Care Plan for Nipple Shield Use
A nipple shield is a flexible silicone nipple that fits over Mom’s nipple while she is breastfeeding. Nipple shields
are best considered a short-term solution and should be used only under the guidance of a Lactation Consultant.
Nipple shields can be used to help baby successfully latch on in a variety of circumstances:
1.
2.
3.
4.
5.
Very flat or inverted nipples
Latch-on difficulties due to weak, ineffective or disorganized suck or tongue tie
Nipple confused infant (one who has received many bottles)
Prematurity
As the very LAST resort for severely sore or painful nipples
Although nipple shields should be used only after other options are exhausted, it is better to have a baby
on the breast with a shield than not on the breast at all!
For nipple shield use, please follow these suggestions:
Choose the correct size shield. Consider the size of your nipple and the size of baby’s mouth. You can try different
sizes to determine which works best. Many times baby will do best with a smaller sized shield initially and move
up to a larger sized shield within a few days.
Use a little warm water or lanolin inside the shield to help it adhere to the breast.
Turn the shield partially inside out. Place it directly over the nipple and then peel or roll it back over the nipple and
areola, creating a tight fit or seal.
Latch baby on over the shield. Once your baby latches well, you should notice that the nipple is drawn more deeply
into the shank of the shield. A good latch is very important when using a shield. Ideally, the entire shielded nipple
should be inside baby’s mouth with latch extending onto the areola. Sucking only on the tip of the nipple pinches
off the milk flow and fails to stimulate the milk supply, which could result in baby not getting enough milk.
Listen for frequent swallowing. Breast compression and massage can help facilitate more swallowing.
Once milk supply is established, you should also feel good overall breast softening after feeding.
Closely monitor your baby’s wets, stools and weight to ensure adequate intake. Contact a Lactation Professional
or Physician if these seem insufficient.
(Continued)
Some Mothers will need to consider pumping their breasts after some or all feedings with an efficient pump (preferably
double electric) to protect the milk supply when using a nipple shield. Pumped milk can be used to supplement the
baby if needed. Your baby’s weight and wetting/stooling patterns as well as the advice provided by your Physician and
Lactation staff can help you determine whether or not extra pumping and supplementing are necessary.
Wash the nipple shield in warm, soapy water following use and rinse well. Boil the shield or sterilize
using a microwave steam sterilizer once daily.
The nipple shield is a tool to help solve a specific breastfeeding problem. Often, as the babies mature, their
coordination matures and as they develop more practice and positive experiences at the breast, it becomes easier
to latch without a nipple shield. As your baby’s breastfeeding ability improves, try removing the shield at various
times during some feedings. If your baby seems unable to nurse without the shield, this means the problem is not
yet resolved. Do not allow baby to become frustrated by these attempts. It is currently suggested that you use the
nipple shield as long as your baby needs it, which could be days, weeks or even months. As long as your baby is
growing well and your milk supply is well protected, the continued use of a nipple shield is not a major concern.
You may hear advice to cut or trim away the tip of the nipple shield in an attempt to wean from it. This is no longer
recommended because it can leave sharp edges that could hurt your nipple or your baby’s mouth.
References: Mohrbacher: Breastfeeding Made Simple, 2010.
Medela.com: Nipple Shields. Medela: Nipple Shield Instructions.
12/2013