LLL: Will nipple guards harm my breastfed baby?

Today is Day 2 in our two-part tongue-tied, breast-feeding, nipple guard series. Read part 1, regarding what tongue-tied means and how it  here.
It stems from the question of the mother of a six-week old who’s son was born tongue-tied and she didn’t think he was nursing properly. Nurses told her to try a nipple guard, but advised her to wean the child from it as soon as possible. The mother questioned: Will using the guard to long harm my child?
Below is the answer from La Leche League Leader, Lindsey Cramer.
It was once believed nipple shields caused more problems than they solved but in some situations they can be a helpful tool to help preserve breastfeeding.  
Years ago nipple shields were thicker, made of rubber, and were found to reduce milk supply and alter babies’ sucking patterns.  But now thinner, more flexible silicone nipple shields offer an option that may help baby breastfeed more effectively.  
There are two different styles: a circular shield is a complete circle of soft silicone with the firmer tip that protrudes like a nipple; the contact shield is similar, but there is a cutout area, which is meant to be placed where baby’s nose would be during breastfeeding to allow for skin to skin contact between mom and baby and to prevent the shield brim from curling into baby’s face.  There are different sizes and a good fit is important. In addition to good fit and placement, baby’s latch is equally important.  
One advantage to using a shield is the baby can get mother’s milk through the holes at the tip of the shield, eliminating or reducing the need to express and feed milk in another way.  It also keeps baby at the breast, which can be a significant advantage because if the baby adjusts to a new feeding method (regardless of what that method is) the transition back to the breast can be challenging.  
At first, when using a nipple shield consistently, some moms may want to pump after most feedings to ensure milk supply is being well established and monitor baby’s weight to be sure baby is taking in enough milk through the shield.  Also check for milk in the tip of the shield and for a decrease in fullness of the breast as signs baby is draining the breast during each feeding.  Again it is wise to check baby’s weight after a day or two using the shield and then weekly to ensure baby is getting enough milk.  
You should use the shield as long as it is helping baby breastfeed more effectively.  Some need it for a few feedings, days, weeks, or rarely, months.  Usually as baby gets older, more coordinated, and more experienced at sucking it will be easier to wean from the shield. It was once advised to wean by gradually cutting off the tip of the shield until it is gone, this is not appropriate with newer silicone shields as the sharp edges can hurt the baby.  Every situation is different and if you have special circumstances such as a premature baby you may need to use the shield at least until full-term corrected age is 40 weeks.  When weaning a premie off the shield careful attention should be paid to baby’s weight gain.  
If latch-on problems are being solved by the shield it may only be needed for a few feedings.  Try removing the shield after a few minutes of nursing and see if baby will latch onto the bare breast.  As baby gets more coordinated and practiced the shield will be needed at fewer and fewer feedings.  If baby will not latch on bare breast continue to use the shield.  Sometimes the easiest feedings to try without the shield are when baby is relaxed, and when mom is not feeling stressed or has extra help.  Also at night, when baby is barely awake they may be more willing to latch without the shield.  
Some moms find skin to skin contact encourages baby to latch on a bare breast.  Try taking a bath with baby and holding baby skin to skin.  The more relaxed mom and baby are the easier this transition to the bare breast can be.  Weaning from the shield can be a stressful time for many moms, but as long as baby is getting enough milk through the shield everything is OK!  Every few feedings try to remove the shield after a few minutes or begin by offering a bare breast and if baby refuses, use the shield and try again tomorrow.  
You are doing your best for your baby and many moms have gone through this challenge and effectively weaned from the shield.  
If you have additional questions please do not hesitate to contact me at lindscramer@yahoo.com or 320-3889.

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