What are nipple shields and why do we use them?
Nipple shields are a tool that have been used for decades. They are made of a thin silicone and are designed to mimic the shape and texture of a nipple whilst offering protection and mechanistic benefits during breastfeeding.
Nipple shields are primarily used to facilitate breastfeeding in the presence of difficulties such as:
- Maternal anatomical challenges to breastfeeding: including breast engorgement and/or smooth or inverted nipples.
- Baby anatomical challenges: including small size, high palate or tongue restrictions.
- Damaged/cracked nipples that make breastfeeding very painful.
- To aid transitioning from bottle feeding to breastfeeding.
Shield use is usually a temporary measure, and most mothers discontinue use once nipple pain has lessened and/or when baby’s latch has strengthened. However, others find them a beneficial tool to support breastfeeding long-term.
Pros and cons of nipple shields:
When babies are struggling to get a good latch due to anatomical challenges, nipple shields can offer a larger and firmer structure to latch on to. The teat part of the shield is designed to reach the soft palate of baby’s mouth, this triggers their natural feeding reflex and encourages a successful latch.
Nipple shields create a barrier between mum’s nipple and baby’s mouth which can be a welcome reprieve if nipple damage has occurred. In this way, shields allow continuation of breastfeeding, giving nipples time to heal.
It is important to note that most babies can latch onto all sorts of nipples, but in the presence of difficulties, shields can offer great assistance.
Breastfeeding skills change over time. Shields can offer support in the early days as babies hone their skills and grow stronger.
Sometimes shields can prevent the identification of anatomical issues that may need attention, for example a restricted tongue, so they should always be used consciously and with support and education from a health professional.
What does the data say?
Research in any area of breastfeeding is complex due to the variability between individuals and circumstances. The amount of research available on nipple shields is limited and requires more work. We have summarised the evidence on the potential impacts of nipple shield use below:
Impact on milk transfer/sucking dynamics
Conflicting evidence exists regarding how nipple shields impact milk transfer from breast to baby. One study measured milk transfer in two groups of women. Group 1 breastfed regularly without shields and had no nipple pain, group 2 breastfed regularly with shields and used them for nipple pain. No difference in milk transfer was seen when wearing a nipple shield vs not within group 2. However, the mothers in group 1 who did not use shields/have nipple pain experienced less milk transfer. This study measured milk transfer by weighing baby before and after each feed and they calculated the percentage of available milk removed based on the fat concentrations of milk across the feeds.
Another group also observed less milk transfer with nipple shields, but they used a different approach. They compared milk transfer in a nipple shield group vs a control group. This makes comparisons a little more difficult due to the differences in mums and babies across both groups.
A similar observation was reported in studies that measured milk transfer during breast pumping sessions. When using nipple shields the pump removed less of the available milk from the breast versus when shields were not worn.
An older study on pre-term infants, however, recorded increased milk transfer when infants fed with a nipple shield in place. However, this paper does not report a sample size justification, meaning it is difficult to comment on the statistical strength of their findings.
Another study has researched the impact of nipple shield use on infant sucking and feeding dynamics. To do this they placed a tube in the babies mouth during test feeds that measured the pressure of vacuum created as they sucked. This tube also provided data on frequency and duration of sucks and pauses. This study did not find any negative impact on the sucking pressure or frequency. Interestingly, they noticed a slightly increased pressure when nipple shields were used as well as more frequent sucking and slightly longer feeding time.
Impact on breastfeeding duration
A few studies have researched how nipple shield use impacts the continuation of breastfeeding. One paper reporting on mother’s satisfaction with shields found that they helped to prevent early breastfeeding termination, and another showed that 88% of mums felt shields helped to sustain breastfeeding.
Other observational studies reported higher likelihoods that breastfeeding stops earlier when nipple shields were used. One study carefully considered other factors that could lead to early cessation of breastfeeding and still found a negative association with shield use. However, they failed to report on education in shield use and access to breastfeeding support as a contributory factor.
In contrast, a study on pre-term infants found no association between duration of nipple shield use and duration of breastfeeding.
Impact on baby/mum
The impact of shield use on babies has not been well explored. The evidence discussed above suggests nipple shields do not impact the dynamics of baby’s latch, but they might have an impact on milk transfer. One study assessed the impact of nipple shields on infant weight gain and found no association with insufficient weight gain.
A qualitative study assessing nipple shield use with pre-term babies described them as ‘short-term solutions’ and a ‘rescue remedy’. This suggests they can be a useful tool for overcoming early hurdles when used as a temporary measure. However, they were also linked to perceptions of a mother’s breast not being ‘good enough’ when shields were suggested by healthcare professionals. Two older studies reported 86% and 88% of mums felt nipple shields helped them to continue/succeed at breastfeeding.
