Nipple Shield: How to Use for Breastfeeding Success

What Is a Nipple Shield and How Does It Work?

A nipple shield is a thin, flexible silicone cover worn over the nipple and areola during breastfeeding. It has a hole at the tip that allows breast milk to flow through when the baby sucks. The shield helps by positioning the baby's tongue correctly under the nipple and creating a more prominent surface for the baby to latch onto.

Nipple shields have been used for centuries in various forms, but modern versions are made from ultra-thin, soft medical-grade silicone that closely mimics the feel of natural skin. Unlike older rubber or latex versions, today's silicone nipple shields are transparent, odorless, and hypoallergenic, making them much safer and more comfortable for both mother and baby.

The design of a nipple shield is carefully engineered to support breastfeeding mechanics. When properly applied, the vacuum created between the shield and the breast draws the nipple into the tip of the shield, elongating it and making it easier for the baby to latch. The cutout section at the base of the shield allows the baby's nose to touch the mother's skin, maintaining the important sensory connection that stimulates both mother and baby during feeding.

Nipple shields are available from pharmacies and baby stores in different sizes, typically ranging from 16mm to 24mm in diameter. The size corresponds to the diameter of the nipple tunnel at the tip of the shield. Selecting the correct size is crucial for effective milk transfer and comfort. A lactation consultant can help measure and recommend the appropriate size based on your specific anatomy.

How the Nipple Shield Helps Breastfeeding

The nipple shield works through several mechanisms that facilitate successful breastfeeding. First, it provides a more pronounced target for the baby to latch onto, which is especially helpful for infants who struggle with a shallow latch or who have difficulty maintaining suction. The rigid structure of the shield tip gives the baby something firm to compress against the roof of their mouth.

Second, the shield positions the nipple correctly within the baby's mouth, guiding it toward the soft palate where milk extraction is most efficient. This proper positioning helps the baby's tongue wave in the correct rhythm to compress the milk ducts effectively. For babies who have developed poor sucking patterns or who were bottle-fed before establishing breastfeeding, the shield can help retrain proper latch technique.

Third, the protective barrier of the shield shields damaged or sensitive nipples from direct friction and compression. This protection allows healing to occur while breastfeeding continues, which is important for maintaining milk supply and preserving the breastfeeding relationship during challenging periods.

When Should You Use a Nipple Shield?

Use a nipple shield when breastfeeding causes pain, when you have sore or cracked nipples, when your baby has difficulty latching properly, or if you have flat or inverted nipples. Always try other breastfeeding techniques first and seek professional support before starting to use a nipple shield.

Nipple shields serve as a valuable tool in specific breastfeeding situations where other interventions have not resolved the problem. Understanding when a nipple shield is appropriate—and when it might not be the best solution—helps mothers make informed decisions about their breastfeeding journey. The key principle is that nipple shields should address a specific problem, not be used routinely without clinical indication.

Before reaching for a nipple shield, mothers should work with a lactation consultant to optimize positioning and latch. Many breastfeeding difficulties can be resolved through technique adjustments alone. However, when these adjustments are insufficient, a nipple shield can be the difference between continuing to breastfeed and switching to formula or exclusive pumping.

Painful or Damaged Nipples

One of the most common reasons for nipple shield use is to protect sore, cracked, or damaged nipples while they heal. Nipple trauma often occurs in the early days of breastfeeding when both mother and baby are learning proper latch technique. While the underlying cause of the damage should always be addressed, a nipple shield provides a protective barrier that allows continued breastfeeding during the healing process.

The shield reduces direct contact between the baby's mouth and the injured tissue, minimizing pain during feeding. This pain reduction is significant because severe nipple pain can trigger a cascade of problems: mothers may limit feeding frequency due to pain, which leads to engorgement, reduced milk production, and potentially early weaning. By making breastfeeding tolerable, the shield helps maintain the nursing relationship.

Latch Difficulties

Some babies have persistent difficulty achieving a proper latch despite optimal positioning and technique. This may occur in babies who are tongue-tied (ankyloglossia), have high palates, or have neurological conditions affecting their oral motor function. In these cases, a nipple shield provides a more defined surface that compensates for the baby's anatomical or functional limitations.

Premature babies often benefit from nipple shields because their small mouths and underdeveloped sucking reflexes make breastfeeding challenging. The shield can help bridge the gap between bottle feeding and direct breastfeeding, allowing these infants to transition more successfully to the breast as they mature.

