Nipple Shields: When to Use, Sizes & Weaning Guide

Nipple shields can sometimes help with early latch challenges—but they are not a first-line solution. This guide explains when short-term use may be considered with IBCLC support, how to size (in mm), how to use a shield safely, and practical steps to wean off the shield. At Go Mommy, we understand that every breastfeeding journey is unique. While these tools address specific latch issues, addressing the root cause of breastfeeding pain is crucial, as highlighted by resources from WomensHealth.gov.

Starting right is key; reviewing a comprehensive breastfeeding essentials checklist can help you prepare for these early challenges.

What is a nipple shield?

A nipple shield is a thin, flexible silicone cover that resembles a sombrero, designed to be placed over the nipple and areola during breastfeeding. At its center, it features a raised nipple "tunnel" with holes at the tip to allow milk to flow through. The primary function of this device is to serve as a temporary bridge between the breast and the baby, providing a firmer, more distinct shape that can stimulate the baby’s palate. This stimulation triggers the sucking reflex in infants who may be struggling to maintain a latch due to oral anatomy issues or low muscle tone.

It is important to understand that a nipple shield is a medical tool, not a convenience accessory. While they are widely available over the counter, they function best when used as part of a therapeutic plan. There are different types of shields available, but "contact" nipple shields are the most recommended by lactation professionals. These feature a cut-out section on the brim, allowing the baby’s nose and chin to remain in direct contact with the mother's skin. Clinical guidance from organizations like ACOG often emphasizes the importance of professional oversight during this process.

When (and when not) to use

Consider short-term use with IBCLC guidance in specific situations where the baby is physically capable of feeding but struggles with the mechanics of the latch. One of the most common scenarios is for premature or late-preterm infants. These babies often have smaller mouths and weaker suction; the firmness of the shield provides the necessary tactile input to the roof of the mouth, helping them "hold on" while they grow stronger. Another valid indication is for mothers with flat or inverted nipples, a condition further explained by the American Pregnancy Association.

Why caution? Despite their utility, shields are not risk-free. High-quality evidence for shields is limited, and some research shows reduced milk transfer when a shield is used. Using a shield without professional assessment can mask the real problem—such as a tongue tie or severe oral restriction. While shields are a temporary fix, using natural methods like the benefits of silver nursing cups can support healing in between feeds. Major organizations note that routine, unsupervised use is not supported; if used, it should be part of a short-term plan under lactation supervision. For detailed clinical context, the Academy of Breastfeeding Medicine provides specific protocols.

• Priority: Identify and treat the root cause (latch/positioning, oral tension, engorgement management) with an IBCLC or qualified clinician. Issues such as a lip tie / tongue tie should be evaluated by a medical professional, consistent with advice from the Mayo Clinic.
• Short-term tool: Use the smallest effective size, ensure deep latch to breast + shield, and monitor diapers/weight closely. This is vital for newborns, especially preemies, as noted in care guides by Stanford Medicine.
• Exit plan: Start gentle weaning strategies as soon as latch improves. Support groups such as La Leche League International can offer peer encouragement.

Sizing in millimeters (mm)

Selecting the correct size is arguably the most critical factor in using a nipple shield successfully. Shields are sized by nipple diameter in millimeters (not areola) and the fit must be precise to avoid damaging the breast tissue or restricting milk flow. To measure correctly, wait until your nipple is slightly stimulated (erect). Use a ruler or a sizing guide to measure across the very base of the nipple. If the shield is too small, the tunnel will squeeze the nipple, potentially causing friction blisters. If the shield is too large, the areola will be pulled into the tunnel. Proper anatomy assessment is key, similar to how the Cleveland Clinic advises on general latch mechanics. Similar principles apply to pumping; see our guide on how to measure flange size for more details.

Fit check: Visual confirmation is essential during the feed. When the baby latches, they should draw breast tissue—not just the tip of the shield—deeply into the mouth. You should see your nipple moving freely back and forth within the tunnel without rubbing against the sides. There should be comfortable suction with rhythmic swallowing sounds (a "ka" or sighing sound). If you are unsure about the fit, staff at WIC Breastfeeding Support can often provide additional sizing assistance.

