Nipple Shields: How To Choose, Size & Best Practices
When breastfeeding gets off to a rough start, many parents consider using nipple shields. And since we see many parents in the early weeks dealing with breastfeeding issues with all types of causes, we field a lot of questions about nipple shields.
Nipple shields can be a great tool to help you get closer to your breastfeeding goals, though their usage comes with certain considerations. This post will cover the basics of nipple shield use & how to find the right fit for you and your baby.
What Is A Nipple Shield?
A nipple shield is a flexible clear piece of molded silicone that goes over the nipple & attaches to the breast. Modern-day nipples shields are thinner than those in the past (which were made of thick latex) & have holes at the tip of the shield to allow milk to pass through during feedings.
Nipple shields differ from pump flanges ( also called breast shields) & they differ from nipple protectors & everters. The primary purpose of nipple shields is to allow more effective, less painful nursing at the breast.
How A Nipple Shield Can Help
Nipple shields can help improve breastfeeding success & duration in certain situations, though the reasons for use vary greatly. They provide additional length, texture, & structure, which can be helpful for babies with tongue ties, tone, or sensory issues or for parents who have short shanked, flat, or inverted nipples. They can provide some protection against nipple pain & discomfort, possibly reducing the frequency or severity of nipple compression, depending on the cause.
Common reasons an IBCLC might suggest Nipple Shield use include
Providing structure so a baby with feeding challenges can maintain a latch
Creating projection to help stimulate a baby's suck reflex with Flat or Inverted Nipples
Increasing sensory input & support if the baby has low tone, premature, or sensory issues
Reducing the flow rate into the baby's mouth if hyperactive letdowns are an issue or if the baby is struggling with fluid management
Protecting a nipple wound during feeding
While nipple shields can possibly reduce nipple pain with nursing, for many parents, adding a shield alone does not eliminate pain. And for some people with inverted nipples, nipple shield use can make breastfeeding feel worse.
When Not To Use A Nipple Shield
There are no contraindications to nipple shield use, though there are things to consider before buying.
Nipple shields are not a solution to breastfeeding difficulties, and babies that struggle with breastfeeding without the shield may continue to struggle on the shield, despite the intervention. Even in cases where breastfeeding improves with shield use, if the underlying issues underlying the challenges remain unaddressed, there may be significant challenges trying to wean off the shield.
It's recommended that you use nipple shields only under the guidance of an IBCLC who can help you find the shield that works best for your baby, resolve the challenges, and provide advice & oversight when ditching the shield. IBCLC care is critical in cases where weight gain or milk supply issues are a concern or when babies continue to cough, choke or gag with the shield.
Challenges with Nipple Shield Usage
There are many things to consider with nipple shields. While nipple shields are highly accessible and relatively easy to use, there is a wide variety of shapes & sizes, making finding the right fit for your and your baby quite challenging.
Weaning off a nipple shield can be quite the feat, and in some cases, without proper oversight & follow-up, nipple shield cans worsen milk supply or transfer issues. During the first few weeks of use, we usually recommend that you pump after feedings to ensure good breast drainage, which may be overwhelming if breastfeeding is already stressful and time-consuming.
Possible issues with using nipple shields
Challenges finding the right size/type of nipple shield
Difficulties applying the shield, especially for public feedings
Poor transfer / not complete breast drainage
Constantly losing the shields (they're small, thin, & clear which seems like a design flaw when you can't find them)
Difficulties with weaning / Reliance on the shield
How to Size
Getting fitted for a nipple shield is pretty straightforward. The first step is to measure your nipple using a standard ruler, circular ruler, or calipers. To get an accurate measurement, you may find it helpful to finger stimulate your nipple to get it as erect as possible.
You will want to measure the base of your nipple (both side to side and up & down) OR the largest part of your nipple. This post by Genuine Lactation covers measuring your nipples, and while it's written about breast pumps, the method is the same for nipple shields. They also offer a free L-shaped ruler you can download to size yourself easily.
Once you have your nipple measurements, add 4 mm to the largest dimension. If you have inverted nipples, measuring can be a bit more tricky & you may need a tighter fit. You can trial sizes 2-4 mm
Example: Your nipples measure 15 x16 mm. Your nipple shield size would be 20 mm. For inverted nipples, you can trial 18-20 mm nipple shields.
Sometimes there's, 's not an exact size available. You can try the closest size available to you.
How To Know If Your Nipple Shield Is Sized Correctly
Too large & too small sizing can pose problems with transfer & discomfort with use.
Signs Nipple shield it's too small:
Your nipple suctions through the holes at the top, or you notice white or purple circles on your nipple face.
There is space between the sides of your nipple & the side of the nipple shield.
Even before latching your baby, there is no space between the top of the shield (where the holes are).
Signs nipple shield is too big:
There is excessive space between the sides of the nipple & nipple shield: More than 2 mm on each side.
Milk Leaks out of the shield/ down the breast.
The shield doesn't stay on despite proper application technique.
Nipple Shield Size Options
Different brands carry different sizing, and knowing where to look for your size can be challenging. At Untied Latch, we carry a variety of shields on hand to ensure that any parents we see that need one get their proper fit without the struggle of searching online for hours.
Sizing options range from 15 mm to 28 mm, with a 30 mm specialty shield available.
In addition to the internal diameter of the hole your nipple will go in, there are a few other dimensions to keep in mind. Nipple Shields vary in length (the height of the cone), tip size, & taper, all of which can change how well your baby can feed with the nipple shield and how comfortable it feels for you.
If trying to size your shield is feeling overwhelming, don't worry- Our team of IBCLCs can help you find a nipple shield that works best for you. Yes, even virtually!
Nipple Shield Shape, Texture, Flexibility & More
Cone vs. Cherry
Conical nipple shields are the most common; the nipple projection is a similar shape to a thimble. Cherry-shaped shields are made by only one company but are a great alternative if your baby can't keep the nipple shield in their mouth while feeding, even with proper sizing, attachment, & positioning.
Cherry-shaped nipple shield are also extremely helpful for babies with tongue ties, something we here at the Untied Latch specialize in managing.
Even among the same shape nipple shield, the taper & tip shape will vary greatly, with some tips being wide & bulbous & others more narrow. Nipple shields with a gradual slope may be preferred by some babies, where some need that extra material to suck effectively.
Texture & Flexibility
Mostly all nipple shields available are very thin. Recently, more manufacturers have been making a large, thick nipple shield more akin to a bottle teat than a nipple shield. These specialty shields can be helpful in certain situations but can increase some of the issues we see with nipple shield usage when not indicated, especially poor transfer/poor breast drainage.
There is variation in texture & rigidity even among the super-thin shields. Some are very soft & pliable, whereas others don't compress easily under suction.
No one shape, texture, or rigidity works best for every baby. It can take some trial & error to find a shield that works well. (Again, something we excel in!)
Nipple Shield Best Practices
A few best practices will help you on your nipple shield journey.
Continue to attempt to resolve the underlying cause of the need for the nipple shield
Do weighted feeds and/or pump after use for the first few weeks
Ensure you're working with an IBCLC when you start using a shield or very soon after
Never, never, never cut the shield
Wash the shield in hot soapy water after every use
Boil the shield if you find that it's losing its texture
Use water/milk to help with the application of an appropriately sized shield
If your baby is having difficulties with breastfeeding, we can help. If you're in Southeast Manitoba (Winnipeg & surrounding areas), we are happy to make a home visit to support you. If you're outside of our area or out of the country, we are available to help via our virtual consultations.