Flat or Inverted Nipples

While many babies can breastfeed successfully regardless of nipple shape, some infants struggle to latch onto flat or inverted nipples. The nipple shield provides an artificial nipple protrusion that gives the baby a clear target. The vacuum created during application also helps draw out flat or inverted nipples, potentially helping them become more prominent over time.

It's worth noting that flat nipples usually do not cause breastfeeding problems. Babies nurse from the areola, not the nipple, and many adapt well to various nipple shapes. However, when nipple shape does create persistent difficulties, a shield can be an effective solution.

How Do You Apply a Nipple Shield Correctly?

To apply a nipple shield, first wash your hands. Moisten the shield with water, then fold back the edges almost inside out. Position it centered over your nipple with the cutout toward where your baby's nose will be. Hold a finger over the hole to create a vacuum that draws your nipple into the tip, then release the edges to seal against your breast.

Proper application of the nipple shield is essential for effective milk transfer and comfortable feeding. A poorly applied shield may slip during feeding, cause pain, or fail to draw the nipple sufficiently into the tip. Taking time to learn correct application technique will make each feeding session more successful.

The application process may feel awkward at first, but with practice, it becomes second nature. Many mothers find it helpful to practice the technique a few times before using the shield during an actual feeding, especially when learning to create the vacuum seal that's crucial for proper function.

Step-by-Step Application Instructions

1. Wash your hands thoroughly with soap and water before handling the nipple shield. This prevents introducing bacteria to your breast or to the feeding equipment.
2. Moisten the nipple shield with a small amount of clean water or express a few drops of breast milk onto it. This moisture helps the shield adhere better to your skin and creates a more comfortable seal.
3. Hold the edges of the shield and fold it almost inside out, like turning a hat brim up. This technique allows you to position the shield more precisely and helps create the vacuum seal.
4. Orient the cutout section toward where your baby's nose will be during feeding. This cutout is designed to let your baby smell your skin during nursing, which is important for bonding and for stimulating feeding reflexes.
5. Center the shield over your nipple while holding a finger over the hole at the tip. This prevents air from entering and helps create a vacuum.
6. Release the folded edges so they snap flat against your breast. The vacuum created should pull your nipple into the tip of the shield. You may see your nipple elongate into the tunnel portion.
7. Check that the shield is secure and that your nipple is drawn into the tip. The shield should stay in place without you holding it.

Positioning Your Baby

Once the shield is in place, position your baby for feeding just as you would without the shield. Bring your baby to the breast rather than leaning your breast toward the baby. The baby's nose should be level with your nipple, and they should approach the breast with their head tilted slightly back.

Allow your baby to root and find the shield naturally. Touch the shield to your baby's upper lip to trigger the rooting reflex. When your baby opens their mouth wide, guide them onto the breast so they take in not just the tip of the shield, but as much of it as possible. A deep latch is just as important with a shield as without one.

How Do You Breastfeed with a Nipple Shield?

Breastfeeding with a nipple shield differs from nursing without one. Let your baby root and find the shield naturally rather than pushing it into their mouth. Touch the shield to baby's lips to trigger rooting, wait for a wide gape, then guide baby to latch onto the entire shield. Ensure the shield stays in place and watch for active sucking and swallowing.

While the mechanics of breastfeeding change somewhat with a nipple shield, the principles of effective feeding remain the same. Your baby still needs to open wide, achieve a deep latch, and suck rhythmically to extract milk. Understanding how to optimize feeding with a shield helps ensure your baby receives adequate nutrition while protecting the nursing relationship.

The most common mistake mothers make when using a nipple shield is treating it like a bottle nipple—pushing it into the baby's mouth rather than letting the baby latch naturally. This approach can create feeding aversions and make eventual transition away from the shield more difficult. Instead, use the shield as a breastfeeding aid that works with your baby's natural instincts.

Achieving a Good Latch with the Shield

A proper latch with a nipple shield looks similar to a latch without one: your baby's lips should be flanged outward like fish lips, their chin should be pressed against your breast, and you should see rhythmic sucking with occasional pauses for swallowing. The difference is that the baby is latched around the shield rather than directly onto your breast tissue.

Watch for signs of effective milk transfer during feeding. You should see your baby's jaw moving in a wide, rhythmic motion—not just quick, fluttery sucks. Listen for swallowing sounds, which indicate that milk is being extracted and swallowed. Your breast should feel softer after feeding, and your baby should appear satisfied.