Safe-use checklist & milk transfer monitoring

Using a nipple shield requires a more active management style than direct breastfeeding. The most common mistake is "slapping it on" like a sticker. Instead, use the "flip and stretch" technique: turn the brim of the shield halfway inside out, stretch it slightly, and place it centrally over the nipple before rolling the brim down onto the breast. Once applied, focus on the airway & latch. The baby must have a wide, gaping mouth—a "fish lips" flange—over the silicone. Maintaining a clear airway is a fundamental safety principle echoed by general child safety advocates like Safe Kids Worldwide.

• Placement: Moisten the brim with a little breast milk or warm water if needed so the shield lies smoothly without gaps; ensure centered placement to avoid pinching.
• Milk transfer: This is the most critical metric. Listen for audible swallows (not just sucking clicks) and observe the baby's jaw movement—it should be a pause-open-close rhythm. Track wet/dirty diapers (at least 6 heavy wet diapers and 3-4 stools after day 4) and weight gain per clinician guidance.
• Duration: Treat the shield as temporary. Re-evaluate frequently with your IBCLC.
• Hygiene: Wash with hot soapy water after each use to remove milk fat which can degrade silicone. Follow brand instructions. Strict sanitation is essential to prevent infection, following hygiene standards outlined by the CDC.

• Pumping back-up: If milk transfer is uncertain, consider pumping after feeds to protect supply—per your clinician’s plan. The shield can reduce the hormonal feedback loop, so "triple feeding" (nurse, pump, bottle feed) is often prescribed temporarily. Studies archived by the NCBI suggest that stimulation is critical to maintain supply during shield use. If you are pumping on the go, a portable bottle warmer for travel can help maintain the perfect temperature for your baby.

Having the right tools is essential; explore our curated breastfeeding products collection to support your journey.

How to wean off the shield

Weaning off a nipple shield is a process that requires patience, timing, and a low-stress environment. It is rarely a "cold turkey" event. The goal is to build the baby's confidence in latching directly onto the breast. Start by picking calm moments; a starving, crying baby is not in the mood to learn a new skill. Try offering the breast without the shield when the baby is showing early hunger cues (rooting, hand-to-mouth movements) or during a "dream feed" when they are sleepy. Skin-to-skin contact is your best ally here.

1. Warm-up & The "Bait and Switch": Begin the feed with the shield to take the edge off the baby's hunger. Once the baby has settled and milk is flowing (after the let-down), break the suction gently, remove the shield quickly, and attempt to re-latch without the shield.
2. Shaping & support: Use the "sandwich hold" (compressing the breast to match the baby's mouth shape) and hand-express a few drops to evert/soften the nipple-areola.
3. Gradual practice: Do not force it. If the baby struggles or cries, put the shield back on and finish the feed. Try to remove the shield for one feed or one side per day. No battles at the breast!
4. Get help: If attempts are frustrating or weight gain slows, pause and work with an IBCLC. Finding a skilled lactation consultant is easier with directories provided by the U.S. Breastfeeding Committee. Patience is vital during this phase, as part of your broader postpartum recovery journey.

FAQ

Do nipple shields reduce milk supply?

They can reduce milk transfer if size/fit/latch are not optimal. That’s why shields should be short-term, carefully monitored tools with IBCLC guidance—paired with frequent reassessment and a weaning plan. For more on maintaining supply, the Breastfeeding Network offers extensive fact sheets.

Are shields safe for premature or late-preterm babies?

Some teams use shields selectively with preterm infants as a bridge to direct breastfeeding. Supervision by your care team is essential, with close monitoring of transfer and weight gain. Global health initiatives like UNICEF Parenting emphasize the importance of skin-to-skin contact alongside these interventions.

How do I choose between 16/20/24 mm?

Measure nipple diameter (mm) and match to the nearest size range (see table above). When between sizes, trial the smaller and larger under IBCLC guidance and keep the one that yields deep latch and reliable swallowing.

When should I stop using a shield?

As soon as latch improves and transfer is reliable without it. Many families transition over days to a few weeks. If weeks pass without progress, seek targeted help. Persistent difficulties warrant a check-up, a sentiment reinforced by NHS guidelines on infant feeding.