How can I wean my baby from a nipple shield?

My lactation consultant gave me a nipple shield to help ease my breastfeeding discomfort (I was engorged and had flat nipples), and now I’m having trouble weaning my baby from it. I’ve heard that I can lose my milk -- is this true? I’ve used the shield on and off for nine days and I still have plenty of milk.

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When you have offered the breast without the shield and your baby has refused to latch on, you must have felt frustrated and upset. Mothers and babies who experience latch-on difficulty sometimes feel they are in conflict.

Athough you may feel a sense of urgency, it’s comforting to know that as long as your baby is properly monitored, it’s okay if this situation takes some time to resolve. A few extra days or weeks will not decrease the likelihood your baby will latch without the shield. Babies tend to become more competent with age, and mothers are less worried if their babies experience moments of frustration.

I do recommend you put in the effort to wean your baby from the nipple shield though. Although there are conflicting reports about their impact on milk supply, (not all mothers develop supply problems), shields worn during feedings create a barrier for milk flow and interfere with proper latch-on. Some nipple shields restrict milk flow by as much as 60 to 70 percent. A few babies of mothers who have used nipple shields without appropriate follow-up care have lost weight without immediate detection, resulting in serious problems. 

Lactation consultants tend to use techniques and equipment that have proven successful with previous clients. I recommend you follow up with your consultant until you are able to feed directly on the breast. She may suggest you use one of the following strategies to achieve your goal:

  1. Hand-express to soften your areola before latching so your breast is more graspable. Flat nipples usually do not inhibit latch-on except when breast fullness is causing the nipples to flatten. The tightness of the breast hampers the baby’s ability to draw it into the mouth properly.
  2. If necessary, initiate the feeding with the shield in place. After three to four minutes, remove the shield and relatch your baby. After a few days, latch-on should occur more spontaneously without priming the feeding with the shield. Some mothers find priming the breast with a pump helpful as well.
  3. If your baby opens wide but does not grasp when offered the breast, try letting your baby suck on your finger while in the nursing position. To do this, place a washed index finger in your baby’s mouth. (Position your finger so the pad is on the roof of the mouth and the nail side toward the tongue.) Introduce your finger slowly and carefully to allow your baby to accept it without gagging. After a few sucks, quickly remove your finger and latch your baby to the breast. Another family member can assist you by using a washed finger as well. This will enable you to stay in latch-on position so latching can be initiated more quickly after the finger is removed. (I call this the bait and switch!)

Your consultant can help you select a strategy that is best suited to your circumstances as well as determine all the causes for your baby’s reluctance to latch on. If your latch-on difficulty has persisted beyond 24 hours, there are likely to be causes besides engorgement, which is easily resolved within 24 hours.

If you decide to continue your use of nipple shields, have your baby’s weight monitored closely for at least the first six weeks. In addition, observe your baby for signs of adequate intake. These include stooling at least four to five times a day during the first month of life (when exclusively breastfeeding). If your baby isn’t stooling enough and/or you experience breast tenderness that is not resolved by the next feeding, you may be experiencing decreasing milk production. When milk supply is reducing very slowly, the changes may be gradual and unnoticeable.

Unfortunately, babies can feed inadequately without demonstrating unsatisfied hunger. This is because suckling releases a hormone that causes drowsiness. If a baby has suckling opportunities but milk transfer is hampered (if the baby is positioned at the breast with a nipple shield, for example), the suckling may cause sleepiness before the baby is totally satisfied. This sleepiness can mimic satisfaction, causing the poor intake to go undetected if the baby’s weight is not checked regularly.

In spite of what we know about the potential risks, there are breastfeeding mothers who use nipple shields with great satisfaction. Any amount of breastfeeding is beneficial, even if circumstances aren’t optimal and supplementation is necessary.

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