Using a Nipple Shield: Benefits and Concerns
The short answer
A nipple shield is a thin silicone cover placed over the nipple during breastfeeding, often used to help babies who struggle to latch due to prematurity, flat or inverted nipples, or tongue tie. When used correctly and with proper sizing, nipple shields can be a valuable tool that allows breastfeeding to continue. Many concerns about decreased milk supply are related to improper use rather than the shield itself.
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By Age
What to expect by age
Nipple shields are most commonly introduced in the early weeks when latch difficulties are identified. If your baby is premature or has trouble latching, a shield can make the difference between breastfeeding and not. It is important to work with a lactation consultant to ensure proper fit, as an incorrectly sized shield can reduce milk transfer. Monitor your baby's weight gain closely during this time.
Many families begin working on weaning off the nipple shield during this period as the baby's mouth grows and their latch strengthens. Try offering the breast without the shield when your baby is drowsy or calm, and use the shield as a backup. Some babies transition easily while others need a more gradual approach. There is no rush to stop using a shield if it is working well for your family.
If you are still using a nipple shield at this age, there is no medical reason you must stop as long as your baby is gaining weight well and your supply is maintained. Some babies naturally refuse the shield as they get older and their latch improves. If you want to wean off the shield, a lactation consultant can help develop a strategy.
What Should You Do?
When to take action
- Your baby latches and feeds well through the shield with audible swallowing and good weight gain
- You were advised to use a shield by a lactation consultant due to latch difficulties or nipple shape
- Your baby occasionally feeds without the shield but prefers it for most sessions
- You find the shield helpful for managing nipple pain while a latch issue is being addressed
- Your baby's weight gain has slowed since starting the nipple shield
- You notice your milk supply seems to be decreasing and feeds feel less effective
- You want guidance on the correct shield size or help weaning off the shield
- Your baby becomes very distressed when you attempt to feed without the shield
- Your baby is not gaining weight or is losing weight while using the nipple shield
- You notice signs of dehydration such as fewer wet diapers, dry mouth, or lethargy
Sources
Related Resources
Trust your instincts. If something feels wrong, reach out to your pediatrician.
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Related Feeding Concerns
When to Introduce Allergens to Baby
Current guidelines recommend introducing common allergens (peanut, egg, cow's milk products, tree nuts, wheat, soy, fish, shellfish, sesame) starting around 4-6 months when your baby is developmentally ready for solids. The landmark LEAP study showed that early introduction of peanuts (by 4-6 months) reduced peanut allergy risk by 80% in high-risk infants. Do not delay allergens - the old advice to wait until 1-3 years has been reversed because early exposure actually prevents allergies.
I'm Worried My Baby Is Aspirating During Feeds
Aspiration means liquid or food enters the airway instead of the stomach. Occasional coughing during feeds is common and does not usually indicate aspiration. True aspiration is less common and may present as recurrent respiratory infections, a wet or gurgly voice after feeds, or chronic cough. If you are concerned, a swallow study can provide a definitive answer.
Could My Baby Be Aspirating During Feeding?
Aspiration occurs when food or liquid enters the airway instead of the esophagus. Signs include coughing or choking during every feed, a wet or gurgly voice after eating, recurrent chest infections, and breathing changes during meals. Silent aspiration can occur without obvious coughing. If you suspect aspiration, contact your pediatrician as a swallowing study can diagnose it.
Baby Biting Nipple While Nursing
Biting during breastfeeding is a common challenge, especially when babies start teething. It can be startling and painful, but it is almost always a phase that can be managed. Babies cannot actively nurse and bite at the same time because their tongue covers the lower teeth during proper sucking. Biting typically happens at the beginning or end of a feed when the latch is not active. With some gentle strategies, most babies learn quickly that biting ends the feeding session.
My Baby Keeps Clamping Down on the Spoon
Clamping down on the spoon is very common, especially during teething or when babies are learning new oral motor skills. It is often a sensory exploration behavior rather than a feeding problem. Using a soft silicone spoon and placing food on the front of the spoon can help.
How Can My Baby Get Enough Calcium Without Dairy?
If your baby cannot have dairy due to allergy or intolerance, there are many other calcium sources. These include calcium-fortified foods, broccoli, kale, tofu made with calcium sulfate, beans, calcium-fortified plant milks (after 12 months), and sardines. Breast milk and formula provide adequate calcium before 12 months. If dairy-free after 12 months, planning is important.