Breastfeeding does not always look the way we planned for it to. While breastfeeding is natural, it is not always easy. When your baby is having difficulty latching, and you want to breastfeed, you may be given a nipple shield. In other situations, a nipple shield may be used to protect the breastfeeding relationship, and all should include a clear plan for its use and a timeline for weaning from it. You may have heard lots of different stories about nipple shields, from why to use them to why not to use them and everything in between

A nipple shield is made of thin, soft silicone. It is a tool or device that may be helpful for some breastfeeding issues. The nipple on the shield is placed over the mom’s own nipple to help with latching and feeding her baby. It is very flexible and comes in different shapes, styles and sizes. 

The nipple shield has a base that lays on top of the areola and the nipple to fit over the mom’s nipple. Some styles of shields have a cut-away part on the base so that the baby’s nose is in direct contact with the breast. At the end of the nipple are holes for milk to transfer from the mom to the baby during feeding.

• Conical nipple - the nipple shape has straight sidewalls of the nipple right to the base. It does not indent down the shaft of the shield’s nipple. It is slightly wider at the base of the nipple than the tip.
• Cherry style nipple - this style is similar to the conical shape except that as the shield’s nipple meets the shield's base, it indents a little. It can help the baby’s mouth “grab” the nipple or be able to hold on to the nipple better.
• Bottle-like nipple style - there are a few different shapes in this category. 
  • Round shields look like a more traditional bottle nipple combined with a shield. The nipple part is conical and rounded and gradually flares out wider as it reaches the base of the shield that fits over the areola.
  • Orthopedic shape shields have a nipple that is flat on one side and round on the other. The shaft of the nipple is flatter rather than rounded. It is narrow right until it meets the shield's base, which is placed on the areola.
  • Triangle style has a rounded nipple. It slightly indents as the shaft of the nipple meets the flared base, similar to the cherry-shaped nipple shield.

Most of the time, after a baby is born, they are placed on the mom’s body and given time to find the nipple, latch and begin feeding. There can be reasons that it doesn’t always go smoothly, and the mom and baby may be given a nipple shield to assist with latching and feeding.

Nipple shields are a tool or device and not a solution. They can offer assistance immediately so that a mother can protect her milk supply and the baby can breastfeed. Tools like nipple shields can buy some time to figure out the underlying feeding challenges and come up with a game plan to address them. 

Using a nipple shield can make feeding your baby at the breast possible when they are not able to latch well on their own. While it is important to try other interventions first to help achieve comfortable and successful positioning and latching, it is better to have your baby at the breast with a shield than not at the breast at all. Using a tool like a nipple shield may help avoid stopping breastfeeding earlier than desired and contribute towards a longer breastfeeding relationship. (2)

• Latching difficulties - babies sometimes have tension in their bodies from how they were positioned in utero or from birth. Tension can interfere with your baby’s ability to be comfortably positioned at the breast and latch on deeply to breast tissue. Think about if you wake up with a sore neck and how that can make turning your head to one side not feel so great. If your baby has tension or tightness like that, they may not be able to move their neck well enough to tilt their head back and latch well.
• Engorgement - fluids given during the birth can cause edema and engorgement, contributing to making the breasts feel very firm or hard, making it hard for the baby to grasp and latch on to breast tissue. In some cases, until the engorgement is addressed, a nipple shield can help your baby latch and feed.
• Cracked or painful nipples - a nipple shield can be a thin barrier between your body and your baby’s mouth if your nipples become damaged or latching is painful. The shield’s nipple has some firmness to help your baby latch while keeping your nipple more protected.
• Premature babies - sometimes, babies who are born early have a more challenging time latching. They may get tired more quickly from feeding. A premature baby’s reflexes may not be fully developed at the time they are born. Depending on when the baby was born, they may have less plump fat pads in their cheeks, which assist with supporting the baby’s tongue and decreasing the amount of space inside their mouth so their cheeks do not collapse inward as well as being able to create the proper intraoral pressure for milk removal. (1) Still put your baby skin-to-skin and give them many opportunities to do the breast crawl and self-latch.
• Flat or inverted nipples - remember you should be “breast” feeding, not “nipple” feeding. Your baby needs to take a mouthful of breast tissue and not just the nipple to be latched on deeply to remove milk. Some babies have a hard time if they do not have stimulation on their palate from the nipple right away. 
• Tongue ties - a tongue tie restricts the ability of the tongue to lift and move how it is designed to for latching and removing milk. A baby will often have a more shallow latch or use other compensations to compensate for the tongue’s lack of range of motion. Sometimes, the latch is painful for Mom, but not always. While using a shield may help, it is necessary to meet with a skilled IBCLC (International Board Certified Lactation Consultant) to assess your baby’s oral function and create a plan with you for treating the ties.
• Palate issues - cleft palate, bubble, or high palates can make latching and feeding more complicated, and a nipple shield can be a tool to help along the way.
• Bottle preference - If your baby is starting to prefer the bottle instead of the breast and it is getting in the way of times you would rather breastfeed, a nipple shield may help your baby stay attached to the breast longer and get less frustrated. Babies will choose what is easier. Nobody wants feeding to be hard. How they feed at the bottle versus the breast can be helpful information to figure out how to help them be more comfortable switching back and forth between breast and bottle more easily.
• Breast refusal - Getting the baby back to the breast after refusal can take time and patience. It is often accomplished with many strategies in place, and sometimes, using a device like a nipple shield can ease the transition. 

• Nipple shields do not fix latch issues - A nipple shield can be a helpful device while you are working on addressing the underlying causes of latching and feeding difficulties.
• It may reduce milk supply - older studies show a decrease in milk supply from nipple shield use, while newer studies show mixed results. For many people, using a shield allows for breastfeeding to be possible, but reduced supply should be monitored while it is being used. (3)
• Less milk transfer to the baby - Shields can reduce the amount of milk able to be removed. (4) Your baby’s weight should be closely tracked to make sure they are gaining appropriately while you are using a nipple shield.
• It can be hard to wean off of - Your baby can get used to the shield, and it can be hard to stop using it. 
• Inconvenient - you must always have it with you if your baby relies on using it for every feeding. Keep extras in different locations so you are never in a bind.

Nipple shields can make latching and breastfeeding possible for some people. Shields are available in different shapes and sizes. They are a tool that comes with benefits and cautions. They are best used when under the care of a skilled IBCLC (International Board Certified Lactation Consultant) to ensure you look at other possible factors of feeding difficulties and have support and an individualized care plan for getting off the nipple shield. Nipple shields can offer temporary assistance, allowing you to protect your milk supply and nurture a breastfeeding bond with your baby.

• https://connect.springerpub.com/content/sgrcl%3A%3A%3A7%3A%3A%3A3%3A%3A%3A100.full.pdf
• https://physicianguidetobreastfeeding.org/wp-content/uploads/2022/02/nipple-shield-survey-BFmed-journal2010.pdf