Official Journal of the United States Lactation ... - Clinical Lactation

three weeks, two months, and four months (Bodley &
Powers, 1996). In the 2004 study, 88% of the 200 women
interviewed felt the nipple shield helped them breastfeed,
and 98% stated they would use the nipple shield
again with subsequent children if needed (Powers &
Bodley Tapia, 2004). Nipple shields can be used in several
different situations.
Situations That May Warrant the Use of
Nipple Shield
Infants with Inadequacies in Their Suck Due
To Tongue-Tie, a Receding Jaw, Painful
Cephalhematoma, or Prematurity
Infants with these issues often transfer an ounce or less,
as measured by a pre- and post-feed weight on an electronic
scale designed for test weighing. Usually, their
weight is already trending downward, with more than a
10% loss from their birth weight. A nipple shield may be
used for the next feeding attempt, with pre- and postfeed
weights to identify any improvement in milk transfer
using the nipple shield. If the infant transfers more milk
with the shield, the shield can be used until the infant is
able to transfer adequate milk without it. This generally
happens as the infant takes in more calories, often
improving the sucking coordination and strength. There
is no timetable for the infant’s readiness.
Painful Nipples Where the Mother Says She
Dreads Every Feeding
By covering the damaged nipple, the shield may reduce
further injury, thereby speeding healing. Remind the
mother that even with the shield, the first minute or two
of breastfeeding might still be painful, but after that the
pain should subside. When using the nipple shield for
abraded nipples, the mother uses the shield until the
nipples have healed, with occasional use thereafter as
needed. When nipples have been severely damaged, it is
imperative to address the underlying cause of the soreness,
most often incorrect latch and/or positioning of
the infant, so that when the shield is discontinued, abrasion
to the tender nipple skin is not repeated.
For Women Who Have Very Flat Nipples or
Inverted Nipples
If women are aware prior to delivery that this anatomical
situation might prevent the infant from maintaining a
latch, they may have been wearing breast shells for the
last four weeks of pregnancy, providing there was no history
of pre-term labor. Based on the authors’ study of
200 breastfeeding women, breast shells helped to evert
nipples approximately 50% of the time prior to the
infant’s birth (Powers & Bodley Tapia, 2004).
Many pregnant women are not aware of the importance
of nipple anatomy for ease of breastfeeding until they
have difficulty and seek assistance after delivery. This
mother may need a nipple shield until the nipples are
more easily graspable by the infant, or the infant develops
greater sucking strength and coordination to
maintain a latch on nipples with less-than-ideal
elasticity.
For Women with Hyperlactation
If the mother produces a copious amount of milk, it can
cause a newborn infant to choke, sputter, and pull away
from the breast, sometimes turning red and struggling to
breathe. This phenomenon is alarming to the mother
and infant. Depending upon the child’s disposition,
some infants will even go on a nursing strike when faced
with too rapid a milk flow. A mother may find using a
nipple shield will slow the flow of the milk into a more
manageable quantity for the infant, since there are only
four holes in the nipple shield rather than a spray of
milk from approximately 7 to 15 nipple pores. The nipple
shield is thus used to keep the baby breastfeeding
with ease while the mother simultaneously downregulates
her milk supply.
Infants may handle high milk flow better if fed in an
upright position, straddling the mother’s thigh, or prone
on a mom lying flat on her back. Milk production can be
reduced by breastfeeding on one breast only per feed. If
these techniques are insufficient to improve feeding
within several days, the mother may increase the amount
of hours spent breastfeeding on alternating sides. Some
mothers find if they feed the infant on just one breast
per feeding, for as many as 12 hours, alternating with the
other breast, they will successfully diminish the milk supply
within several days. A mother might also take the
original Sudafed containing pseudoephedrine, as
directed, for a couple of days to help downregulate her
supply. (Note: This is an off-label use of a medication
that is non-prescription, but kept behind the counter of
pharmacies. It should not be used by women with hypertension,
heart disease, or who are taking an MAOI
antidepressant, or are allergic to any of the ingredients.)
Once the milk supply decreases, the mother would no
longer need a nipple shield to manage the milk flow.
© 2012 United States Lactation Consultant Association 27