How to use nipple shields

A nipple shield can feel like a very small piece of equipment carrying a great deal of hope. For some families, learning how to use nipple shields can provide a short-term bridge through painful feeding, latch difficulty or an unsettled start. For others, it may not improve feeding at all. The aim is not simply to get a shield to stay on, but to support comfortable, effective milk transfer while understanding what is happening for both baby and parent.

Nipple shields are thin, flexible silicone covers worn over the nipple during breastfeeding or chestfeeding. They are not a treatment for every feeding difficulty, and they do not replace a skilled assessment of positioning, attachment, milk production, infant wellbeing and oral function. Used thoughtfully, with follow-up, they can be one useful option within a wider feeding plan.

When might a nipple shield be considered?

A clinician may suggest a nipple shield when a baby is struggling to latch directly to the breast, particularly where the nipple is very sore, the nipple shape makes attachment more difficult, or a baby is finding the transition from bottle to breast challenging. Sometimes a shield is considered for babies born early or for babies who need help maintaining a latch while feeding skills develop.

The research base is limited and mixed. Older shield designs were associated with reduced milk transfer, while modern thin silicone shields may be helpful for some dyads when appropriately selected and monitored. However, studies are generally small and do not show that shields are the right answer for every situation (McKechnie and Eglash, 2010; Chertok, Schneider and Blackburn, 2006). This is why individual feeding assessment matters.

Painful feeding, frequent slipping off, clicking, very long feeds, concerns about milk transfer or a baby who is not gaining weight as expected deserve careful attention. These experiences can have several contributing factors. Anatomy provides information; function provides context.

How to use nipple shields: fitting and application

A shield should fit the nipple, not merely cover it. The tunnel should allow the nipple to draw in comfortably during a feed without rubbing tightly against the sides or leaving a pronounced compressed ring afterwards. A shield that is too small may cause friction and restrict nipple movement. One that is too large may be difficult for a baby to hold deeply in their mouth. Sizes vary between manufacturers, so the number on a packet is not a substitute for observing a feed.

Before feeding, wash your hands. Follow the manufacturer’s instructions for cleaning and sterilising the shield, particularly for young babies. Check that it is intact, clean and free from tears.

To apply it, turn the outer edges partly inside out, centre the nipple in the tunnel, then roll the edges back on to the breast. This gentle turning action often helps create a seal. A few drops of expressed breast milk inside the tip may encourage a baby to begin sucking, though it is not essential.

Bring baby to the breast in a stable, close position. Their nose should be level with the nipple and their body held facing yours, rather than turning their head towards the breast. Wait for a wide mouth, then bring them on deeply. The baby needs to take a generous mouthful of breast as well as the shield, not just the shield’s tip.

If the shield repeatedly slips, pauses can help. Repositioning yourself and baby, drying excess milk from the breast or checking the fit may make more difference than pressing the shield more firmly into place.

How to clean and sterilise nipple shields

Nipple shields come into direct contact with your baby's mouth and breast milk, so good hygiene is important. They should be cleaned after every use and sterilised regularly.

After every feed

Wash your hands before handling the nipple shield. After the feed, rinse the shield and then wash it thoroughly in hot, soapy water. Pay particular attention to the inside of the shield and the small openings through which milk passes. Rinse it thoroughly in clean, running water and allow it to dry completely before storing it in a clean, dry container.

For a healthy, term baby, nipple shields should be washed after every use and sterilised at least once every 24 hours. This approach is consistent with NHS guidance used for infant feeding equipment and specific NHS guidance relating to nipple shields.

Sterilisation can be carried out using an appropriate steam steriliser, cold-water sterilising solution or boiling, provided the nipple shield manufacturer confirms that the particular product is suitable for that method. NHS guidance recommends following the steriliser manufacturer's instructions for steam sterilisation, keeping equipment submerged for at least 30 minutes when using cold-water sterilising solution, and boiling suitable equipment for at least 10 minutes.

If using cold-water sterilisation, the solution should be changed every 24 hours in accordance with the manufacturer's instructions.

What about premature or neonatal babies?

The requirements can be different for babies who are premature, receiving neonatal care or otherwise particularly vulnerable to infection.

In neonatal settings, more stringent infection-control procedures may be used. If your baby is receiving neonatal care, follow the specific instructions provided by your neonatal or infant-feeding team.

What about after tongue-tie division?

Extra care with hygiene is appropriate when a nipple shield is being used following tongue-tie division (frenulotomy). The procedure leaves a healing wound beneath the tongue, so anything placed into the baby's mouth should be kept particularly clean.

If a nipple shield is being used following division, it should continue to be cleaned thoroughly after every use. In this situation, I would recommend following the specific post-procedure advice given by the clinician who performed the division regarding sterilisation. Depending on the baby's age, health and clinical circumstances, this may be more stringent than routine advice for a healthy term baby.

