How to choose and use a nipple shield

Note: this is a guide offering tips on finding your nipple shield size, and on feeding your baby with a nipple shield. If you are following this link from the guide provided by Netcare Femina Hospital, remember that you can contact Parentwood@Femina Clinic to purchase a shield and to obtain breastfeeding advice. You can message myself, Christine Klynhans on 072 490 7386 for breastfeeding support from a certified lactation consultant.

First things first – why a nipple shield?

Sometimes newborn babies struggle to latch on their own. There are many reasons for this.

Moms are often told that their nipples are flat or inverted. I want to stress that all breasts and nipples are different, as are all babies’ mouths. Each mom and baby dyad will have their own dynamic. One baby may struggle with an inverted nipple, whilst for another it may not present a problem at all. Moms should not feel that they are doing something wrong.

If you are considering a shield it means that your baby is struggling to latch. I want to encourage you to read our guide on ‘newborn babies not latching’ for more complete information on how to deal with this situation.

What you should know is that, if it is managed well from the start, baby will mostly get it right eventually.  It may require a bit of patience. A nipple shield provides a firmer surface for a baby to latch on to. It also provides pressure on the palate, which stimulates the sucking reflex. If used correctly it can be a wonderful tool to help you succeed with breastfeeding.  

How to choose your nipple shield size 

The first challenge is finding your size. This is very important.

• If the shield is too small your baby won’t be able to pull the nipple into the shield and to get out milk.
• If it is too big it will ‘collapse’ during suction and will get in the way of the nipple.

This provides some challenges as nipple shield sizes are limited. There are also different brands and shapes. I personally prefer the following shields, which I recommend depending on the nipple size.  Note that I offer this recommendation based on my personal preference as a lactation consultant. There are various brands on the market, which may work well for many moms.

• Medela and Ameda’s shields are very similar in look and feel. We stock Ameda’s shields as you can purchase it as a single shield making it less expensive for parents. And unless you have twins, baby can only feed on one breast at a time. Plus not all women’s two nipples are exactly the same size, and many women need different shield sizes for each breast. The Ameda shields are sold as a 16mm, 20mm and 24mm. They can also be ordered online here.
• Pigeon has shields sized 13 and 17mm, which are helpful for moms with smaller nipples.

There are many moms with nipples bigger than 24mm who may not be able to find a shield; I am not currently aware of a brand with a bigger shield. They would need to try the 24mm and see how it goes.

The other challenge is that even a 24mm shields is quite big for baby’s small mouth. Note that this does not mean that a larger nipple will be too big, but a shield is firmer and less pliable than your nipple. A baby who is able to deal with a bigger nipple, may struggle with a bigger shield.

How to measure your shield size

1. Try to stimulate your nipple so that it stands out. You can use ice, or rub your nipple between your fingers.
2. Now measure the diameter of your nipple at the base (not of the areola) in millimeters
3. Try to find the closest size; keep in mind that it should rather be 2-3mm too big than too small.
4. For example, if you measure 17mm you will probably do better with a 20mm shield than a 16mm shield.
5. If you struggle, consider seeing a lactation consultant. You may also have to try two shields to see which works best.

How to latch baby using a shield

Firstly, be sure that you are positioning baby correctly to obtain a good latch. You can watch this video clip for some guidance.

Position the shield so that the open area is opposite your baby’s nose; this is so that baby can easily breathe and also so that baby can smell your nipple. This helps with latching!

Apply the shield in the following manner (courtesy https://www.ameda.com/ameda-washable-skin-to-skin-nipple-shield):

Position baby at the breast:

• Sit back and relax your shoulders.
• Choose your position – you can either feed in football hold or in the classic Madonna hold.
• Turn baby so that his whole body is turned towards you (tummy to mommy), with your palm between his shoulder blades and his head supported underneath his ears by your thumb and forefinger.
• Position baby so that your nipple is pointing towards his nose.
• If possible, hand-express some colostrum into or on to the shield for baby to smell and taste.
• With your other hand, hold the shield in position and bring baby closer.
• Simulate baby’s lips with the tip of the shield so that baby starts opening and searching.
• In the moment that baby latches on to the breast, put gentle pressure with the palm of your hand between baby’s shoulder blades to bring baby nice and close, ensuring a deeper latch.
• Never grab hold of baby’s head, as this triggers a reflex that leads to them pulling away. You should also never force baby’s head onto the breast.
• Once baby is on, sit back and relax . Make sure that you hold baby close to your body throughout the feed.

How to know that baby is latching well?

This is the big question. A shield may make an incorrect latch less painful, and mom may not realise that baby is latching incorrectly

You should see the following:

• Baby’s mouth should be wide open and his lips should flange out.
• He must manage to suck the nipple into the shield
• You should hear swallowing
• You should see milk in the tip of the shield when baby pulls away (especially after the first 2-3 days, when your ‘normal’ milk has come in; it may not be quite as visible with colostrum)
• Baby should preferably stay on the breast and suck for some time. There is not an exact rule here, but it would be concerning if baby feeds for only a 2-3 minutes and then fall asleep or start crying.

You should not experience the following:

• Pain during feeding
• A baby simply sucking on the tips of the shield, pushing it in and out of the mouth, without actually pulling the nipple in and keeping it there.

Milk supply and a nipple shield

The following piece of advice is what I offer to moms who feed with a shield in the early phases of breastfeeding. It is based on years of experience in working with breastfeeding babies and moms, and not necessarily on official guidelines.

The first few weeks of breastfeeding is a vulnerable time for establishing your milk supply. Most mothers introduce a shield after experiencing latching difficulties, and breastfeeding is already off to a rocky start. Also, the stimulation on the nipple is not as good as without a shield. These are moms who are vulnerable for developing milk supply problems related to latching difficulties.

I choose to rather be proactive and possibly ‘overreact’ a little bit, rather than not acting and creating milk supply issues down the line. For this reason I recommend the following.

Firstly, I would suggest seeing a certified lactation consultant for some guidance and support in this time. Contact us on the numbers mentioned at the start of this article if you need to find someone.

After feeding your baby, express by hand or with a breast pump for another few minutes. How long will depend on how well baby drank and on whether baby drank from both or only one breast. If baby had a good feed with the shield you can express for another 5 minutes. If baby did not feed well on a breast, or skipped a breast completely you can express 10-15 minutes on that breast. This may seem like overkill, but it will ensure that you establish your supply. You can reduce this as soon as we can establish that baby is gaining weight well and managing well with the shield.

Note: You will be advised against expressing in the early weeks as it can cause overstimulation and an oversupply. However, moms with breastfeeding difficulties at the start have a bigger risk of too little stimulation and supply problems. For this reason I choose to be proactive. You can also read this guide on when to express for which reason, for more perspective. Do speak to a lactation consultant if possible,

If there is concern over baby’s intake your lactation consultant will suggest giving baby small top-ups of expressed breast milk with a syringe (not a bottle as this may worsen the latching difficulties). Top-up feeds can cause a lot of harm to breastfeeding if not done correctly. However, it has got a place, and ‘feed the baby’ is always the first priority. Once it has been established that baby is getting out enough milk with the shield you will be able to relax about this.   

Using a shield for sore nipples

Moms are often advised to use a nipple shield to reduced nipple pain during feeding. However, this does not address the cause of pain and may create more problem than it solves. Read our complete guide to nipple pain in breastfeeding for more information on this topic.

Feeding long-term with a shield

Most babies will wean themselves off the shield once they’ve gotten the hang of breastfeeding.  You can read more here about weaning baby of a shield.