Nipple Shields: When They Help and How to Wean Off Them

Key takeaways: Nipple shields can help with flat nipples, premature babies, or latch difficulties. They don’t fix the cause of pain. Use the right size, watch weight and diapers, and work with a lactation consultant on a plan to wean off when your baby is ready.

A nipple shield is a thin, flexible silicone cover worn over the nipple during breastfeeding. For some families, it’s the bridge that makes breastfeeding possible. For others, it can create new problems. Here’s how to use one wisely.

When a Shield May Help

• Flat or inverted nipples that are hard for a baby to grasp.
• Premature or small babies who struggle to maintain a latch.
• Babies with a weak suck or low muscle tone.
• Transitioning a bottle-fed baby to the breast.
• Babies who refuse the breast after bottles or a difficult start.

Research suggests shields can help some babies latch, especially premature infants, without reducing milk intake when used with support.

When a Shield Isn’t the Answer

Shields are sometimes offered for sore or damaged nipples. They may make feeds more bearable for a short time, but they don’t fix a shallow latch, tongue-tie, or other causes. Without addressing the cause, pain may continue.

Potential Downsides

• Reduced milk transfer for some babies, which can lead to low weight gain and lower milk supply.
• Dependence: some babies become used to the shield.
• Plugged ducts or mastitis if milk isn’t removed well.

That’s why shields should ideally be used with guidance from a lactation consultant, with close monitoring of your baby’s weight and diapers.

How to Use a Nipple Shield

1. Choose the right size. The opening should fit your nipple without pinching. Common sizes are 16, 20, and 24 mm. Smaller shields are often used for premature babies. A lactation consultant can help with fit.
2. Warm and moisten the shield slightly so it sticks better.
3. Turn it partway inside out, place it over your nipple, and roll the brim back onto your breast. This helps draw your nipple into the shield.
4. Latch your baby deeply, with their lips flanged on the brim of the shield, not just on the tip.
5. Watch for swallowing and check that milk is in the shield’s tip after feeding.
6. Clean the shield with hot, soapy water after each use.

Protecting Supply

If you’re using a shield, consider pumping after some feeds, especially in the early weeks, until you’re sure your baby is transferring milk well. Track wet and dirty diapers and get regular weight checks.

Weaning Off the Shield

Many babies can transition off a shield once they’re bigger, stronger, or your nipples have changed shape with breastfeeding. Tips:

• Start the feed with the shield, then remove it once your baby is calm and milk is flowing, and try latching directly.
• Try when your baby is relaxed, not frantic.
• Use skin-to-skin and laid-back positions to encourage instinctive latching.
• Express a little milk onto the nipple first.
• Be patient. It may take days to weeks. If your baby is frustrated, put the shield back on and try again later.

Call your baby’s doctor if: your baby isn’t gaining weight, has fewer wet or dirty diapers, or is very sleepy at feeds. Call your provider if: you have breast pain, a red or hot area, fever, or flu-like symptoms.

The Bottom Line

A nipple shield can be a helpful tool for specific problems, but it works best with expert guidance and close monitoring. Plan for how and when to transition off.

For a complete guide to the first year including multiple chapters on breastfeeding, see my book, From First Breath to First Birthday.

Sources

1. McKechnie AC, Eglash A. Nipple shields: a review of the literature. Breastfeed Med. 2010;5(6):309-314.
2. Meier PP, Brown LP, Hurst NM, et al. Nipple shields for preterm infants: effect on milk transfer and duration of breastfeeding. J Hum Lact. 2000;16(2):106-114.
3. Chow S, Chow R, Popovic M, et al. The use of nipple shields: a review. Front Public Health. 2015;3:236.
4. Wambach K, Spencer B, eds. Breastfeeding and Human Lactation. 6th ed. Jones & Bartlett Learning; 2021.
5. Meek JY, Noble L; Section on Breastfeeding. Policy statement: breastfeeding and the use of human milk. Pediatrics. 2022;150(1):e2022057988.

This article is for general education and is not a substitute for individualized medical advice. Always talk with your baby’s health care provider or your own provider about your specific situation. If you think your baby or you may have a medical emergency, call 911.