How does the above info relate to our product?
Coro, whilst being a type of nipple shield, does not have a primary use to support breastfeeding in the ways listed above. Our product has been designed to provide information on milk flow during a feed, helping mums quantify how much baby has consumed and to gain insight into their milk storage capacity and baby’s feed volumes. Following our instructions for application and use, Coro should not impede milk transfer to baby.
We suggest that Coro is used intermittently and not at every feed, meaning it is very unlikely to impact long term breastfeeding outcomes or milk supply. Whether you are a regular nipple shield user, or not, adding Coro to your toolkit should not impede your breastfeeding. Instead, we hope that it will benefit your breastfeeding journey.
Summary
Nipple shields in general are a useful tool, used by mums to support breastfeeding when difficulties arise. Research suggests that shields do not impact baby’s latch or suction, however, some studies indicate they may disrupt milk transfer and influence longer term breastfeeding. Overall, the evidence is lacking and many studies report contrasting findings. With appropriate use of Coro, our form of nipple shield is unlikely to lead to such outcomes and we believe it will be a positive addition to your breastfeeding toolkit.
References:
Chertok, I. R., Schneider, J., & Blackburn, S. (2006). A Pilot Study of Maternal and Term Infant Outcomes Associated With Ultrathin Nipple Shield Use. Journal of Obstetric, Gynecologic & Neonatal Nursing, 35(2), 265-272. https://doi.org/https://doi.org/10.1111/j.1552-6909.2006.00028.x
Coentro, V. S., Perrella, S. L., Lai, C. T., Rea, A., Dymock, M., & Geddes, D. T. (2021). Nipple shield use does not impact sucking dynamics in breastfeeding infants of mothers with nipple pain. European Journal of Pediatrics, 180(5), 1537-1543. https://doi.org/10.1007/s00431-020-03901-3
Coentro, V. S., Perrella, S. L., Lai, C. T., Rea, A., Murray, K., & Geddes, D. T. (2020). Effect of nipple shield use on milk removal: a mechanistic study. BMC Pregnancy Childbirth, 20(1), 516. https://doi.org/10.1186/s12884-020-03191-5
dos Santos, D. A., Giugliani, C., Bizon, A. M. B. L., & Justo Giugliani, E. R. (2024). Nipple shield use in the maternity ward increases risk of exclusive breastfeeding interruption in the first six months of infant’s life. Midwifery, 128, 103873. https://doi.org/https://doi.org/10.1016/j.midw.2023.103873
Flacking, R., & Dykes, F. (2017). Perceptions and experiences of using a nipple shield among parents and staff – an ethnographic study in neonatal units. BMC Pregnancy and Childbirth, 17(1), 1. https://doi.org/10.1186/s12884-016-1183-6
Kronborg, H., Foverskov, E., Nilsson, I., & Maastrup, R. (2017). Why do mothers use nipple shields and how does this influence duration of exclusive breastfeeding? Maternal & Child Nutrition, 13(1), e12251. https://doi.org/https://doi.org/10.1111/mcn.12251
Maastrup, R., Walloee, S., & Kronborg, H. (2019). Nipple shield use in preterm infants: Prevalence, motives for use and association with exclusive breastfeeding—Results from a national cohort study. PLOS ONE, 14(9), e0222811. https://doi.org/10.1371/journal.pone.0222811
McKechnie, A. C., & Eglash, A. (2010). Nipple shields: a review of the literature. Breastfeed Med, 5(6), 309-314. https://doi.org/10.1089/bfm.2010.0003
Meier, P. P., Brown, L. P., Hurst, N. M., Spatz, D. L., Engstrom, J. L., Borucki, L. C., & Krouse, A. M. (2000). Nipple shields for preterm infants: effect on milk transfer and duration of breastfeeding. J Hum Lact, 16(2), 106-114; quiz 129-131. https://doi.org/10.1177/089033440001600205
Sakalidis, V. S., Ivarsson, L., Haynes, A. G., Jäger, L., Schärer-Hernández, N. G., Mitoulas, L. R., & Prime, D. K. (2020). Breast shield design impacts milk removal dynamics during pumping: A randomized controlled non-inferiority trial. Acta Obstetricia et Gynecologica Scandinavica, 99(11), 1561-1567. https://doi.org/https://doi.org/10.1111/aogs.13897
Viviane S. Coentro , S. L. P. s. p. u. e. a., Ching Tat Lai , Alethea Rea , Kevin Murray and Donna T. Geddes. (2021). Impact of Nipple Shield Use on Milk Transfer and Maternal Nipple Pain. Breastfeeding Medicine, 16(3), 222-229. https://doi.org/10.1089/bfm.2020.0110
