Breastfeeding might be natural but it doesn’t always mean it comes naturally for new mamas.

You might experience sore and cracked nipples as you figure out breastfeeding. Or your baby may have tongue tie or breast refusal.

Should you use nipple shields while you get through this tricky time?

Using a nipple shield

Let’s look at the 5 most common questions about nipple shields.

#1: What is a nipple shield?

A nipple shield is an ultra thin, flexible silicone cover a mother puts over her nipple area before breast feeding. The shield is there to encourage her baby to latch and breastfeed.

Nipple shields look like Mexican hats, each with a brim and a crown with holes in the top. They come in different sizes. Some shields have cut out sections on the brim where your little one’s nose goes.

Nipple shields have been used in human lactation for a long time.

#2: When should I use a nipple shield?

A breastfeeding mother might use a nipple shield for a variety of reasons, such as when:

A baby has difficulty attaching to her mother’s breasts (e.g. if a baby is premature; or because of breast variations such as flat or inverted nipples)
A baby has a tongue tie or poor latch and the parents choose not to revise
The mother has sore nipples and can’t continue feeding directly at the breast without shields
A bottle-fed baby is switched to the breast and is refusing to latch.

#3: What size nipple shield should I use?

It’s important to reach out to a lactation professional (such as an IBCLC – an International Board Certified Lactation Consultant) for help in using a shield, as it needs to be the correct fit for your breast. This is especially true if you have flat or inverted nipples or if your baby is not gaining weight. If your baby isn’t gaining weight, it’s important to have regular check-ins with your baby’s health care professional.

To get the correct fit:

Find a tape measure or ruler that shows millimetre (mm) measurements. Measure across the base of your nipple, not including the areola (the darker area of skin around your nipple)
The shield should be slightly bigger than your measurement (e.g. a nipple up to 17mm would need a 20mm shield; a 20mm nipple would need a 24mm shield, etc.)
The nipple shouldn’t reach all the way to the end of the shield, touching the holes
You should have minimal discomfort.

#4: How do I use a nipple shield?

When you use a nipple shield, the right fit will make all the difference. Here are some tips and tricks on how to get a good fit:

Make sure your shield and your hands are clean
Warm the shield to make it more soft and flexible
Make sure the gap on the brim is around the area where your baby’s nose will be
Gently invert the crown of the shield and place it over your nipple
Fold the brim around the breast and areola, close to the skin, and allow the crown to pop out while suctioning the nipple into the crown as much as possible
See this handy instructional video
The nipple should protrude into the chamber nicely so the baby latches onto the shield, nipple and part of the areola, if possible.

#5: How do I clean a nipple shield?

Cleaning a nipple shield is simple. It’s no different from cleaning any other item that has come into contact with your breastmilk:

Rinse the shield in cold water
Wash it in hot soapy water until there is no milk residue left
Rinse again with clean water
Allow to air dry on a clean drying rack or paper towel
To store it, use a clean, airtight container, which should also be washed daily.

In the case of nipple infection it’s important to sterilise your shield. You can do this by leaving it in boiling water for at least 5 minutes, or adding it to your sterilising unit if you have one.

For more information about nipple infection, check out Nipple Thrush – Treatments for Nipple Thrush.

#6: How can I wean baby off a nipple shield?

Consult your healthcare provider, breastfeeding counsellor or lactation consultant about the right time to stop using a shield. It can be tricky to wean your baby off using a nipple shield but these tips can help:

Have frequent skin-to-skin contact with your baby and allow her to attempt to latch before you use the shield if she shows interest
Hand express or pump for a short time to encourage the nipple to protrude and get the let-down flowing for instant satisfaction
Shape the breast in the same way the baby’s mouth is going (like a burger) to encourage a bigger mouthful of nipple and areola
Ensure correct positioning and attachment
Try different positions to see if one way works better than another
Start the feed with the shield and then remove it when baby has a rest (this often helps the nipple to protrude)
Feed when you and baby are calm and relaxed, such as just after waking or when sleepy
If baby becomes distressed, calm her down before attempting again. A baby who feels frustrated might not want to try
Don’t put too much pressure on yourself. It might take some time, and practice, before you and your baby adjust.

Nipple shields – do they help or hinder breastfeeding?

There’s been some controversy amongst lactation professionals over the use of nipple shields.

