Monday, February 15, 2016

When & How to Use a Nipple Shield

Nipple shields have changed over the years.  You will find videos and images of rubber or latex nipple shields which are no longer used due to their thickness. Latex is also no longer used since it has a tendency to break down, has a smell and a taste and is an allergen to some.

Modern nipple shields are silicone.  Medela even made them with a cut-out which was supposed to be used for more skin to skin contact with the baby's chin or if flipped the other direction to prevent possibly obstructing the infants airway.  Since these "contact" style have less surface area, they do not adhere as well as a full circle design such as the Ameda Nipple Shield.

When is the use of a nipple shield indicated?

1.  When a mom has an inverted nipple and the baby does not latch or suck because it does not feel the nipple in its mouth.  Some nipples are easily identified as inverted, but others only invert when the baby tries to latch.  An easy test for this is to take your index finger and thumb and compress the areola 1" behind the nipple.  If the nipple goes in, it is indeed flat or inverted even if it appears to protrude upon inspection.

2.  When a mom has a flat nipple or a nipple that "hides" when compressed as explained above.

3.  When a baby is bottle confused and does not identify a fleshy nipple as it's trigger to suck.  Depending on how long the baby is on a bottle, moms can train the infant to go from bottle to nipple shield and then to breast in the following steps:
     a.  For the first 24 hours, use a wide mouth bottle nipple on the baby's bottle, but turn the baby in tummy to tummy held tightly to feed.  Babies who are used to feeding on their backs tend to fight you when you hold them tightly at first so this is the first step to getting back to the breast.
     b. Wet the nipple shield with your own expressed milk to help it adhere.  You can even take a syringe and squirt some milk into the tip of the nipple shield so that babies who are used to immediate gratification from a bottle will continue to suck.
     c.  After using the nipple shield to get the baby to feed from the breast, try removing it after the feeding has started.

When should I not use a nipple shield?

A nipple shield is a last resort.  It is not the first thing to try when you have a sore or abraded nipple.  If the nipple is sore, it is most likely a poor latch and that needs to be corrected.  Using a nipple shield for a poor latch is not indicated.  See our blog post on correcting the latch instead because a nipple shield used incorrectly can cause more problems down the road as discussed below.

How long should I use the nipple shield?

Nipple shields were intended for short-term use as a bridge to help a mom with a flat or inverted nipple until the baby has a strong suck.  Or to help a bottle-confused baby nurse at the breast.  This short term should last no more than a few weeks.  It you use a nipple shield for longer than a few days, it is important to pump 2-3 times per day with a good double electric breast pump after feedings.  This will offset the decrease in stimulation and milk supply that a nipple shield can cause. 

How can I wean my baby off the nipple shield?

1.  Try removing the shield after the first 2-3 minutes of the feed.
2.  Try feeding the baby when she is in instinctive mode such as half-asleep or in the bathtub without the nipple shield.
3.  Buy a second nipple shield, invert it and take a sliver off with a clear sharp razor each day until the tip is gone.  Make sure you invert the shield and you do not use the only one you have in case your baby has a bad feeding in the middle of the night.  Inverting the shield before slivering it keeps any uneven edges towards you and not towards the baby.

What if my baby refuses to get rid of the nipple shield?

If the baby refuses to nurse without the nipple shield, it is not the end of the world.  Many moms who did not try a nipple shield for a baby who refused to latch, end up exclusively pumping.  Therefore pumping 2-3 times a day after feeding is much easier than pumping 8 times per day.  Your baby will still benefit from the tooth and jaw development that occurs when they are directly at the breast and of course whether you are pumping or nursing, the benefits of breast milk are immense. 

Best wishes, Mamas!

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