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scientific article

Nipple shields in pre-term and term babies

Angela Willis

Nipple shields are devices, often made from silicone which are placed over the nipple during breastfeeding. They have many uses and indications including providing a barrier during pain and discomfort or cracked sore nipples. In relation to premature babies, they are particularly useful in assisting mothers of preterm infants who may face challenges in establishing successful breastfeeding. One of the benefits of using nipple shields is their potential role in increasing milk supply, which can be crucial for preterm infants who have higher nutritional needs compared to full-term infants.1

Premature babies and the role of nipple shields

Preterm infants often have difficulty with latching onto the breast effectively due to their oral motor skills being underdeveloped and the physical challenges associated with being born early. One study researched 34 premature infants using ultrathin silicone nipple shields.1 Feedings with and without the shields were observed. Mean milk transfer was 18.4 mL in the nipple shield feedings compared to 3.9 mL in the no nipple shield feeds. Within this study, length of breastfeeding duration was explored and there was no difference in the length of duration when using the nipple shields. The average length of breastfeeding was 169 days, with the average length of nipple shield use of 33 days.1 In a previous study of 15 babies, nipple shield use increased milk intake.2 A more recent study found nipple shield use in pre-term babies aided the transition from bottle to breast feeding.3 

Nipple shields can help facilitate breastfeeding in premature infants by providing a more pronounced surface for the baby to latch onto, reaching the soft palate more easily and stimulating the suckling reflex which can promote a more effective transfer of milk. Studies suggest that the use of nipple shields can enhance breastfeeding success rates among preterm infants, thus indirectly contributing to increased milk supply from the mother.1,2,3
A key aspect of milk production is the supply-demand relationship dictated by the infant’s feeding behaviour. Breastfeeding stimulates the release of hormones such as prolactin and oxytocin, which are essential for milk production and ejection. When preterm infants latch and suckle effectively, they signal the mother’s body to produce more milk.2,3  
Research indicates that the early initiation of skin-to-skin contact, or kangaroo care, combined with nipple shield use, can improve breastfeeding outcomes for preterm infants. Mothers who utilised nipple shields reported a greater sense of confidence in their ability to breastfeed, which can further increase milk supply.3,4 The psychological aspect of breastfeeding, including maternal confidence and comfort, plays a role in milk volume and milk production which can lead to a more successful breastfeeding journey.

Effects of Nipple Shield Use on Nipple Pain and Milk Supply in Term Breastfeeding

Nipple pain and trauma are common breastfeeding issues with as many as 58% of women and people in the first 6-8 weeks of breastfeeding reporting pain and discomfort. The highest prevalence of nipple pain and trauma in the first week following birth.5,6 Nipple trauma can also happen at other points within the breastfeeding journey.6 Ankyloglossia (known as tongue tie) is another common reason for causing nipple pain and trauma. Trauma of the nipples, pain and discomfort are all commonly cited reasons for ending the breastfeeding journey earlier than intended.6,7

Nipple shield use can provide interim relief alongside face to face in person support to observe latch and attachment or until treatment for the ankyloglossia occurs.7,8 The introduction of nipple shields help parents to continue breastfeeding whilst also using a variety of healing methods such as moist wound healing.9 Nipple shields can provide a barrier to support healing and provide the physical relief for mothers who may experience pain or discomfort while breastfeeding due to issues such as nipple soreness or trauma. Research has found many midwives, lactation consultants and healthcare professionals will recommend nipple shields as an interim intervention.9,10 The alternative to nipple shields is to express milk or alternatively to avoid feeding on the affected nipple until healed, however this can have impacts on breastmilk supply. By alleviating these discomforts, nipple shields encourage more frequent breastfeeding sessions, ultimately helping to establish and maintain an adequate milk supply.11 

A large study of 7113 mothers with a 72% return questionnaire rate found short term use of nipple shields had a mostly positive impact on reducing nipple pain and continuation of breastfeeding.12 Women who used the nipple shields for longer were more likely to have challenges with the transition back to breastfeeding without a nipple shield and found them an inconvenience. However it is worth acknowledging that in the study the women who were more likely to continue nipple shields longer term were more likely to have had a pre-term or late pre-term baby, more likely to have had a lower birthweight baby, more likely to be primiparous, more likely to smoke, have a higher BMI and more likely to be younger – highlighting the impacts of various sociodemographic factors on breastfeeding duration. First-time mothers in the study who continued using nipple shields long term were more likely to stop breastfeeding earlier. The shorter breastfeeding duration observed among first-time mothers using nipple shields highlights the importance of specialist lactation support when initiating nipple shield use. However, it is important to highlight here was no difference in breastfeeding duration in multiparous women who used nipple shields either short or longer term in this study. The most common reason for using nipple shields in this study was painful breastfeeding, often with sore or damaged nipples. When nipple shields were primarily used for this reason, nipple shield use was more likely to be short term and breastfeeding rates were higher. When the reasons cited for using nipple shields was difficulty latching or attaching and concerns with milk supply, breastfeeding durations were shorter highlighting the importance of specialist lactation support.12

