Abstract
A nipple shield is a breastfeeding aid with a nipple-shaped shield that is positioned over the nipple and areola prior to nursing. Nipple shields are usually recommended to mothers with 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. The use of nipple shields is a controversial topic in the field of lactation. Its use has been an issue in the clinical literature since some older studies discovered reduced breast milk transfer when using nipple shields, while more recent studies reported successful breastfeeding outcomes. The purpose of this review was to examine the evidence and outcomes associated with nipple shield use. A literature search was conducted in Ovid MEDLINE, OLDMEDLINE, EMBASE Classic, EMBASE, Cochrane Central Register of Controlled Trials, and CINAHL. The primary endpoint was any breastfeeding outcome following nipple shield use. Secondary endpoints included the reasons for nipple shield use and the average/median length of use. For the analysis, we examined the effect of nipple shield use on physiological responses, premature infants, mothers' experiences, and health professionals' experiences. The literature search yielded 261 articles, 14 of which were included in this review. Of these 14 articles, three reported on physiological responses, two reported on premature infants, eight reported on mothers' experiences, and one reported on health professionals' experiences. 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.
Highlights
The immunologic and anti-infective properties of breast milk are advantageous to babies, high-risk premature infants (1)
We examined the effect of nipple shield use on physiological responses, premature infants, mothers’ experiences, and health professionals’ experiences
Three studies reported on the physiological responses during breastfeeding with a nipple shield (9, 10, 12)
Summary
The immunologic and anti-infective properties of breast milk are advantageous to babies, high-risk premature infants (1). Breastfeeding establishes important emotional and bonding experiences for the mother–infant dyad (2). Since breastfeeding confers benefits to both mothers and infants, it is necessary to promote breastfeeding and mitigate barriers that may prevent its success and/or lead to early breastfeeding. The use of nipple shields termination (3). The reluctant or non-nursing infant is an overwhelming challenge to a new mother (4). Many women in this situation wean their breastfeeding efforts due to the absence of timely help or the lack of resources/support (4). When maternal and/or infant-related factors challenge breastfeeding, nipple shields may preserve and facilitate breastfeeding (3)
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