This can be quite confusing for mothers and can affect their breastfeeding experience.

Most of the controversy around using nipple shields has been about whether they help mothers with breastfeeding, or whether they cause problems

Can nipple shields help breastfeeding or not?

Here are 4 things you should know.

#1: Modern nipple shields are different from older types

Older style nipple shields used to be made of latex and rubber. Modern shields are made from thin, flexible silicone.

Lactation consultants are now less concerned about mothers using nipple shields. This is because the new material has less risk of interfering with how well a baby gets breast milk, or of lowering milk supply.

Using a nipple shield helps mimic the natural nipple shape and encourages baby to latch.

Bear in mind, though, shields can interfere with baby’s direct skin contact with your bare breast. This lack of contact might inhibit the let-down reflex.

Breastfeeding can also take longer, as the milk flow is slowed to some degree. It’s really important to position and attach your baby well, even with a nipple shield in place.

#2: You need to keep a close eye on your supply

The biggest concern is to make sure your milk supply doesn’t drop when you are using a nipple shield.

This is less likely to happen if you use the nipple shield correctly so your baby is well positioned and can latch properly.

It’s common for a mother to worry her baby isn’t getting enough milk.

See our article 3 Reliable Signs Your Baby Is Getting Enough Milk to ease your concerns.

When using a shield, you might also need to pump, to protect your supply, as your baby might not be able to drain the breast as well as with skin-to-skin.

Using breast compressions and massage towards the end of the feed will ensure you are emptying the breast well.

A great sign of effective milk transfer is seeing milk collecting or dripping between the end of the nipple and the shield tip when your baby comes off the breast.

An IBCLC can help you with latch and correct positioning, and make sure you know how it sounds when your baby is gulping well at the breast. It’s best to have support from breastfeeding experts, as they can set you up with a good plan to ensure it is working for you.

#3: More research is needed

Research into the effects of nipple shields is limited. Most studies focus on older style nipple shields and are based on small numbers of subjects.

This 1980 study of 34 mothers compared different types of nipple shield and their effects on milk flow.

The results showed both rubber and latex nipple shields reduced the amount of milk babies got from their mothers’ breasts.

This study from 2009 showed no difference in weight gain between babies who were fed with silicone shields and babies who were fed without them.

Over 40% of the babies were given formula by 2 weeks, however, so the researchers couldn’t tell whether the shields interfered with how well the babies got milk from their mothers’ breast.

A study in 2000 assessed how well premature babies got milk from their mothers’ breasts, with or without a nipple shield in place.

It was found the premature babies could get the milk much better when feeding with shields.

Overall, more research is needed to assess the specific effects of nipple shields on how well babies can get milk from their mothers’ breasts, and on milk supply.

Good quality clinical trials will allow researchers to reach stronger conclusions about whether using shields helps or hinders breastfeeding.

#4: Some mothers find shields helpful

Despite the controversy that exists about the use of nipple shields, there’s no denying some mothers find them helpful. Some mothers say they can’t latch their baby without shields, and it becomes a stressful event to keep trying.

Studies about mothers’ perceptions of nipple shields mostly show mothers have positive feelings towards them.

If a mother believes breastfeeding works best using shields, if she’s happier using them, and her baby is thriving, or if she feels she can’t continue to breastfeed without them, then it’s probably better to continue to use nipple shields.

As with many breastfeeding issues, there’s no ‘one size fits all’ approach.

It’s important that shields aren’t seen as the solution for all breastfeeding problems. It’s equally important not to write them off completely.

When it comes to the use of a nipple shield, it’s best to consider the individual situation of every mother and baby.

Nipple shield for flat or inverted nipples

If you have flat or inverted nipples, many mothers recommend the Medela contact nipple shield.

“I have flat nipples and have used Medela contact nipple shields since the very first time we breastfed in the hospital. I was told so many times to wean my baby off it because it would effect my supply, his latch, and my nipples. I tried briefly but it was just so stressful for both of us. Let me just say, if it ain’t broke, don’t fix it. Ive never had issues with my supply or his latch. I have a happy and healthy 21 pound nine month old who’s exclusively breastfed – this nipple shield made it possible.”

Be sure to speak to a lactation professional if you’re struggling or if you need further help using the shield. Having someone by your side with a skilled eye can help pick up any potential issues and provide some helpful advice which might make all the difference.