Within this study there were a range of experiences both positive and negative. It is important to note that while nipple shields can be beneficial, they are not a one-size-fits-all solution. Some infants may not take to the shield as expected, and extended use can sometimes lead to decreased milk supply if the infant is unable to effectively stimulate the breast. Therefore, it’s essential for healthcare providers to assess each situation individually, providing appropriate guidance and support for mothers using nipple shields, and finding out the reason behind using the nipple shields to provide individualised support.

Reducing reliance on nipple shields and weaning off

The plan to introduce as well as discontinue nipple shields should be on an individual basis following specialist lactation support and advice, ensuring the latch and attachment is optimum before introducing them.

The ways to discontinue nipple shields include:

1) Firstly, discussing the reasons behind using the nipple shield to begin with to provide individualised advice.

2) In person support to check the latch and attachment without a nipple shield

3) Trying to feed without a nipple shield and if this is not possible, starting the feed without the nipple shield and as the let down begins, to remove the nipple shield and re-attach, 

4) Attempt different positions to feed in, for example an under-arm hold, laid back or deep latch techniques to aid the attachment when removing the nipple shields.

5) Removing during skin-to-skin sessions, or trying to latch baby when beginning to wake from a nap half asleep

6) Pumping before feeding may soften the breast to help baby latch and attach more easily at the breast, similarly, pumping the initial milk then trying to attach baby at the point of a let down may encourage baby to latch onto the breast without the shield

7) Breast compressions during a feed if baby starts to become fussy on and off without the shield may help a continued latch without the shields

8) Patience is key and trying to keep feeding as relaxed as possible. It may take time and reassuring parents is key along with repeating all of the above regularly

In conclusion, nipple shields can play an important role in increasing milk supply for preterm babies by facilitating effective latching, enhancing breastfeeding comfort, and boosting maternal confidence. While they are not without limitations, when used appropriately, nipple shields can help mothers of pre-term infants navigate the challenges of breastfeeding and ensure their babies receive the nutrition they need for healthy growth and development. For term babies, nipple shields can provide interim comfort and support feeding where there is nipple pain or nipple damage, but individualised support should be provided to feed with the nipple shields and discontinue when nipple healing has occurred. 
This scientific article was written by an expert who received remuneration from MAM. Published in January 2026.

Angela Willis MSc

Professional development, PGDip Specialist Community Public Health Nursing, BSc Hons Midwifery

Angie Willis is a registered and practising midwife in the NHS in the UK, and a registered Health Visitor. Angie has undertaken her masters in professional development with her specialist modules in public health nursing, perinatal mental health, and choices for women following previous caesarean birth. Angie has also been a breastfeeding peer supporter and volunteer, seeing first hand the impact of birth trauma on women and the impact it can have on their feeding journeys.

References
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  2. Aloysius, A. Lozano, S. (2007) Provision of nipple shields to preterm infants on a neonatal unit: A survey of current practice. Infant 3(3). Pp94-99.
  3. Lang S. Breastfeeding Special Care Babies. 2nd ed. Balliere Tindall. 2002
  4. Clum, D., Primomo, J. (1996) Use of a silicone nipple shield with premature infants. J Hum Lact. 12:287–290.
  5. Geddes, D.T., et al. (2014). The Effect of Nipple Shields on Breastfeeding Outcomes in Preterm Infants. Breastfeeding Medicine.
  6. Buck, M., et al (2014) Nipple pain, damage and vasospasm in the first 8 weeks postpartum. Breastfeeding medicine. 9(2). Pp56-62.
  7. Camargo, B et al (2023) Initial nipple damages in breastfeeding women: analysis of photographic images and clinical associations. Rev bras enferm 8;77(1).
  8. Koberling, A., et al (2023) Nipple trauma in lactation – literature review. Journal of pre-clinical and clinical research 17(3).Pp171-175.
  9. Olalere, O., Harley, C. (2024) An evidence-based nipple care pathway for new breastfeeding mothers: A delphi study. British journal of midwifery. 32(7). Pp352-362
  10. Amir, L., Bearzatto, A. (2016) Overcoming challenges faced by breastfeeding mothers. Aust Fam Physician. Aug;45(8):552-6. PMID: 27610443.
  11. Breastfeeding Network. (2025) Cracked nipples and moist wound healing. Available from: https://www.breastfeedingnetwork.org.uk/factsheet/moist-wound-healing/. Accessed 2 October 2025.