Plastic Nipple Cap for Breast Feeding

A nipple shield is a thin, silicone teat that can be placed over a mother's nipple and may help a baby who is having difficulty learning to breastfeed. Holes in the tip allow milk to flow into the baby's mouth. A nipple shield can be used temporarily to help establish breastfeeding or in some cases to help ensure that breastfeeding continues. A shield provides a firm stimulus at the roof of a baby's mouth where the soft and hard palate meet. This can help him suckle more effectively.

If your baby is not nursing at all, or is nursing ineffectively despite improving attachment and increasing milk flow, a nipple shield may help by providing a firmer stimulus in your baby's mouth. A nipple shield may be a useful tool in some situations. When nothing else works, it can be a temporary way to establish and maintain breastfeeding.

A nipple shield may be helpful if

Your baby is struggling to learn how to breastfeed
You have flat or inverted nipples, or very soft breasts as it can help maintain nipple shape
Your baby thrusts his tongue, has a retracted tongue or has neurological problems
Your baby was born prematurely
Your baby needs extra stimulus to prompt sucking

In these situations, a nipple shield can

Give a baby the opportunity to learn to breastfeed
Allow a baby who breastfeeds ineffectively to take more milk directly at the breast. This can be particularly helpful for premature babies
Avoid or reduce the need to express milk and use cups or bottles
Help keep breastfeeding going

Not a magic solution

It is very important to seek skilled help with positioning, attachment and any other problems if you are planning to use nipple shields or are already using them. Helping your baby get a deep latch at the breast is the key to effective and comfortable nursing with or without a nipple shield. A shield cannot correct underlying problems, especially those of sore and damaged nipples or low milk production. And if your baby is not attached well he may compress your nipple, causing damage and intense pain. When your baby latches on deeply at the breast he gets plenty of milk. Also, as you wean from the shield he will be able to adapt to breastfeeding effectively and comfortably without it.

Source: United States Breastfeeding Committee

Even with a nipple shield, your baby may still need help to learn to breastfeed well. Sometimes just a small adjustment to the way you hold your baby makes a big difference. You may find the suggestions and pictures in Comfortable Breastfeeding helpful. If you cannot get comfortable or breastfeeds are taking an hour or more, seek help from an LLL Leader who can give you personalised suggestions.

Holding your baby in skin-to-skin contact can make a big difference too. With or without a shield, laid back or 'natural' breastfeeding positions (see above) can be a great help in encouraging your baby to latch on effectively, as well as being comfortable for you. You can either lie down or recline with your baby on top of you and with his whole front against you and his body completely supported by yours. Such positions also leave both your hands free to shape your breast and help him latch.

If your baby won't breastfeed

Don't panic! Some babies take time to learn. However, babies will often latch on and suckle spontaneously if they can snuggle up close to their mother's bare chest for periods of time. Try letting your baby lie on your body as you recline so that both his chest and tummy are against you. This kind of contact, known as Biological Nurturing™, or laid back breastfeeding usually stimulates a baby's instinct to attach and suckle well at the breast. In such positions, babies can also latch on when sleepy or even asleep. Watch for signs your baby is stirring and gently encourage feeding. If he is not breastfeeding effectively or at all you will need to express your milk for him. This will help maintain your milk production while he learns to breastfeed. An LLL Leader can give you tips for effective milk expression.

Is he getting enough milk?

Offer frequent feeds and monitor wet and dirty nappies for evidence your baby is getting plenty of milk. His weight will need checking regularly—as often as every three days for premature babies. For more information see Is My Baby Getting Enough Milk?

Check your breasts

Areas that aren't being drained well may appear swollen, sore or red. Treat early signs of localised engorgement to avoid a blocked duct or mastitis.

Practicaliti es
Type and fit
Modern nipple shields are made of clear ultra thin silicone. Different makes vary in flexibility. Some shields have a cut out section, but these may not stay in place as well as a full nipple shield. Full nipple shields do not bother babies or affect their breathing. Nipple shields come in different sizes but choice is limited. Both the width of the tip section and the shape of the flat part vary and you may need to experiment to find which size and shape you prefer. A comfortable fit is very important and some mothers need more than one size of nipple shield due to differences between their breasts.

Applying
Stretching the shield onto the breast can help it stay in place. You can also moisten the shield's edges or warm it with hot water to help prevent it moving. Turn the nipple shield almost inside out before applying it. Smooth it onto the breast, starting well away from the nipple in the area where your baby's lower jaw will latch on. Stretch the shield over your breast, with the tip centred over your nipple. The nipple shield should be tight against your breast with your nipple extending into the tip. If necessary, you can express milk into the tip or drip expressed milk onto the outside to encourage your baby to latch on.

3 photos showing stages of turning a nipple shield inside out to place on nipple

Turning a nipple shield almost inside out before applying helps draw your nipple in. Put on your nipple and then smooth the edges onto your breast.

Cleaning
If you and/or your baby are in hospital, wash the nipple shield thoroughly in hot soapy water and sterilise it before each use. If you have a healthy, full-term baby and are at home, cleaning with hot soapy water or washing in a dishwasher on a hot cycle will be sufficient. Shields should be dried thoroughly before use and stored in a clean, sealed container or bag.

A faster flow
Swallowing encourages sucking, which will help keep milk flowing. A baby who has become used to a continuous fast flow from a bottle may need help to persist with breastfeeding. Hand expressing for a few minutes can encourage a good flow of milk before your baby latches on. You can even hand express milk into your baby's mouth to encourage him to latch on or keep him nursing when your milk flows more slowly.

Try breast compression

Support your breast with one hand—thumb on one side, fingers on the other.
Wait while your baby breastfeeds actively, his jaw moving all the way to his ear. When he stops swallowing, compress your breast firmly. Hold it squeezed until he stops nursing actively and then release your hand.
Rotate your hand around your breast and repeat step 2 on different areas of the breast as needed. Go gently—this should not hurt.

Use a shield with a nursing supplementer

If your baby needs extra milk, a nursing supplementer can be used to deliver this through a tube as your baby breastfeeds. This avoids the need to bottle feed. The end of the supplementer tube can be placed either inside or outside the shield. Consult an LLL Leader if you think a nursing supplementer may be helpful.

Giving up the shields

Nipple shields are intended to be a temporary solution until your baby learns to breastfeed without them. When using a shield, help your baby to latch on by himself with a wide open mouth. This will help him to learn to breastfeed without a shield. Offer your baby some time in skin-to-skin contact every day without a nipple shield so he has the opportunity to latch on if he is able. It can take time to wean from shields but do keep gently trying. Try at times when you and your baby are most comfortable and relaxed and there are fewest distractions. You can try different methods to see what suits your baby.

Start with skin-to-skin next to breast without the nipple shield before nursing with the shield.
Start a feed with a shield, removing it part way through nursing from one breast or when switching breasts.
Gradually offer the breast without the shield.

DO NOT CUT a silicone shield as this could leave sharp edges that would hurt you and your baby.

Smiling mother and baby looking at camera

Source: United States Breastfeeding Committee

Seek support

Whilst you may be relieved that a nipple shield is enabling your baby to breastfeed, it can be frustrating if he will not feed without it. However, given time and patience, it is usually possible for a baby to learn to breastfeed without the shield. An LLL Leader can be a useful source of support if you need to choose, use and wean from nipple shields.

Written by Karen Butler, Sue Upstone and mothers of La Leche League GB.

Teresa Fand1976