The Case for and Against Nipple Shields

The Case For and Against Nipple Shields

A nipple shield is usually a thin, flexible silicone cover that is worn over the parent’s nipple.  This tool can be helpful or detrimental to breastfeeding, depending on how, why and when is being used.  The research on using nipple shields is very mixed.  The most important thing is that that parents have support from an IBCLC when using a nipple shield

The arguments against nipple shields:

  1. Nipple shields may be given in place of good lactation support, and can be difficult to wean from.

    The analogy that we use for nipple shields, is that they are kind of like the “gutter guards” at a bowling alley…they make it hard to miss the target.  We see them given out frequently to new parents in the hospital, because they make it easy to get the baby to latch on, even if the baby is not latching correctly.    The shields are often longer and firmer than the parent’s nipple.  And often when using a nipple shield, the parent will force their nipple into the baby’s mouth instead of waiting until the baby is open WIDE and latching the baby properly to the breast.  Because of this, both babies and parents often learn bad habits or compensations that won’t work without the nipple shield and can make it difficult to wean from the shield. 

 

  1. Nipple shield use may be correlated with a reduction in the rate of exclusive breastfeeding and premature weaning.

    New research published in September of 2019, showed that nipple shield use in the hospital with NICU babies resulted in less exclusive breastfeeding rates at discharge. Older research had mixed results, with some studies showing a decrease in breastfeeding rates and durations and others showing no significant difference.

    In our practice, parents often expressed frustration with using a nipple shield when the need to use a shield went beyond the first week or two of breastfeeding. They often find them hard to keep up with, a hassle to clean, and reported that it made it more difficult to breastfeed in public.  All of these frustrations could easily lead to premature weaning.

 

  1. Nipple shields might decrease the amount of milk the baby gets when feeding at the breast, which could decrease the parent’s supply.

    This is another area where the research has mixed results. Several studies have shown that less milk may be transferred when using a nipple shield; however, some of these studies used older-style, thicker nipple shields, so this may not be applicable to using the newer thinner shields most parents use today.  Another study looking at milk transfer with premature infants, found that nipple shield use increased how much milk the babies were able to get when feeding at the breast.  Studies of full term infants have shown no difference in milk transfer for infant using a shield and those not using a shield.

    One of the theories as to why using a nipple shield would decrease a parent’s supply is that the nipple shield forms a barrier between the parent and baby, decreasing the sensation and stimulation at the breast.  It is theorized that premature infants may be able to transfer more milk with a nipple shield due to lack of fat in their cheeks, which makes it difficult to create an effective seal at the breast.

 

  1. Using a nipple shield might decrease a parent’s confidence in breastfeeding.

    While most studies show that parents who used nipple shields for a short period of time reported that using a shield helped them be more successful in breastfeeding, this is not true for all parents. In some studies, the need to use the nipple shield, especially long-term, undermined the parent’s confidence, which could explain the reduced duration of exclusive breastfeeding noted in some studies.  Additionally, the need to use something artificial to facilitate the baby’s latch on the breast can undermine the parent’s confidence.

 

The argument for using a nipple shield:

  1. Can be helpful to establish latch with a baby who is premature, has difficulty sealing at the breast, or has a weak suck.

    For babies who are premature, have oral dysfunction or a weak suck, the nipple shield can form the seal at the breast for the baby.  This creates a place of negative pressure that allows the parent’s milk to flow and collect in the end of the shield, making it available to the baby.  For these babies, using a shield can help improve their experience at the breast in the short term, giving the baby time to grow and improve in skills.

  2. May allow a parent to continue to offer the breast when having trouble latching the baby to the breast.

    Research shows that using a nipple shield can increase a parent’s confidence and willingness to continue to breastfeed when they are having difficulty with latching, especially when their baby seems frustrated and distressed when latching or when the parent is experiencing nipple pain.

  3. May reduce nipple pain from an incorrect latch, allowing the parent to continue to offer the breast while working on improving the baby’s latch.

    Sometimes, a nipple shield can decrease the pain a parent experiences when the latch is incorrect. If we are having difficulty getting to a comfortable latch, nipple shields might be helpful to decrease the pain. However, not all parents experience a decrease in nipple pain when using a nipple shield and in some cases has been reported to increase nipple trauma or pain when latching.

  4. Can increase a parent’s confidence in their ability to feed their baby at the breast.

    There is some good research that shows that when a parent is struggling with breastfeeding, and is unable to feed their baby directly at the breast, using a nipple shield can help the parent gain confidence in their ability to breastfeed.

The Verdict:

There are a lot of pros and cons to using nipple shield.  Ultimately, we believe that if using a nipple shield prevents a parent from discontinuing breastfeeding, that is the better choice.  Nipple shields can be helpful in some situations, but we also believe that they should only be used when all other interventions have failed, and only with the support of an IBCLC.  The goal should be to use the nipple shield to bridge the gap and keep the baby feeding at the breast while the parent and their IBCLC work towards a solution that allows the baby to feed effectively without the shield.

 

Sources:

https://lacted.org/questions/0166-nipple-shield-premature-infants/

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4607874/

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