Nipple Shields – A Note from our IBCLC

Consider this a PSA about nipple shields. Nipple shields can be a valuable tool for certain breastfeeding problems.

Here are a few examples of those problems:

  1. Preterm babies, some studies have shown that a nipple shield can be effective when working with babies that aren’t term.
  2. Babies with tongue tie, if you are waiting on a referral to get a tongue tie revision a nipple shield can be helpful and it extends far enough into the baby’s mouth to maintain latch.
  3. Babies with poor muscle tone can sometimes benefit from the rigidity of the shield.

 

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Here are some reasons NOT to use a nipple shield:

  1. Baby will not latch, if you are using a shield, baby is still not latched.
  2. Breastfeeding is painful, if breastfeeding is painful it is because baby isn’t latching well. If you are using a shield, you still have a baby that is not latching well only now it is to the shield.
  3. Baby keeps coming off the breast, if baby stays on with the shield, please have infant evaluated for tongue tie/lip tie.
  4. If you are using a shield for any reason, please note that there is s good chance that your milk supply will diminish over time. This is because your baby’s saliva doesn’t come in contact with your nipple and stimulation is decreased by the layer of silicone.
I like to think of nipple shields the same way that we would consider antibiotics. With judicious use, they truly can be a lifesaver. But most of the time they are not necessary and they certainly aren’t going to do a thing for the common cold (or sore nipples).
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Weaning

Is it Time to Wean?

Sooner or later, every breastfeeding mother faces the prospect of weaning. It begins when you start offering anything other than breastmilk to a breastfed baby. It is nice to know that weaning is a natural part of development. It is best to determine when to wean based on the mother and child’s needs, not the expectations of others.
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If you’re considering weaning your child, it might be best to clarify your feelings—why do you want to wean? What are your goals? It’s important to understand that your feelings will affect your child. If you’re feeling anxious or worried, your child may pick up on that and want to nurse more, creating a vicious cycle that will leave you both frustrated.
Determine your goals—what do you want to or believe you will achieve? Do you want your child to be more independent? Or is more sleep what you’re after?
Next, are your goals realistic? Many women wean thinking that their child will now sleep through the night and that just isn’t the case. “Sleeping through the night” is a very loose term, but for most professionals, sleeping 4-5 hours in one stretch is considered “sleeping through the night.” So, logically, if an infant goes to bed at 9:00 pm and only wakes at 3:00 am, he’s already sleeping through the night. Weaning most likely will not affect that. Instead of being able to easily comfort a child back to sleep with nursing, you’ll now be stuck with trying other methods to comfort a now awake child.
For an older baby or toddler, nursing is not just about food, necessarily. Nursing is a source of comfort and feeling of closeness to momma.
It is important to also note reasons not to wean. Those reasons include:
  • Teething
  • Mastitis
  • Returning to work
  • Mom or baby facing surgery or medications
  • Mother or baby’s illness or hospitalization
  • Pregnancy
Although each of the reasons listed above presents challenges, usually a solution can be found that does not require weaning. However, a nursing relationship is a symbiotic relationship and can only continue as long as both parties—mom & baby—are happy.

Approaches to Weaning

Gradual weaning is best. This allows mom’s body to naturally decrease her milk production, preventing mastitis and a host of other problems. How you wean will largely be determined by the age of your child.
  • 0-9 mos: you’ll need to substitute bottles instead of nursing.
  • 9-12 mos: you can use sippy cups/other foods to replace some nursing sessions **Please consult your pediatrician to determine best ways to meet your child’s nutritional needs.**
  • > 12 mos: planned weaning of a toddler should be a positive experience that helps a child develop independence.
One approach you might consider is Partial Weaning. Partial Weaning includes eliminating some, but not all nursing sessions. If your child is older than 1 year, you can also try shortening the nursing sessions. If your child is less than 1 year, though, it is best to consult with the doctor to make sure your child’s nutritional needs are being met.
Until at least 1 year, a breastfed baby gets most of their nutrition from nursing. If you are cutting those nursing sessions or shortening them, you will need to substitute with something—formula, pumped milk or other foods. You might be able to make up that missed nursing session with food and drink, or substitute with formula or pumped milk (either from mom or donor milk).
Abrupt Weaning is extremely hard on both mom and baby. For the mom, the physical discomfort and risk of mastitis or breast abscess is a very real possibility. Also, there will be hormonal changes as a result. The hormone prolactin is associated with feelings of well-being. Abrupt Weaning will cause a sudden drop in prolactin, which can lead to mood changes and is associated with depression.
For the baby, abruptly stopping can be especially traumatic. Nursing is not only food, it is comfort and closeness. If that is suddenly gone, the emotional trauma to a baby or toddler can be severe, leaving the child feeling as if the mother has withdrawn her love and rejected him.
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Methods of Gradual Weaning

