Nipple Shield for Breastfeeding: Should You Use One?

What is a nipple shield and how does it work?

A nipple shield is a thin, flexible silicone device worn over the nipple and part of the areola during breastfeeding. The baby latches onto the shield rather than directly onto the nipple. The shield has holes at the tip that allow milk to flow through as the baby sucks.

The intended mechanism is to create a firmer, more consistent surface for a baby who is having difficulty latching onto a soft, flat, or inverted nipple, or who has learned to expect the firmer feel of a bottle. Nipple shields come in different sizes; proper fit matters for both comfort and milk flow 1Ref 1Coentro VS, Perrella SL, Lai CT, Rea A, Murray K, Geddes DT (2020).Effect of nipple shield use on milk removal: a mechanistic study.Mechanistic study finding that nipple shield use may reduce milk removal — approximately 25% less milk pumped with shields, highlighting the supply risk when shields are used without monitoring.

When is a nipple shield recommended?

A lactation consultant may suggest a nipple shield in specific circumstances:

• Flat or inverted nipples that make it difficult for the baby to latch and maintain suction
• Prematurity — preterm babies often have immature suckling coordination and may feed more effectively with a shield in the short term while developing strength 2Ref 2Berens P, Eglash A, Malloy M, Steube AM; Academy of Breastfeeding Medicine (2016).ABM Clinical Protocol #26: Persistent Pain with Breastfeeding.Clinical indications for nipple shield use including flat/inverted nipples, prematurity, and nipple pain; cautions regarding milk supply and transfer; importance of lactation consultant guidance and weaning planning
• Latch refusal or breast-bottle confusion — when a baby is used to a bottle and is refusing the breast, a shield can bridge the difference in texture and firmness
• Nipple pain — while not a first-line solution, a shield is sometimes used short-term to reduce pain while latch issues are being corrected 2Ref 2Berens P, Eglash A, Malloy M, Steube AM; Academy of Breastfeeding Medicine (2016).ABM Clinical Protocol #26: Persistent Pain with Breastfeeding.Clinical indications for nipple shield use including flat/inverted nipples, prematurity, and nipple pain; cautions regarding milk supply and transfer; importance of lactation consultant guidance and weaning planning

These are specific clinical indications, not general breastfeeding difficulties. A shield is not a first-step fix for routine early feeding challenges.

What are the potential downsides?

Nipple shields carry real tradeoffs that make professional guidance essential:

Reduced milk removal. A 2020 mechanistic study found that nipple shield use may reduce milk removal — in pumping experiments, approximately 25% less milk was removed with shields compared to without 1Ref 1Coentro VS, Perrella SL, Lai CT, Rea A, Murray K, Geddes DT (2020).Effect of nipple shield use on milk removal: a mechanistic study.Mechanistic study finding that nipple shield use may reduce milk removal — approximately 25% less milk pumped with shields, highlighting the supply risk when shields are used without monitoring. If a baby is not fully draining the breast because of the shield, milk supply can decrease over time.

Reduced milk transfer signal. Because the baby's mouth does not directly contact the nipple and areola, the nipple stimulation that signals the body to produce milk may be reduced.

Size matters. A shield that is too large or too small for a parent's nipple can worsen milk removal rather than improve it.

Extended dependence. Some babies become accustomed to the shield and resist returning to direct nursing. Weaning from the shield requires a deliberate plan 2Ref 2Berens P, Eglash A, Malloy M, Steube AM; Academy of Breastfeeding Medicine (2016).ABM Clinical Protocol #26: Persistent Pain with Breastfeeding.Clinical indications for nipple shield use including flat/inverted nipples, prematurity, and nipple pain; cautions regarding milk supply and transfer; importance of lactation consultant guidance and weaning planning.

These risks are manageable when a lactation consultant is monitoring weight gain, diaper output, and milk transfer — and is helping guide timing for weaning off the shield.

Should I just buy one at the pharmacy and try it?

This is where many parents run into problems. Nipple shields are widely available over the counter, but purchasing one and using it without guidance can mask latch problems rather than address them, and can inadvertently reduce supply without your noticing — because the baby may appear to be nursing effectively when less milk is actually being transferred 1Ref 1Coentro VS, Perrella SL, Lai CT, Rea A, Murray K, Geddes DT (2020).Effect of nipple shield use on milk removal: a mechanistic study.Mechanistic study finding that nipple shield use may reduce milk removal — approximately 25% less milk pumped with shields, highlighting the supply risk when shields are used without monitoring2Ref 2Berens P, Eglash A, Malloy M, Steube AM; Academy of Breastfeeding Medicine (2016).ABM Clinical Protocol #26: Persistent Pain with Breastfeeding.Clinical indications for nipple shield use including flat/inverted nipples, prematurity, and nipple pain; cautions regarding milk supply and transfer; importance of lactation consultant guidance and weaning planning.

If you are considering a nipple shield, the appropriate step is to see a lactation consultant first. An IBCLC can: - Assess whether a shield is genuinely indicated - Help fit the correct size - Observe a feed to confirm milk transfer is adequate - Monitor weight gain while the shield is in use - Guide weaning from the shield when the time is right

Gale's care team can help you connect with a lactation consultant if you are struggling with latching.

How do you wean off a nipple shield?

Weaning from a nipple shield typically involves gradually reducing its use as the baby's latch improves:

1. Start feeds with the shield, then remove it after the baby is latched and actively nursing, transitioning to direct nursing mid-feed. 2. Try direct latching first at feeds when the baby is calm and milk has let down (the areola is softer and easier to latch onto after initial ejection). 3. Track progress with diaper output and weight to ensure supply and intake are maintained during the transition.

A lactation consultant can guide this process and troubleshoot if the baby resists the transition 2Ref 2Berens P, Eglash A, Malloy M, Steube AM; Academy of Breastfeeding Medicine (2016).ABM Clinical Protocol #26: Persistent Pain with Breastfeeding.Clinical indications for nipple shield use including flat/inverted nipples, prematurity, and nipple pain; cautions regarding milk supply and transfer; importance of lactation consultant guidance and weaning planning. Most babies can wean from a nipple shield with time and support.