A nipple shield is a thin, flexible silicone cover that fits over your nipple and areola during breastfeeding. It creates a firmer surface for your baby to latch onto when direct breastfeeding isn’t working. The shield has a cone-shaped tip with tiny holes that allow milk to flow through to your baby’s mouth, while a wider base wraps around your areola. Most are transparent and thin enough that your baby still gets some skin-to-skin contact, and some designs have a cutout section specifically to increase that contact.
Why Nipple Shields Are Used
The most common reason for using a nipple shield is difficulty with latch. In studies tracking why mothers start using one, latch problems account for 62 to 73% of cases. That includes babies who can’t get a deep enough hold on the breast, who slip off repeatedly during pauses in sucking, or who fall asleep within minutes of being positioned at the breast.
Flat or inverted nipples are the second most frequent reason, showing up in about 62% of cases in one large review. The shield gives the baby a more defined shape to grip, compensating for nipple anatomy that makes direct latching difficult. Other common situations include sore or damaged nipples, oversupply (where milk flows too fast for the baby), and transitioning a baby from bottle feeding back to the breast. Breast refusal, where a baby actively turns away from the bare breast, accounts for a significant share of cases as well, appearing in roughly 69% of mothers who seek help with shields.
How They Help Premature Babies
Premature babies have weaker suction pressures than full-term newborns. That weak suction makes it hard for them to get a secure latch and to remove milk effectively. A nipple shield compensates for this by giving the baby a firmer, more structured surface to hold onto, reducing the effort needed to stay latched.
Most premature infants use a 20-millimeter shield, typically starting just before or after NICU discharge. As the baby matures, suction strength naturally increases. Most premature babies can transition off the shield by about two weeks after their original expected birth date, when their suction pressures catch up to those of a full-term infant.
Getting the Right Size
Nipple shields come in several sizes, typically ranging from 16 to 36 millimeters. The right fit depends on your nipple diameter, not your breast size. To measure, use a ruler or measuring tape across the base of your nipple (not including the areola) in millimeters. The shield size you need is slightly larger than your nipple measurement:
- Nipple up to 17 mm: 21 mm shield
- Nipple up to 20 mm: 24 mm shield
- Nipple up to 23 mm: 27 mm shield
- Nipple up to 26 mm: 30 mm shield
- Nipple up to 32 mm: 36 mm shield
A shield that’s too small will compress your nipple painfully. One that’s too large won’t stay in place and can reduce the amount of milk your baby transfers. If you’re unsure, most lactation consultants can help you find the correct fit.
Risks to Watch For
Nipple shields solve real problems, but they come with trade-offs. The biggest concern is reduced milk transfer. Because the silicone barrier sits between your baby and your breast, some babies don’t remove milk as efficiently as they would during direct breastfeeding. Over time, this can lead to decreased milk supply, and it raises the risk of plugged ducts and mastitis (a painful breast infection caused by milk backing up).
To protect your supply while using a shield, you may need to pump with an electric breast pump after feedings until your baby is consistently transferring milk well. Your baby’s weight gain should be monitored closely during this period. Steady weight gain is the clearest signal that your baby is getting enough milk through the shield.
Cleaning and Sanitizing
Clean your nipple shield after every use. Wash your hands first, then disassemble any parts and rinse them under running water. Avoid rinsing directly in the sink, which can harbor bacteria. Instead, scrub in a clean basin dedicated to infant feeding items, using hot water and soap. Squeeze soapy water through the holes at the tip, rinse under fresh running water, and let everything air-dry on a clean dish towel or paper towel.
Sanitize the shield daily if your baby is under two months old, was born prematurely, or has a weakened immune system. The simplest method is boiling: submerge the shield in water and boil for five minutes. If boiling isn’t an option, soak it for at least two minutes in a solution of two teaspoons of unscented bleach per gallon of water. Don’t rinse after a bleach sanitization, as the residual solution is safe and rinsing could reintroduce germs.
Weaning Off the Shield
Most nipple shields are meant as a temporary bridge, not a permanent solution. The timeline for weaning off varies widely. Some mothers transition in as little as two days, while others take four to five weeks.
A few strategies can help. Start by making sure your baby’s entire body faces yours during feeding, since positioning plays a large role in latch quality. Try nursing during a warm bath, when both you and your baby are relaxed. You can also drip expressed milk over your nipple or into the corner of your baby’s mouth with a syringe while they’re at the breast, giving them an incentive to stay latched without the shield.
If your baby struggles with the bare breast, try compressing your breast about an inch and a half from the base of your nipple, like squishing a thick sandwich to take a bite. This firms up the nipple so it feels more like the shield. Hold the compression until your baby is sucking steadily, then slowly release. Applying ice to your nipple before a feeding can also make it firmer and easier for your baby to grip. If your baby gets frustrated, stop, calm them, and try again later rather than pushing through distress.