There are six strategies you can use to start weaning, gradually. They are listed and discussed below.
  • Changing your daily routine: Most children have certain times and places they expect to nurse. Think about your routines. Try to come up with a way to change your routine so that your child is not reminded of nursing. For example, when my oldest son was weaning, I could not sit down in our nursing chair. As long as I didn’t sit down in that chair, he was not reminded of nursing. On the upside, my house has never been so clean!
  • Daddy’s turn: Remember all those feedings in the middle of the night when baby wanted no one but momma? Remember those nights where you tried for hours to get your baby to go to sleep and Daddy just slept or did his own thing? *This* is when you get payback! Remember when Daddy complained, “When do I get to help?” Well, now’s the time! Daddy can start helping by getting up in the night and handling those bottles (if your child is less than 1 year). If your routine has been to nurse first thing in the morning, perhaps Daddy can get up and fix your child breakfast, thereby breaking up that nursing routine. If your routine has been that you do baths and then nurse down for the night, perhaps now Daddy can take over that chore of giving baths and settling down for the night by reading a book.
  • Anticipate nursing and distract with a substitution: This method works better for some children than others, so if it doesn’t work, don’t stress yourself. This method works well for older children who are not dependent on nursing for nutrition. If you are familiar with your child’s routines and can anticipate when he will want to nurse, you can offer a snack and drink before he asks to nurse. Then distract with something else, like playing with a new toy, going to the park, playing with older children. Once the child has already asked to nurse, it will be much harder to distract and/or substitute.
  • Postponement: This method works better and easier for older children that understand the sequence of events. If your child can understand “Not Now… when Momma gets done [insert activity here].” Or if your child understands “Only when the sun is up/down” or “Only at night-night time.” Sometimes they will forget about asking to nurse again.
  • Shorten length of nursing sessions: If you are able, you can shorten how long your child stays latched. Many women either set an alarm on their phones or use a count-down method (“Ok, now I’m going to count down. When I get to 1, you need to let go.”).
  • Bargain: If all else fails, bribe ‘em! Just kidding, but seriously, some children can be motivated to stop nursing with the promise of a new toy or new privilege.
Most importantly, it is imperative that you, the mom, remain flexible. Understand that some nursing sessions are more important than others (i.e. bedtime, during an illness). Weaning is a process. It is not going to happen overnight or possibly even over a week or month. It might take months. And some days will be better than others.
Sometimes, it’ll even be two steps forward and one step back before any sort of progress will be made.
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There are certain behaviors associated with weaning too fast. If your child starts to exhibit these signs, you are strongly encouraged to back off on the weaning process for a little bit and resume some time in the future.
  • Child becomes upset/cries/distraught/insists upon nursing
  • Stuttering
  • Night-waking increases
  • Increased clinginess during the day
  • New attachment to an object or a toy
  • New or increased fear of separation
  • New habit of biting.
For mom, there are also signs that weaning is going too fast. Signs for mom include:
  • Mastitis or breast abscess
  • Uncomfortably full feeling of the breasts
  • Feelings of resentment
  • Being overwhelmed with meeting the child’s needs to make up for not nursing.

Weaning is an emotional process for mothers and children. It is a transition from some of the last parts of babyhood into full fledged toddler or childhood. With the freedom of weaning comes new challenges and stages in your child’s live. We wish you all the best!