What is a nipple shield? This is a silicone nipple shield which can be helpful to the breastfeeding mother. It is a device that a mother places over her nipple-areolar space prior to latching her baby onto the breast. A nipple shield can be this amazing tool that helps a baby breastfeed, who would otherwise not have been able to breastfeed. It can be a tool to help a baby who has early difficulty in latching. Once the original problem is solved, mom can work with her baby to gradually make the transition to the bare breast. I love nipple shields for all the benefits they provide to the breastfeeding mother. I do want to share what I call the good, the bad, and the ugly when it comes to nipple shields though.
The Good:
1. Wonderful tool to help babies latch on, when they were struggling to do so. Whether it be flat or inverted nipples or a baby that is premature or a baby with tongue tie, a nipple shield can be very useful in the early days of breastfeeding.
2. When used appropriately, this may help you avoid bottles if your baby is able to get a full feeding at the breast. 3. When used for nipples that have suffered damage, the nipple shield is a wonderful tool to use. Mom can continue breastfeeding, avoid bottles and allow her nipples to heal.
The Bad:
I am not a big fan of using a nipple shield in the first few days of life. Here are the reasons why:
1. I notice that nipple shields are frequently given to moms in the hospital before discharge. This frequently presents a problem for several reasons. A majority of mothers do not have the milk volume to support the proper use of the shield. The colostrum is a highly concentrated fluid, with everything a newborn needs to sustain them through this period. However, it is usually a rather sticky substance and is in very low volume. This means that it can be quite difficult for the newborn to get adequate milk transferred when using it.
2. I find that nipple shields are given to moms during their hospital stay without a plan for follow up. Things change quickly in a newborns life and without proper follow up, a nipple shield can create more harm than good. A very common scenario is what happens at the pediatricians office a few days later. A weight check reveals your baby is continuing to lose weight. Moms are often very surprised and feel defeated when they realize the last few days their baby has not been getting good feedings.
3. Good follow up is important to be sure the nipple shield is the right size and is being used correctly.
4. Information about the need to pump ( if warranted) when using the shield is often not given to moms. 5. Moms struggle without having guidance as to when and how to gradually wean from the shield when the time is right. This often leads to long term nipple shield use.
The Ugly:
1. As helpful as nipple shields are, they can also hinder breastfeeding progress. 
2. I have seen way too many mothers coming into consultations with poorly fed babies. There are many things wrong with this picture. I find that the mother has no idea that her baby is not actually transferring good volumes of milk. She has not been taught how to tell when her baby is actively sucking and swallowing and I notice that her baby is mostly sleeping. Moms think that the nudging and poking and tickling and blowing on their babies to keep them feeding, is a normal thing to do. It is not. A full term, healthy baby, who has a mom with a good supply, will keep breastfeeding until there belly is full.
3. I have seen way too many babies that are really sleeping at the breast and not actually feeding. This is dangerous because the baby is not being well fed and well hydrated. Too much weight loss, too quickly puts the baby at risk. The longer baby has poor feedings, the more they lose weight, the more tired they get and the less active breastfeeding they do. None of this is a good combination. This is why I say that the inappropriate use of a nipple shield is the
Ugly part of Nipple shield use.
4. I have seen some pretty disgusting looking nipple shields. Moms come in with them in poor shape. My worst nightmare are the shields with the tips cut off. At some point, moms were given advice to cut off a piece of the tip of the shield every day. This would mean that they had more of the nipple in their mouth when they breastfed. As more of the tip was cut away, the closer to bare breast feeding the baby would be. This is one way of weaning from the shield, but I feel it is dangerous.
What about the possibility of some of these jagged ends being swallowed by the baby. YIKES!
For all of these reasons, I would love for all moms using a nipple shield to be working closely with an IBCLC. This way we can start you off by using the shield properly and provide good follow up care.
We will be looking to make sure that the shield is:
1. Comfortable for you and your baby – no squeezing or biting the tip of the shield.
2. The right size equals good results. The wrong size = poor results.
We want to be sure your baby is having good milk transfer – no sleeping instead of feeding. If needed, appropriate pumping instructions will be given.
You will be given proper instructions on weaning from the shield and be told in no uncertain terms – “No messing with the shield.”
Lori Jill Isenstadt, IBCLC is the creator and founder of the All About Breastfeeding class. She became an IBCLC ( lactation consultant) 20 years ago and shortly after founded her private practice, All About Breastfeeding. Lori is an international speaker, author and host of the All About Breastfeeding podcast. Lori lives, works and plays in sunny Arizona. You can contact Lori at: aabreastfeeding@hotmail.com