Nipple shields may be used as a short term solution for damaged, flat or inverted nipples after all other options have been exhausted and the mother's milk is 'in'. Unfortunately they have the potential to reduce milk transfer, reduce breast stimulation and create a habit as the baby becomes used to the feel of the shield and becomes reluctant to breastfeed without it. It has been shown that the use of nipple shields is associated with premature weaning. For this reason every attempt must be made to correct the underlying problems and resume direct breastfeeding as soon as possible. Expressing after feeds will protect the milk supply, should it begin to decline. 'Supply and demand' will ensure that if you remove adequate milk for your baby at each feeding session and you feed regularly, your supply will be maintained.
Choosing a shield:
The chosen shield should be made of thin silicone, not latex, and may have cut-out sections top and bottom to permit the baby’s nose and chin to come into contact with the breast. The shield should fit comfortably over your nipple with room at the tip to avoid chaffing while in use. They come in small 16mm, medium 20mm and large 24mm sizes. Shields with a number of holes in the tip allow milk to flow better than those with only one. Ensure that the shield is no longer than the baby’s mouth – measured from the lips to the junction of the hard and soft palates.
Moistening the areola before application of the shield may assist the shield to remain stable. Position the shield according to the chosen feeding position so that the baby’s nose and chin will sit in the cut-out areas, if applicable and centre the shield over the nipple. Stretch the shield before placing it on the nipple so that the shield pulls the nipple and some of the areola into the chamber once released. Fold the edges down firmly against the breast and hold them in place with your fingers. Some mothers like to express some milk into the shield so that it is readily available for the baby as soon as sucking commences.
The next, crucial step is to ensure that baby is deeply latched over the shield to the breast. If baby is only sucking on the shaft of the nipple shield then that is not breastfeeding and milk transfer will be inadequate. Wait for a wide, 'Special K' gape with the bottom lip planted firmly at about the edge of the areola, then pop baby on firmly. Look for rhythmic sucking and swallowing to ensure that milk transfer is taking place. Milk should be visible in the shield when baby detaches.
Weaning off the shield:
As soon as appropriate try removing the shield once baby is sucking vigorously and then re-latch directly to the breast. If baby refuses to suck, replace the shield and try again at the next feed. Experiment - try removing the shield when baby is sleepy; full; or hungry. Be aware that the feed may take longer when using a shield. It is possible to feed successfully long term with a shield but deep latching is essential and some expressing may be required if supply begins to wane. Ensure that baby's output is adequate and that baby is gaining weight as anticipated.
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