Nipple Shields: When They Help and How to Stop

What a nipple shield actually is

La Leche League GB describes it as "a thin, silicone teat that can be placed over a mother's nipple", with "holes in the tip" that "allow milk to flow into the baby's mouth." Most have a cut-out section so your baby's nose and chin still meet your skin.

It is a bridging device. It changes the shape and firmness of what your baby is trying to take into their mouth, which can be enough to get a feed to happen when nothing else is working. It does not change the reason it was not working.

When one might genuinely help

The HSE's framing is that "a lactation nurse or midwife or your PHN may recommend nipple shields if you or your baby have problems positioning and attaching (latching)." Note who is doing the recommending.

La Leche League GB lists the situations where a shield may benefit: babies "struggling to learn how to breastfeed", babies feeding on "flat or inverted nipples", and babies who need "extra stimulus to prompt sucking." It also notes a shield can "allow a baby who breastfeeds ineffectively to take more milk directly at the breast." Premature babies transitioning from tube or bottle feeds are a recognised group.

What a shield cannot do

This is the sentence to hold on to. La Leche League GB states that "a shield cannot correct underlying problems, especially those of sore and damaged nipples or low milk production."

If nipples are damaged because the latch is shallow, a shield may reduce the pain while leaving the shallow latch in place. If supply is low, a shield does not increase it and may reduce it further. If there is restricted tongue movement, the shield may make feeding possible without addressing the restriction. In all three cases you have bought time, which is worth something — as long as you use the time to get the underlying issue assessed.

The real risks

The HSE is direct about the mechanism: "Your breasts do not get the same stimulation when using a nipple shield." Less stimulation and less complete drainage can mean a falling supply, slower weight gain, blocked ducts and mastitis, and a baby who becomes reliant on the shield.

Because of this, weight monitoring is not optional. La Leche League GB notes that a baby's weight "will need checking regularly — as often as every three days for premature babies." If you start a shield, arrange the weight checks at the same time.

Size is the thing that goes wrong

The HSE explains both failure modes. "A nipple shield that is too large may stop milk passing to your baby properly" and reduce milk production; one that is too small makes feeding painful and prevents deep attachment. It concludes that "a lactation nurse or midwife or your PHN can advise you on choosing the correct size."

La Leche League GB adds a practical caveat: "Nipple shields come in different sizes but choice is limited", and some people "need more than one size of nipple shield due to differences between their breasts." Buying the only size on the shelf is how most badly fitted shields happen.

Putting one on so it stays on

Both the HSE and La Leche League GB describe the same trick. "Stretch the nipple shield almost inside out before applying", then "place the shield over the nipple with the base of the shield close to the base of the nipple" and release, so it draws the nipple in. La Leche League GB adds: "Smooth it onto the breast, starting well away from the nipple." Moistening the edges with water, or warming the shield first, helps it grip.

Once feeding, you should still see the signs of a working feed — rounded cheeks, audible swallowing, a nipple that comes out its normal shape. Milk should visibly collect in the tip. If the shield is empty at the end of a feed, milk is not transferring.

Keeping it clean

The HSE's rule depends on your baby: "If you are using a shield at home and your baby is a healthy, full-term baby, wash it after each use" in hot soapy water, rinse, dry completely, and store in a clean container. Sterilising requirements are stricter for premature or unwell babies — follow your unit's instruction there.

Coming off the shield

Plan the exit from the start, but do not rush it. The HSE advises: "Talk to your PHN, lactation nurse or midwife about how to stop using nipple shields", and describes starting a feed with the shield and then attempting a latch without it after a few minutes.

La Leche League GB's approach is gradual: "Start with skin-to-skin next to breast without the nipple shield before nursing with the shield." Other things that tend to work are trying a shield-free latch when your baby is sleepy or half asleep rather than frantically hungry, waiting until your milk has already let down so flow is fast from the first suck, and switching to a laid-back position where gravity helps.

Expect it to be a process rather than an event. Some babies come off in a week; some are on a shield for months and come off when their mouth grows. Neither means you have done something wrong. It is also fine to keep using one — a full feeding journey with a shield is a full feeding journey.

When to get help

Ask your midwife, health visitor, public health nurse or a breastfeeding specialist if:

• You are thinking about starting a shield — get one fitted rather than guessing the size.
• Your baby's weight gain slows, or nappy output drops, after starting one.
• Feeding still hurts with the shield on — that means the latch, not the nipple, is the issue.
• Milk is not collecting in the tip of the shield during feeds.
• You want to come off the shield and attempts are not working.

The HSE's advice on flat and inverted nipples is worth repeating here: "Do not use nipple shields to help your baby latch on without support from a lactation nurse or midwife."

Where to get real help

In the UK the National Breastfeeding Helpline is 0300 100 0212, run by the Breastfeeding Network and the Association of Breastfeeding Mothers, and open every day of the year. La Leche League GB runs local groups and a helpline. In Ireland the HSE offers an "Ask our breastfeeding expert" live chat and email service, Monday to Friday.