Monitoring Milk Intake

Because nipple shields can potentially reduce milk transfer, it's important to monitor your baby's intake closely. Count wet diapers (expect at least 6 heavy wet diapers per day after day 4) and bowel movements. Weigh your baby regularly to ensure adequate weight gain. If you have concerns about milk transfer, consider doing weighted feeds with a lactation consultant.

Some mothers find it helpful to express milk after feeding with a shield, both to ensure breast drainage and to build a supply of pumped milk. This extra pumping can also help maintain milk production if the baby is not removing milk as efficiently through the shield.

What Are the Potential Disadvantages of Nipple Shields?

Nipple shields may reduce milk transfer if the baby cannot suck strongly enough, potentially decreasing milk supply over time. They can increase infection risk, especially with damaged nipples, requiring careful hygiene. Some babies become dependent on the shield and have difficulty transitioning to direct breastfeeding.

While nipple shields can be tremendously helpful in certain situations, they are not without potential drawbacks. Understanding these risks helps mothers use shields appropriately and take precautions to minimize negative effects. The key is to use shields as a temporary bridge while working toward shield-free breastfeeding when possible.

These disadvantages don't mean nipple shields should be avoided—for many mothers, the benefits clearly outweigh the risks. However, awareness of potential problems allows for proactive monitoring and intervention before serious issues develop.

Potential Impact on Milk Supply

One concern with nipple shield use is the potential for reduced milk transfer. Some babies, particularly those with weak sucks or other oral motor challenges, may not be able to generate enough suction through the shield to effectively drain the breast. When breasts are not fully drained, the body receives signals to produce less milk, which can lead to declining supply over time.

This risk can be mitigated through several strategies. Regular pumping after nursing sessions helps ensure complete breast drainage. Frequent feeding encourages continued milk production. Working with a lactation consultant to optimize latch and positioning can improve milk transfer efficiency. Monitoring the baby's weight gain provides early warning if supply is becoming insufficient.

Increased Infection Risk

Nipple shields create a warm, moist environment that can promote bacterial or fungal growth if not properly cleaned. This risk is heightened for mothers with cracked or damaged nipples, where broken skin provides an entry point for infection. Mastitis (breast infection) and thrush (fungal infection) are potential complications.

Rigorous hygiene practices significantly reduce infection risk. The shield should be rinsed with cold water after each use, then washed with warm soapy water, and sterilized by boiling daily. Keeping both the shield and nipples dry between feedings also helps prevent pathogen growth.

Shield Dependency

Some babies become accustomed to feeding with a nipple shield and resist breastfeeding without it. This dependency can develop if the shield is used for an extended period or if the baby never practices direct breastfeeding. While not all babies experience this difficulty, it can complicate the eventual transition away from shield use.

Preventing dependency involves regularly attempting skin-to-skin nursing alongside shield use and working toward weaning as soon as the underlying problem resolves. The longer a shield is used, the more challenging the transition may become.

How Do You Wean Your Baby Off the Nipple Shield?

To wean off the nipple shield, try removing it mid-feeding after your baby has nursed for a while. At this point, your nipple is elongated from suction, your baby is less hungry, and the milk let-down reflex is active. If unsuccessful, replace the shield and try again at the next feeding. Be patient and attempt this regularly.

Weaning from a nipple shield should be a gradual process that works with your baby's readiness and comfort level. Rushing the transition can create feeding aversions and frustration for both mother and baby. The goal is to help your baby discover that direct breastfeeding is comfortable and satisfying, building on the foundation established with the shield.

The timing of weaning depends on why the shield was introduced in the first place. If it was used for damaged nipples, weaning can begin once the nipples have healed. If the shield addressed a latch problem, ongoing work with a lactation consultant may be needed to ensure the underlying issue has resolved before transitioning.

Mid-Feeding Removal Technique

The most commonly successful weaning strategy is removing the shield partway through a feeding session. Start the feeding with the shield in place. After your baby has nursed actively for several minutes and seems more relaxed, gently break the suction, remove the shield, and encourage your baby to latch directly onto your breast.

This technique works well because several factors align in your favor at this point in the feeding. Your nipple has been drawn out and elongated by the suction, making it more prominent and easier for your baby to grasp. Your baby has taken the edge off their hunger and is less frantic, making them more tolerant of a change. The let-down reflex has been triggered, so milk flows immediately when your baby latches, providing instant reward for direct nursing.

Tips for Successful Transition

If your baby resists when you remove the shield, calmly replace it and continue the feeding. There's no benefit to forcing the issue or creating a negative association with direct breastfeeding. Simply try again at the next feeding. Consistency and patience are more effective than persistence in any single feeding session.

