Nipple Shield Tip Sheet
Kebbie Levi, RN, IBCLC
What are Nipple Shields?
Nipple Shields are soft latex, silicone or rubber nipples that are designed to be worn over mother’s nipples during feedings. Silicone has been used because it is low in odor and taste.
Why are Nipple Shields Used?
A. Nipple Shields can be used to assist baby and/or mother to:
- Latch onto flat or inverted nipples.
- Latch onto nipples which are inverted, but which the baby does not actively draw into his mouth.
- Latch on when baby has experienced difficulty from the previous use of artificial nipples.
- Latch onto engorged breast in which the nipple is surrounded by non-compressible areolar tissue.
- Ease feeding when a weak disorganized or dysfunctional suck is present (in the case of special babies with neurological problems), following pre-term birth or Down’s Syndrome.
- Protect sore or damaged (cracked) nipples during breastfeeding.
B. Nipple Shields should be used for short periods to aid breastfeeding mothers only until latching difficulties have subsided.
Who Should Not Use Nipple Shields?
A. Nipple Shields should not be used to prevent sore nipples.
B. Nipple Shields should not be used to correct soreness of nipple associated with an unusually strong and consistent (tonic) bite reflex, which causes him/her to bit down whenever anything touches the inside of his/her mouth.
Nipple Shields Usually Cause More Problems Than They Solve.
A. Due to the decreased stimulation to the breast caused by the Nipple Shield being placed over the nipple, less milk is produced and transferred to the infant. Milk volume has been shown to be decreased by up to 22% when a Nipple Shield is being used with feedings. (Auerbach 1990). This can contribute to slow, low or now weight gain in the baby - resulting in dehydration, failure to thrive and early weaning.
B. The Nipple Shield often conditions the baby to the feel of the artificial nipple in his/her mouth instead of skin. Many mothers often report that their babies grow to prefer nursing with the shield on, and refuse to breastfeed without it.
C. Babies suck on most types of shields in the same manner, which they suck on a bottle nipple, contributing to nipple confusion.
D. The Nipple Shield is for temporary use only. Continuous use at each feeding can cause a decrease in the mother’s milk supply. The baby’s weight needs to be monitored 2 times per week and mothers need to pump their milk to keep up their supply.
New Recommendations for Healing Sore/Traumatized Nipples
Kebbie Levi, RN, IBCLC
For Mild to Moderate Soreness:
A. Express several drops of hindmilk and massage gently into nipples and allow to dry after every feeding.
B. Apply a “vanishing amount” of “Breastfeeding Lanolin” only (Lansinol or Purlan). Do not wash off. Apply three times a day: morning, midday and at bedtime. Do not use ointments or other medicinal creams, as they promote a slower healing process.
C. Use caffeinated teabag soaks 1-2 times a day for 10 minutes.
For Severely Traumatized/Cracked or Bleeding Nipples:
A. If bacterial infection or purulent drainage is noted, use triple antibiotic cream 3-4 times a day after nursing. For extremely traumatized nipples, patient may need an oral antibiotic. Encourage her to consult her physician, if possible.
1. Teach patient signs of mastitis (fever, flu-like symptoms, malaise, fatigue).
2. Avoid use of teabags. May cause increased dryness, cracking and burning of sensitive tissues.
3. If very painful, encourage mother to pump for 12-48 hours to allow healing to occur. May bottle feed infant with “slow flow” nipple for 12-24 hours to allow nipple to heal sufficiently, then try to relatch again. Rotate positions at each nursing. Alternate breastfeeding and pumping every other feeding or breastfeed on one side and supplement the feed by cup feeding, syringe feeding or Medela’s Supplemental Nursing System.
4. Try to use bottles only as a last choice.
5. Pump at any missed breastfeeding to prevent decreased milk supply, plugged ducts or mastitis.
6. Moist wound healing treatments have gained much popularity since the breast tissue heals without “scabbing” when this method is utilized.
Technique for Proper Use:
Wash hands before providing care to patient.
1. “Gel-like” saline based material known as “hydrophilic polymer”(Soothies) is placed on the nipple via sterile dressing.
2. Dressing should be cut ¼” to ½” larger than the nipple.
3. Use a breast pad in the bra to keep the dressing in place.
4. Replace the dressing every 1 to 3 days if no drainage is noted.
5. Replace the dressing every few hours if milk leakage or thrush is present in mother or baby.
6. Night use is up to the mother; it may make the nipple feel “mushy” and soft.
7. Keep unused dressings in a sealed plastic bag in refrigerator.
To the Mother of the Premature Baby
Kebbie Levi, RN, IBCLC
How to Keep up Your Milk Supply
You will probably notice that your milk volume has decreased after you have pumped for several weeks. Please be assured that his is a normal part, as well as a universal occurrence among mothers of pre-term infants. Although the cause is not 100% understood, experts know that whether a mother breastfeeds or expresses her milk out with a pump, her milk supply is based on supply and demand. The more often she pumps her milk out, the more milk she will produce. A pump, however, is less stimulating to your body than your baby and, therefore, it is less effective at drawing milk from your breast than your baby. Just try to remember that when your baby is able to nurse regularly, he/she will be able to rebuild your supply up to meet his/her needs.
You have also probably noticed that your milk supply changes depending of how your baby’s condition changes. If you become worried or tired, you will also experience a lower milk yield.
We realize that this may be very discouraging and would like to offer a few ideas to help you along.
Tips to Increase Your Milk Supply:
- Rest 10-15 minutes before pumping.
- A warm shower or warm moist cloths on your breasts can help you relax and stimulate your let down before you pump.
- Massage your breasts before pumping, especially under your arms and under both breasts.
- Increase the amount of pumpings daily. Pump 8 to 10 times daily for 10-15 minutes each time or until the flow of the milk has stopped for a few minutes.
- Decrease the length of pumpings - shorter, frequent pumpings are more effective than longer spaced out sessions.
- Look at a picture of your baby. When pumping smell “baby smells” (baby powder, baby clothing).
- Pump in the same place as much as possible. Pump in a dark, quiet area.
- Get a back rub prior to pumping.
- Breathe slowly and deeply, relaxing as much as possible.
- Pump after holding your baby.
- Concentrate your energies on things that are really important.
- Eat well and drink plenty of fluids.
- Get more rest. Nap during the day. Get to bed early! Pump during the night if you awaken, but don’t lose sleep over pumping.
