The primary endpoint was any breastfeeding outcome following nipple shield use. Results: The literature search yielded articles, 14 of which were included in this review. Conclusion: Through examining the use of nipple shields, further insight is provided on the advantages and disadvantages of this practice, thus allowing clinicians and researchers to address improvements on areas that will benefit mothers and infants the most. The immunologic and anti-infective properties of breast milk are advantageous to babies, particularly high-risk premature infants 1.
Moreover, breastfeeding establishes important emotional and bonding experiences for the mother—infant dyad 2. For example, the reluctant or non-nursing infant is an overwhelming challenge to a new mother 4.
A nipple shield is a breastfeeding aid with a nipple-shaped shield that is positioned over the nipple and areola prior to nursing 3. Nipple shields are usually recommended to mothers for flat nipples or in cases in which there is a failure of the baby to effectively latch onto the breast within the first 2 days postpartum.
They are also used for sore nipples, prematurity, oversupply, transitioning infants from the bottle to the breast, and other indications 5. The physical design of the shield has drastically changed over time, dating back to the sixteenth century 6.
The shield needs to be positioned over the center of the nipple. Each stretch of the shield draws more nipple tissue into the shield. The edges of the shield circumference can be secured over the areola with a few drops of water. If the infant is latched onto the shield properly, each suck will show visible movements in the area of the breast distal to the shield.
In contrast, little or no breast movement is visible with sucking if the infant is only on the tip of the nipple shield 8. The use of nipple shields is a controversial topic in lactation. Its use has been an issue in the clinical literature since some older studies discovered reduced breast milk transfer when using nipple shields 9 — Nonetheless, more recent studies have reported successful breastfeeding outcomes following the use of nipple shields 4 , 7 , 13 — Nipple shields are not only debated among healthcare professionals but also among mothers.
The shields may act as a solution to a problem, thus reducing the stress from breastfeeding difficulties, or it may increase stress when women aim to breastfeed without accessories To provide a foundation of evidence for the use of nipple shields, this review was undertaken to evaluate the evidence and outcomes associated with nipple shield use.
A full list of search terms is provided in Figures 1 — 4. Titles and abstracts were screened to identify if studies were relevant for full-text screening, after which full texts were included if they met the pre-specified inclusion criteria. Articles were selected for full-text screening if the title or abstract mentioned nipple shield s. Only English language studies were included. Duplicates of articles found in each database, as well as non-original research, small i.
Of those, 31 articles were identified for full-text review as specified by the inclusion criteria; 17 of the 31 articles were rejected after full-text review.
Three studies reported on the physiological responses during breastfeeding with a nipple shield 9 , 10 , Amatayakul et al. At 1 week postpartum, prolactin and cortisol levels, infant suckling time, and milk transfer were measured with and without a nipple shield.
Use of the nipple shields when breastfeeding had significantly reduced milk transfer, from a median of 47 g in group 1 to a median of 27 g in group 2, which was likely due to the inhibition of oxytocin release in group 2 mothers 10 Table 1. Auerbach 12 also examined milk transfer with a nipple shield. Twenty-five mothers participated in two separate pumping sessions, one for each breast, where different designs of nipple shields were tested.
Pumping without a shield yielded larger amounts of milk, with mean volumes six times greater than when the old shield was used and more than four times greater than when the new shield was in place. Woolridge et al. This nipple shield design increased sucking rate and the time spent resting. In contrast, minimal differences in sucking frequency and pauses were observed when using the thin latex nipple shield 9 Table 1.
Two studies reported the breastfeeding outcomes with nipple shield use for premature infants 2 , Clum and Primomo 2 performed chart reviews for 15 premature infants who were neonatal intensive care unit NICU patients and whose mothers intended to breastfeed.
It was identified that health professionals usually recommended nipple shields if the neonate had difficulty latching for an average of 5 days. The average gestational age at first nipple shield use was Meier et al. This study examined the effect of nipple shields on milk transfer and total duration of breastfeeding. The volume of milk transfer, which was measured by infant test weights, was compared for two consecutive breastfeeding one with and one without the use of a nipple shield.
When using the shield, all infants consumed more milk than without nipple shields. The mean transfer of milk without a shield was 3. Click here to learn how to tell if your nipples are everted protruding , flat, or inverted. If your baby has trouble latching onto your breast and one or both of your nipples are flat or inverted, try using a breast pump before each feeding to gently pull your nipple out.
Though, be sure to talk with your health care provider before using a nipple shield. Too often, nipple shields are used as a substitute for encouragement and support. A nipple shield is a thin silicone device that covers the nipple and the areola—the darker part of the breast around the nipple—and mimics an everted nipple.
Nipple shields, like babies, come in a variety of sizes. If the shield is too large, your baby will have difficulty maintaining a proper latch and will be more likely to gag. Express a few drops of your breastmilk into the tip of the nipple shield, where the holes are. This will help encourage your baby to attach. Stretch the brim of the nipple shield somewhat outwards.
Keeping the brim stretched, place the nipple shield centrally over the nipple, onto the breast, to help draw some of the nipple and areola into the crown of the shield as you release the stretch.
Hold the nipple shield in place with your fingers on the outside edges. There should be a small space between the end of your nipple and the end of the crown of the nipple shield. If your nipple touches the end of the crown of the nipple shield, then the nipple shield is too small for you. Point the crown of the nipple shield at your baby's nose and encourage your baby to open his mouth wide. A lactation consultant or breastfeeding counsellor can help you make sure that your baby is attached to your breast well and that he is getting your breastmilk through the nipple shield.
The following points will help you to recognise if your baby is attached well: His mouth is open wide. His chin is in pressed into your breast. He has a good mouthful of your breast, with his lips over the brim of the nipple shield, not just the crown portion.
His lips are flanged outwards. His tongue is forward over his lower gum and cupping the nipple shield. This may be difficult to see when he is attached well. You may notice his whole jaw moving as he sucks. He should not be sucking in air or slipping off the nipple shield. Latch-on and positioning links. Resources: Is baby getting enough milk?
How to find breastfeeding help links. What is Normal? Can I Breastfeed if…? Nipple shields. Nipple shields with cutout.
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