A nipple shield is a thin, flexible silicone device worn over the nipple and areola during breastfeeding. This tool is often a temporary solution when parents face difficulties with the baby’s latch or the mother’s nipple shape. A major concern for parents using shields is whether they negatively impact milk supply. Managing breastfeeding successfully with this aid requires understanding the biological feedback system that regulates milk production and the potential mechanical interference of the shield.
The Mechanism of Milk Production and Shield Interference
Maintaining a consistent milk supply relies on a biological feedback loop driven by effective milk removal. Infant suckling stimulates nerve endings, sending signals to the pituitary gland. This triggers the release of prolactin, which signals milk production, and oxytocin, which causes the milk ejection reflex or “let-down.”
A nipple shield places a barrier between the infant’s mouth and the nipple, potentially disrupting this process. The shield may decrease the direct nerve stimulation needed to release prolactin and oxytocin. Additionally, the shield can alter the infant’s suckling mechanics, sometimes making milk removal less efficient.
The primary factor affecting milk supply is the effectiveness of milk removal, not the shield itself. If the infant cannot empty the breast sufficiently due to altered suction or slower transfer, the body signals a down-regulation of production. While older, thicker shields reduced milk transfer, modern, ultra-thin silicone shields have shown varied results. The risk to supply relates directly to the volume of milk the baby transfers while the shield is in use.
Clinical Indications for Nipple Shield Use
Nipple shields are used when less-interventive strategies have not resolved a breastfeeding challenge. A common reason is the presence of flat or inverted nipples, as the shield provides a firmer, more extended target for the infant to latch onto. They are also recommended for premature infants or those with poor sucking ability, as the shield encourages effective feeding.
The shield serves as a temporary aid for severe latch difficulty or to protect nipples from trauma, such as cracking or bleeding. Using the device helps maintain a breastfeeding relationship that might otherwise end prematurely, and aids in transitioning infants from bottle-feeding back to the breast.
Strategies for Maintaining Milk Supply While Using a Shield
To counteract the potential for decreased stimulation, focus on maximizing milk removal efficiency. Maintaining supply requires frequent, effective milk removal, meaning feeding the baby on demand 8 to 12 times in 24 hours. Watch for signs of active swallowing and ensure the infant is properly attached to the shield, with the lips flared over the base.
Incorporating breast compression during feeding maximizes milk transfer by increasing the flow rate. While the infant is actively sucking, applying gentle pressure to the breast helps ensure it is emptied more fully. Maximizing skin-to-skin contact, both during and outside of feeding times, encourages the release of oxytocin, supporting the let-down reflex.
Use a high-quality electric breast pump immediately after the baby finishes feeding. Pumping for 10 to 15 minutes after a feed, or performing a “power pump” daily, ensures the breast is completely emptied. This complete emptying signals the body to continue producing a full volume of milk, safeguarding the supply against any shield-caused inefficiency.
Monitoring Infant Intake and Transitioning Off the Shield
Closely monitor the infant’s intake to ensure the shield is not hindering milk transfer. The most reliable indicators are the infant’s weight gain and output of wet and soiled diapers. By the fifth day of life, an infant should have at least six wet diapers and three or more yellow, seedy bowel movements in 24 hours. Consistent weight gain, tracked by a professional, confirms the baby is receiving adequate nutrition.
When transitioning away from the shield, develop an individualized weaning plan with a lactation consultant. Consistency and patience are important, as the transition may take time. Trying the breast without the shield at every opportunity, such as when the baby is sleepy, helps build the necessary skill set.
Offering the Bare Breast First
A common technique involves offering the bare breast first when the baby is calm and not overly hungry, to see if they will latch directly. If a direct latch fails, the shield can then be applied to start the feed.
Removing the Shield Mid-Feed
Another method is to remove the shield mid-feed, after the initial let-down has occurred and the infant is actively swallowing milk. Since the milk flow is already established, the baby may be less likely to notice the difference and continue nursing directly.