Some babies respond well to the "bait and switch" approach: starting with the shield and then quickly switching to the breast before the baby realizes the change. Other babies do better when offered the bare breast at the beginning of a feeding when they're most eager to nurse. Experiment to find what works best for your baby.

Continue offering direct breastfeeding opportunities at each nursing session, even if many attempts are unsuccessful. Some babies transition quickly over a few days, while others need weeks to fully wean from the shield. Both patterns are normal.

How Should You Clean and Care for a Nipple Shield?

After each use, rinse the nipple shield under cold running water, then wash with warm water and dish soap. Rinse thoroughly with cold water and allow to air dry. Sterilize by boiling in water for 5 minutes once per day. Store in a clean, dry container between uses.

Proper cleaning and maintenance of your nipple shield is essential for safe breastfeeding. Because the shield contacts both your breast and your baby's mouth, contamination can lead to infections for either or both of you. Establishing a consistent cleaning routine reduces this risk significantly.

The cleaning process doesn't need to be burdensome. Once you've established a routine, it takes only a few minutes after each feeding. Think of it as similar to washing bottles or pump parts—an essential part of safe feeding practices.

After Each Feeding

1. Rinse immediately with cold running water to remove milk residue. Cold water is important because hot water can cause milk proteins to coagulate and stick to the silicone.
2. Wash thoroughly with warm water and mild dish soap. Use your fingers or a soft brush to clean all surfaces, paying special attention to the hole at the tip where milk residue can accumulate.
3. Rinse completely with cold water to remove all soap residue, which could irritate your baby's mouth or your nipples.
4. Air dry on a clean surface or drying rack. Avoid using cloth towels, which can harbor bacteria.

Daily Sterilization

In addition to washing after each use, the nipple shield should be sterilized once every 24 hours. Boiling is the most accessible sterilization method: place the shield in a pot of water, bring to a boil, and boil for 5 minutes. Remove with clean tongs and allow to cool and dry before use.

Alternative sterilization methods include steam sterilizers designed for baby equipment, microwave steam bags, or cold-water sterilization solutions. Follow the manufacturer's instructions for these methods and ensure your nipple shield material is compatible with the chosen method.

Storage and Replacement

Store your clean, dry nipple shield in a clean, covered container between uses. Avoid leaving it exposed on countertops where it can collect dust, bacteria, or household contaminants. If you're away from home, bring a clean storage case for the shield.

Inspect your nipple shield regularly for signs of wear, including discoloration, stickiness, cracks, or changes in shape. Replace the shield immediately if you notice any damage. Even without visible damage, consider replacing the shield every few weeks with regular use, as silicone can degrade over time.

How Do You Choose the Right Nipple Shield Size?

Nipple shields come in sizes from 16mm to 24mm, based on nipple diameter. Generally, choose a larger size that allows your baby to open wide and doesn't compress your nipple. A lactation consultant can help measure your nipple and recommend the best fit for your anatomy and your baby's mouth size.

Selecting the appropriate nipple shield size is more nuanced than it might first appear. While it's tempting to match the shield size exactly to your nipple diameter, the best fit often depends on multiple factors including your nipple elasticity, your baby's mouth size, and the specific challenges you're addressing with the shield.

Using a shield that's too small can compress the nipple painfully and restrict milk flow. A shield that's too large may be difficult for the baby to latch onto effectively. Finding the right balance optimizes comfort and milk transfer.

General Sizing Guidelines

Most nipple shield manufacturers offer sizes ranging from about 16mm to 24mm or larger. The measurement refers to the inner diameter of the nipple tunnel—the part your nipple fits into. To measure your nipple, use a ruler or measuring tape to determine the diameter of your nipple at its base when in a resting state.

However, nipple size changes with breastfeeding. During letdown and active nursing, nipples typically elongate and may increase in diameter. For this reason, many lactation consultants recommend choosing a size that allows room for this expansion rather than fitting snugly to the resting nipple size.

When to Size Up

The larger model nipple shield is often preferable for several reasons. A larger shield encourages the baby to open their mouth wide, similar to the wide gape needed for a good latch on the bare breast. This wide opening typically results in better milk transfer and a more comfortable feeding experience.

Additionally, a larger shield is less likely to compress or constrict the nipple during feeding. Nipple compression can be painful and may impede milk flow, defeating the purpose of using the shield. If you experience pain while using your current shield size, trying a larger size may resolve the problem.

Frequently Asked Questions About Nipple Shields