Care Plan: How to Use a Nipple Shield

What is a nipple shield?

A nipple shield is a thin silicone circle with a nipple-shaped protrusion that you place over your nipple, something like putting a contact lens in your eye. It can be a great way to help your baby transition into breastfeeding, since it offers something firm and formed to latch onto.

One common misconception that you want to monitor when using a nipple shield is the assumption that your baby is getting a full feeding while nursing because he's latched on. Always look for signs that your baby is getting enough at each feeding.

Ideally, nipple shields should only be used when the breastfeeding problem is the latch, not your milk supply. If your milk supply is just enough or low, the nipple shield isn't the best answer to the latch problem. If this is the case, you'll have to keep pumping and supplementing until your supply increases.

How to Use a Nipple Shield (Latch Problem)

• Place the shield over your breast, centered over the nipple, with your thumb and forefinger holding it in place at the edges. Support your baby using the cross-cradle hold and allow him to draw himself onto the nipple shield, with you guiding his head (you don't need to focus as much on the proper latch, since the shield does the work for the baby). Once he's on, hold your baby very tightly to the breast by pushing your hand gently between his shoulder blades. The nipple shield tends to work best in transferring milk when your baby is held firmly to your breast and when his mouth is wide open at the shield.
• Look for active sucking and swallowing. When he slows down, pull him closer and compress your breast. This will help the flow of milk into his mouth. Once he's no longer responding to the compression, take him off your breast; you can burp or wake him at this point. Move the shield and your baby to your other breast and keep feeding.
• You might even want to do some switch-nursing, offering 4 breasts per feeding. This helps if your baby is transitioning from bottle feeding, since he'll be used to a consistent flow of milk. Switch-nursing offers a more consistent flow because one breast has a chance to fill up with more milk as you feed from the other.
• Use the shield with breast compressions or switch-nursing for a maximum of 45 minutes at a feeding. At this point, if your baby has been drinking steadily, look for signs that he's satisfied: hiccups, deep sleep and good breaks between feeds. Long-term signs include wet and poopy diapers, steady weight gain and satisfied behavior. If your baby seems satisfied, you don't need to supplement afterward with a bottle.
• If your baby hasn't breastfed steadily and seems fussy or hungry after feeding with the nipple shield, limit his time at the breast to 20 to 25 minutes in total, then supplement with a bottle afterward.
• After each feeding, regardless of whether your baby fed well, double pump your breasts for 12 to 15 minutes to keep your supply up. This helps in both supply scenarios. For those with a good supply, the shield works best when your milk is in oversupply. If you had a low supply to begin with, it will continue to boost your milk.
• IMPORTANT: At each feeding, either after your baby has fed on the shield for a few minutes or at the start of the feeding, offer your breast without the shield. Many times, he'll get it and latch on. If he's still struggling, put the shield back in place and keep feeding.
• When you're confident that he's getting a full feeding on the shield or without it every time you breastfeed, start to wean off pumping. First drop one pumping session, letting your breasts adjust for a few days, then drop another. Take about 7 to 10 days to completely wean off pumping, so your milk supply doesn't drop too much. At the end of this process, if you're still using the shield, keep pushing your baby to latch on without it. In time, he'll catch on.

Don't worry that your baby won't want to breastfeed without the shield. If you persist patiently with the Care Plan, and you keep offering your breast without the shield at every feeding, your baby will latch on.

Tips for Success

• Look for active sucking and swallowing, when your baby slows down, pull them closer and compress your breast.
• Noticing signs that your baby is satisfied is key. Look for hiccups, deep sleep and steady weight gain in the long term. A satisfied baby is most definitely a happy baby.

Source: Heather Kelly is an International Board Certified Lactation Consultant (IBCLC) who also sits on the Bravado Breastfeeding Information Council. Heather has been practicing in New York City since 2001.