It is therefore helpful to distinguish between routine nipple-shield hygiene and the additional precautions that may be appropriate following an oral procedure. There is not a single UK-wide rule stating that every nipple shield must automatically be sterilised after every feed following tongue-tie division; the individual clinical circumstances and the clinician's aftercare instructions should be taken into account.

It is also important to remember that cleaning and sterilising are not the same thing. Cleaning removes milk residue and contamination, while sterilisation is an additional process to reduce microorganisms. The nipple shield should always be thoroughly cleaned before it is sterilised.

Nipple shield sizes and shapes

Nipple shields are available in different sizes and shapes, and choosing an appropriate shield can make a difference to comfort and feeding effectiveness. There is no universal nipple-shield size that will suit everyone.

How do you measure for a nipple shield?

Nipple-shield sizing is generally based on the diameter of the nipple (the distance across the nipple), rather than the size of the breast or areola. The Association of Breastfeeding Mothers (ABM) describes nipple shields as being sized according to the diameter of the base of the nipple, with commonly available UK sizes including 16 mm, 20 mm and 24 mm (Association of Breastfeeding Mothers, 2019).

A nipple-measuring tool or ruler can be used to measure the nipple in millimetres. Measurement should be considered a starting point rather than an exact prescription, as different manufacturers use different sizing systems and the internal dimensions of shields can vary between brands.

Research into nipple-shield sizing suggests that the relationship between nipple diameter and shield diameter may be clinically relevant. In a mechanistic study examining milk removal, Geddes et al. (2020) compared a fitted shield, where the shield diameter was at least 4 mm larger than the nipple diameter, with a smaller shield. The authors found differences in milk removal between the conditions, suggesting that shield size may influence milk removal efficiency.

It is important to note, however, that this study investigated milk removal using breast pumping rather than direct breastfeeding, so its findings should not be interpreted as establishing a universal sizing formula for breastfeeding.

Does the shape of the nipple shield matter?

Nipple shields differ in their overall shape and design. Traditional shields have a more uniform, conical shape, while some modern designs have a cut-out or asymmetric section around the base. This design allows more of the baby's nose or chin to remain in contact with the breast rather than against the silicone shield.

The Association of Breastfeeding Mothers describes a 'contact' nipple shield as having a cut-away section that allows the baby's nose or chin to remain close to the breast (Association of Breastfeeding Mothers, 2019).

Shields can also differ in tunnel length, flexibility, teat shape and the number and position of milk-transfer openings. These differences mean that two shields with the same stated diameter may not behave or feel identically during feeding.

The design of a nipple shield may also influence milk transfer. Earlier research comparing different shield designs found differences in milk transfer between shield types, although the evidence base is limited and much of the research relates to older shield designs that are different from the thin silicone shields commonly used today (Chow et al., 2015).

Consequently, size should not be considered in isolation from the design of the shield. The manufacturer's sizing guidance should always be considered, alongside an assessment of comfort, milk transfer and the individual breastfeeding circumstances.

What effective feeding can look and feel like

Comfort is one important sign, but it is not the only one. Once the initial tugging settles, feeding should usually feel manageable rather than pinching, burning or persistently painful. You may notice slow, rhythmic jaw movement and hear or see periods of swallowing. The shield may contain milk after a feed, but this alone does not tell us how much milk baby has transferred.

Look at the whole picture: baby’s alertness, feeding pattern, nappy output appropriate to their age, weight trajectory and your breast comfort. A baby who comes off content at times can still need review if feeds are consistently exhausting, milk transfer is uncertain or weight gain is a concern.

Protecting milk supply while using a shield

A nipple shield does not inevitably reduce supply, but any situation in which milk removal is less effective can affect supply over time. This is a practical reason for arranging early follow-up rather than assuming that a shield has solved the issue.

Offer feeds responsively and observe whether your breasts soften after feeds. If baby is not transferring milk effectively, a feeding professional may recommend expressing after some feeds to protect supply and provide milk for baby. The right approach depends on baby’s age, weight, feeding frequency, your milk production and the overall plan. There is no single expressing schedule that suits every family.

Where supplementation is clinically indicated, decisions about what, how and for how long should be made with appropriate professional support and in line with your feeding goals. The Academy of Breastfeeding Medicine emphasises that discharge and follow-up planning should include assessment of breastfeeding effectiveness, infant intake and timely support when concerns are identified (Hoyt-Austin et al., 2022).

Common problems and gentle adjustments

Some babies become frustrated because milk is not flowing quickly enough at the beginning of a feed. Gentle breast compression while baby is actively sucking may help maintain milk flow. Others may find the shield changes the feel of feeding and need calm, repeated opportunities to practise.

If feeds are painful, do not assume that pain is an unavoidable part of using a shield. Check the fit and depth of latch first. Persistent nipple pain may be linked to skin damage, positioning and attachment, milk blebs, infection, vasospasm or other causes, each of which needs a different response. A shield can sometimes reduce friction temporarily, but it should not delay assessment of ongoing pain (Berens et al., 2016).

