How to Use a Nipple Shield

Written by: Sabrina Granniss, IBCLC

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Time to read 6 min

Were you and your baby given a nipple shield in the first few days after birth? While babies are designed for breastfeeding and are born with reflexes to assist them in finding the breast and attaching to the areola and nipple to feed right after birth, it doesn’t always go as planned. 


There are many circumstances leading to the introduction of a nipple shield. While a nipple shield won't solve latch or feeding difficulties, it can be a tool that preserves breastfeeding until the challenges are resolved.


Did you know there are a variety of shield options? There are also some tips & tricks that are helpful for properly attaching and using the shield effectively. Each mom and baby is unique, so experimenting with different shields will help you find the best match for you and your baby.


Comparing & choosing the best nipple shield for your baby

Nipple: shape and style

  • Conical - the nipple shape has straight sidewalls continuing right to the base. It does not indent down the shaft of the shield’s nipple. It is slightly wider at the base of the nipple than the tip. It is made of very thin, flexible silicone, and the mom’s nipple will extend into the shield’s nipple tip while the baby is latched and nursing.

  • Cherry - this style is similar to the conical shape except as the shield’s nipple meets the base, it indents a little. It can help the baby’s mouth “grab” the nipple or be able to hold on to the nipple better. Mom’s nipple will extend into most of the nipple on the shield while the baby nurses.

  • Bottle nipple style - the nipple on this shield style resembles a combination of a bottle nipple and nipple shield. The nipple may be more round (similar to the conical-shaped shield), cherry-shaped, or flatter on one side and round on the other side of the nipple tip. All these shapes flare out as they reach the base of the nipple shield. Some nipple shields in this style leave more space between the mom’s nipple and the baby’s mouth compared to the soft silicone shields mentioned above. This shield may be helpful when the baby is transitioning from bottle to breast or vice versa. If the baby is clamping down and causing pain for the mom during nursing, this shield may offer relief.

Nipple shield base: shape and style

  • Round base - Sometimes, the silicone on a full round base shield is slightly thicker than versions with a cut-out section. They are a full-coverage base and can be easier to apply to the breast. Some versions are wider on one side than the other. If that describes your shield, the narrower side is placed where the baby’s nose will land on your breast.

  • Cut-out base - The cut-away part of this shield allows the baby’s nose to have skin-to-skin contact with the mom’s breast while using the nipple shield.

  • Butterfly base - This base has 2 parts that are cut out. When applied, the baby’s nose and chin will be where the cut-out sections are, allowing both the nose and chin to touch the breast directly.


Size matters


  • Nipple shields come in different sizes and should be the closest fit for better comfort so your baby is able to get more milk while using the shield. 
  • You will want to measure your nipple to know what size nipple shield to get. This is not only for your benefit; the nipple size should not be too long for your baby's mouth. If it is longer than the length of the roof of the baby's mouth, where the juncture of the hard and soft palate is, it can cause your baby to gag.
  • Nipple shields come in millimeter sizes but may also be sold in small, medium, or large sizes. (1)
  • You will want a size that allows your nipple and a small part of your areola to pull into the nipple of the shield. 
  • The base of the nipple shaft on a shield is often slightly wider than the nipple tip measurement. For a good fit, select a nipple shield that is 0-4mm larger than your nipple measurement. 
  • You may need to experiment with different styles and sizes to find what works best for you and your baby.


How to apply the nipple shield

  • Always wash your hands and nipple shield before applying it to your body.

  • Hold the nipple shield between your thumb and index finger with both hands. If your shield is butterfly-shaped, hold the wide part of the nipple shield base.

  • Stretch the nipple shield base with your fingers while inverting the shield so the nipple part presses inward.

  • Place the shield nipple directly over your nipple so your nipple is centered in the shield nipple.

  • Give the shield one more stretch as you flatten the base over your areola and see that your nipple and a small part of the areola are drawn into the shield.

  • If the shield is not staying on well, you can run it under warm water or rub a little breastmilk or nipple cream onto the inside of the nipple shield base.

  • Heat from your body or placing the shield between your hands to warm it up can help the material soften and stretch more easily, which helps it grab more breast tissue when applying it.

  • If your nipple is rubbing on the shield tunnel, remove it and ensure it is directly centered over your nipple.

How to know if the nipple shield is on correctly

If your shield is on correctly, it will stay on better and not slide around or come off while your baby is latched. It should be flush against your breast tissue and not roll or curl up when your baby latches on to nurse.


The nipple shield should pull in a small amount of areola as well as the nipple. When your baby nurses with a well-fitting shield, they should be able to latch deeply with the entire nipple of the shield in their mouth as well as a portion of the areola. We want your baby to “breast” feed, not just “nipple” feed.


After you attach your shield, give it a gentle flick or push on the side of the shield’s nipple shaft. It should be secure and not lose suction to your breast tissue. If it stays in place, you are ready to latch your baby.


You may feel a slight tugging as your baby nurses, but at no point should you feel pinching or pain. Your baby’s lips should be flanged while latched, and their mouth and jaw should be open wide, not just a little. Your baby’s lips should be touching your breast, their chin pressed into your breast, and not just latched on the shield’s nipple. Keep your baby tucked in close to your body with their ear, shoulder, and hip in a straight line.


Your breasts should feel less full and relieved after your baby nurses. Your baby should seem satisfied after being nursed and may unlatch themselves until they are ready to feed again.

Other considerations

  • Nipple shields can be used with supplemental nursing systems if your baby needs additional supplementation while feeding.

  • You can hand express a little milk into the nipple shield before your baby latches. This gives your baby milk with their first suck. When your baby gets milk right away from a suck, it triggers them to suck more and stay active during feeding.

  • It is normal for milk to pool inside the shield’s nipple tip at the end of a feeding. It is a good sign that your shield is the right fit and that it is not reducing the amount of milk your baby is able to remove during feeding.

  • Keep a nipple shield in every location you might need to use it, including your bedside table, in the car, in the diaper bag, and where you nurse during the day.

  • Between uses, wash the shield with warm, soapy water. Once per day, you should sanitize the nipple shield by boiling it for 5 minutes or following the sanitization instructions it came with.


Many times, a nipple shield is given in the first few days of your baby’s life and may not come with lots of information on how to use it properly and effectively or a plan for weaning off the shield. Having the proper fit for a shield and one with features that match your baby’s needs to feed well makes a big difference. A longer-term plan for nipple shield use should be discussed with your IBCLC (International Board Certified Lactation Consultant), but knowing how to use it in the meantime will help you and your baby use it correctly. It can be a helpful tool for preserving your breastfeeding relationship.




Footnotes:


  1. https://connect.springerpub.com/highwire_display/entity_view/node/67736/full


References:

https://www.frontiersin.org/articles/10.3389/fpubh.2015.00236/full

https://pubmed.ncbi.nlm.nih.gov/9025446/

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3014757/

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7487699/