium or large. It is recommended that a small size (16mm or 20mm) be used for premature or very small babies. The medium (24 mm) tends to be used most commonly for average sized, larger and older babies.
Some women will choose to use one size shield for one breast but may need a smaller and larger sized shield for the other breast, accommodating for variation in nipple size from side to side. As well, it is best to choose the largest size shield that works for you and your baby, so that the nipple can stretch and move freely within the shield without rubbing against the sides and causing any restriction in the milk flow.
Here is another tip for finding your optimal breast shield size: measure your nipple diameter: Using a ruler or measuring tape, measure the diameter of your nipple at the base (across the middle) in millimeters (mm). 1 cm = 10 mm. Do not include your areola.
After you have determined the correct size for your nipple shield, the next thing to consider is the shape of the shield and length of the nipple. Because each mother’s situation is different and because babies vary in size as well, mothers may need to try more than one shield before finding the right model.
While some shields are round in shape and will cover the nipple and areola more completely, others will have ‘cut-outs’ that allow for more skin contact and also allows for baby to better take in the smells of the mom and the breastmilk. Some cut-outs are more pronounced than others. Nipple lengths vary as well. If the length of the nipple causes your baby to gag, you may want to consider trying a shield with a slightly shorter nipple.
HOW TO USE A NIPPLE SHIELD
- Soaking or rinsing your nipple shield in warm water will not only help to make the shield more supple, but the film of water helps to create a better suction or seal once applied to the breast. Note that not all mother’s follow this step. It is reasonable to try without this step once you get comfortable using one.
Turn the shield inside out most of the way and place the tip of nipple shield over your nipple. Unfold the shield onto the
- breast, drawing the nipple and areola into the shield. Here is link to a video tutorial.
- Bring your baby to breast while holding the shield in place with your thumb and finger. If you are using a nipple shield that has a cut-out, remember, that this cut-out should be situated so that when baby latches, it is under your baby’s nose.
- Some moms find that adding a little lanolin ointment around the outer edge of the shield helps to keep the shield in place.
- It can encourage some babies to start sucking if there is already some of your milk in the end of the shield at the beginning of a feed. You can express a few drops into it, or you can use a dropper to add some already expressed milk into the tip before placing it on your breast.
- It is a good idea to keep an eye on your baby’s wet and dirty diapers while using a shield to make sure that your baby is getting enough milk (6-8 wets and at least 3-4 poopy diapers). You will want to listen for active swallowing sounds while your baby is feeding. Weight checks are also a good way to know if your baby is getting enough milk.
- Using a nipple shield in the early phases of nursing should include pumping after breastfeeding. This will help maximize milk removal and protect your supply.
- After each use, you will want to rinse the shield with cold water, then wash in hot, soapy water. Store shield in a clean, dry place.
- In addition to washing, you may sanitize your shield once per day by using a microsteam bag or boiling for 5 minutes.
HOW TO WEAN OFF OF A NIPPLE SHIELD
Nipple shields are a great short-term tool. Your lactation consultant can help you to identify your particular reasons for breastfeeding challenges and offer you help with overcoming these problems. A great goal to work towards is enjoying breastfeeding without the use of a nipple shield.
And even though this flimsy silicone shield was just the thing that some moms needed to help them continue with breastfeeding, they can be inconvenient to use, frustrating, and difficult to wean off of once a baby gets used to it. But with patience and perseverance, it can be done!
Here are some tips for weaning off of a nipple shield:
- Do not let your baby (or you!) get too frustrated during this process of weaning off of the nipple shield. Give it a try and if your baby fusses, cries or complains, use the shield for that feed, it’s ok. Try again next time, or even the following day.
- Skin to Skin feeds have been proven to re-wire a baby to their natural instincts for breastfeeding. If this is something that you are comfortable with, give it a try.
- Try to latch your baby at the VERY earliest feeding cues. When your baby starts to stir awake from a nap, a good time to latch without the shield is when your baby is barely awake.
- Nurse your baby often, even before feeding cues. A very hungry baby will be less willing to try something new.
- Prime your breasts for a feed by massaging them for a handful of seconds and even express a few drops of milk onto your nipple. Your baby will appreciate a fast taste of milk and the massage may stimulate a more rapid letdown.
- Work with a variety of latch techniques and positions to better help your baby latch. Some moms find it helpful to ‘sandwich’ the breast using your hand, in order to make the nipple/areola a better fit in baby’s mouth. Others find a ‘laid back’ (link to video) nursing position to be helpful in achieving a deeper latch.
- If your challenge is that your nipples are flat, inverted or soft, the above techniques can be helpful, but here are a few other tricks to get your nipple to be more erect or firm: If you gently tug on your nipple, pulling it out slightly, for a few seconds, this may help to elongate it and activate the erectile tissue in the nipple to firm-up. You can also try applying an ice cube to the nipple for a few seconds. There is a product called the ‘latch assist’ (link to video) that also aids in this goal. Pumping for a few minutes might also help to elongate the nipple in preparation for latch.
- Bait and switch: you can always try starting out a feed with the shield and then once your baby starts to show signs of fullness (muscles relaxing, eyes closing) you can unlatch your baby and very quickly remove the shield and try for a latch without it.
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Wambach. Riordan, Breastfeeding and Human Lactation 5th ed. Burlington, MA. Jones& Bartlett Learning 2016.
Medela. “When to Consider Using Nipple Shields” 2019.
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