Some parents find that baby will feed with a shield but not without it. This is not a failure. If direct feeding is your goal, try when baby is calm rather than very hungry. Skin-to-skin contact, offering the breast without the shield at the start of a feed, or removing it partway through when milk is flowing may be worth exploring. If baby becomes upset, return to what enables feeding and seek specialist support from a lactation consultant (IBCLC). There is rarely a benefit in turning feeding into a battle.

When to seek prompt support

Contact your midwife, health visitor, GP, infant feeding team or another suitably qualified clinician promptly if your baby is unusually sleepy for feeds, has fewer wet nappies than expected for their age, appears jaundiced or unwell, or is not gaining weight as expected. Seek support too if you have worsening breast pain, fever, a red or hot area of breast, damaged nipples that are not healing, or significant worries about milk supply.

If you are unsure whether a nipple shield is the right size, shape or solution for you and your baby, or if you are experiencing ongoing pain or feeding difficulties, seeking individual breastfeeding support can be helpful. International Board Certified Lactation Consultants (IBCLCs) are internationally recognised specialists in lactation and breastfeeding care and are considered the gold standard in lactation care. An IBCLC can assess the breastfeeding dyad, including feeding, attachment, milk transfer and nipple-shield use, and provide individualised support. A skilled feeding assessment involves watching a feed and considering the parent, baby and feeding relationship together. It may include discussion of birth history, bottle feeding where relevant, breast and nipple comfort, infant growth, positioning, attachment and oral function. Tongue-tie can be one consideration in some babies, but it is not the sole explanation for complex feeding difficulties, and not every visible frenulum requires treatment.

Using a shield as a bridge, not a test to pass

For many families, nipple shields are temporary. For others, they remain useful for longer. Neither outcome defines the success of your feeding journey. The priority is that baby is fed, the feeding parent is supported, and decisions are made with clear information rather than pressure.

If a shield is helping, continue to monitor feeding and keep review in place. If it is not helping, you do not need to persist alone. Thoughtful support can identify what is working, what needs adjusting and what matters most to your family.

References

Alder Hey Children's NHS Foundation Trust (2023) Nipple Shields – Breastfeeding Leaflet. Available at: https://www.alderhey.nhs.uk/wp-content/uploads/2023/06/Nipple-Shields-Breastfeeding-Leaflet-PIAG-343.pdf (Accessed: 14 August 2026).

Association of Breastfeeding Mothers (2019) Weaning from a shield. Available at: https://abm.me.uk/wp-content/uploads/ABM-nipple-shields-breastfeeding.pdf (Accessed: 14 August 2026).

Berens, P., Brodribb, W., Academy of Breastfeeding Medicine and Protocol Committee (2016) ‘ABM Clinical Protocol #26: Persistent pain with breastfeeding’, Breastfeeding Medicine, 11(2), pp. 46-53.

Chertok, I.R.A., Schneider, J. and Blackburn, S. (2006) ‘A pilot study of maternal and term infant outcomes associated with ultrathin nipple shield use’, Journal of Obstetric, Gynecologic, and Neonatal Nursing, 35(2), pp. 265-272.

Chow, S., Chow, R., Popovic, M., Lam, H., Merrick, J., Milne, S., Laks, R., and Theam, M. (2015) 'The use of nipple shields: a review', Frontiers in Public Health, 3, p. 236.

East of England Neonatal Network (2025) Clinical Guideline: Using a Nipple Shield. Available at: https://eoeneonatalpccsicnetwork.nhs.uk/wp-content/uploads/2023/07/EoE-Nipple-Shield-Guideline.pdf (Accessed: 14 August 2026).

Geddes, D.T., Prime, D.K., Hartmann, P.E. and others (2020) 'Effect of nipple shield use on milk removal: a mechanistic study', BMC Pregnancy and Childbirth, 20.

Hoyt-Austin, A.E., Kair, L.R., Larson, I.A., Stehel, E.K., Marinelli, K.A. and Academy of Breastfeeding Medicine (2022) ‘Academy of Breastfeeding Medicine Clinical Protocol #2: Guidelines for birth hospitalization discharge of breastfeeding dyads, revised 2022’, Breastfeeding Medicine, 17(3), pp. 197-206.

McKechnie, A.C. and Eglash, A. (2010) ‘Nipple shields: A review of the literature’, Breastfeeding Medicine, 5(6), pp. 309-314.

NHS (2026) How to sterilise feeding equipment. Available at: https://www.nhs.uk/best-start-in-life/baby/feeding-your-baby/bottle-feeding/how-to-make-up-a-feed/how-to-sterilise-equipment/ (Accessed: 14 August 2026).

NHS (2026) Sterilising baby bottles. Available at: https://www.nhs.uk/baby/breastfeeding-and-bottle-feeding/bottle-feeding/sterilising-baby-bottles/ (Accessed: 14 August 2026).