When using or recommending the use of a nipple shield, it is important to remember not become too dependent on the shield. A nipple shield is a wonderful tool for a mother when she is experiencing difficulties with Breastfeeding. However, it was always intended for temporary or occasional use. It is not a permanent solution. The long term use of a nipple shield will not only reduce your milk supply, and reduce milk transfer during nursing, but it can mask the true problem, create the need for supplementation and lead to premature weaning. I worked with a mom who was told she had flat nipples and was given a nipple shield. When I met her, her infant was 71/2 weeks old and she did not breastfeed without a shield. During our first home visit, I noticed her nipples were not flat. I also noticed her babies frenulum was a little short. But clipping it was not an option. I recommended we try latching without the shield and mom said " nope, I'm fine to just use it forever" On our second visit I offered again "she said no". I explained extensively how to properly latch without it. I also suggested to her that she try it when ever she felt good and her infant wasn't too hungry and she felt like it was a good time for her. I also suggested she get herself mentally ready to let it go. By our third home visit, mom had not used it for two days. nipples did start to get a little sore by the third day. We worked on latching without it to improve technique a little more. Shortly after that visit, she no longer uses the shield, her milk supply has improved and she is even breastfeeding in public.
I also met a mom who was given a nipple shield due to pain with latch. Her baby was already 7 months old when I met her and she had never breastfed without a shield, not even at night or away from home. Her complaint today was that her infant will not latch to her breast without a shield. It was not about pain anymore. This infant has gotten a custom to the shield. He has never used a bottle and even uses a sippy cup for water, but won't breastfeed without a shield.
Before using a shield, seek clear answers as to why the problem exist. Look for and plan for resolve. Most problems related to latch can be improved with better technique. For example: better positioning, that offers comfort and a good vantage point. A calm mother who is aware and patiently looking for an open mouth with the tongue down.
Cracked nipples can be painful and a nipple shield can help for a few days to allow some healing to take place. however, if technique is not improved the problem will just reoccur.
Of course, some issues are not fixable today. For example: an infant who has a tongue or lip tie ( see blog post the uncuttable frenulum ). With these moms the problem can go on for many months. Initially a nipple shield can be used to allow healing and give mom time to gain confidence and perfect her techniques. She will really need some tips on latching with a tongue tied baby. She will need to learn to adapt to what cannot be immediately fixed. She needs to Always work to get a deep latch and may still get a little sore from time to time. When latching the tip of the shield still needs to get up over the tongue and deep into the center of the mouth or the infant will fuss with it but not suck.
When things improve she can choose to use a shield occasionally but should work to not need it anymore. For some moms it still hurts even with the shield on. It is important to give instructions on how to use it. If it is not on properly and it's sliding around, it will limit the amount of milk the infant gets based on the the lack of negative pressure created by the sucking. Make sure the size of the shield is accommodating also, some women use two size shields one that is more comfortable and one that gets more milk. Even with a shield an infant needs to learn and be reminded to open wide and put its tongue down to achieve a deep latch. If not, the infant will only be on the nipple. If just on the nipple, he will be gassy and fussy and he will get considerably less milk.