Reexamination of ultra-thin nipple shield use, infant growth and maternal satisfaction

West Virginia University, School of Nursing, Morgantown, WV 26505, USA.
Journal of Clinical Nursing (Impact Factor: 1.26). 10/2009; 18(21):2949-55. DOI: 10.1111/j.1365-2702.2009.02912.x
Source: PubMed


The primary objective of the multi-site, international study was to examine trends in weight gain for term infants breastfed with and without ultra-thin silicone nipple shields to determine the effect of nipple shield use on infant weight gain over two months. Additionally, the study examined maternal satisfaction with nipple shield use using a structured survey.
The nipple shield may facilitate successful breastfeeding outcomes when indicated. There has been question regarding infant weight gain with nipple shield use. A published pilot study using within-subject design indicated no significant difference in infant test weights and maternal prolactin levels when breastfeeding with and without nipple shields. The current study builds and expands upon the pilot study.
Prospective, multi-site, non-randomised, between-subject study.
Maternal-infant dyads (n = 54) who used a nipple shield for breastfeeding were studied.
Results demonstrate no statistically significant difference in infant weight gain at two weeks, one month and two months between infants who breastfed with and infants who breastfed without a nipple shield. A majority (89.8%) of the women reported a positive experience with nipple shield use and 67.3% of the women reported that the nipple shield helped prevent breastfeeding termination.
Infant weight gain was similar in maternal-infant dyads using nipple shields for two months compared to those not using the shields. Maternal positive report of nipple shield use lends to the clinical importance of nipple shield use when appropriately indicated.
Nipple shield use may facilitate breastfeeding when clinically indicated in maternal-infant dyads without risk of decreased infant weight gain.

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    • "The exception to this was nipple shields. The preference for nipple shields is consistent with other studies showing that women are satisfied with their use of nipple shields, indeed, found them indispensible in aiding to achieve breastfeeding goals, and would use them again in the future [31-35]. Nipple shields are unique amongst the repertoire of second-line strategies by facilitating almost direct breastfeeding. "
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    ABSTRACT: Breastfeeding self-efficacy (BFSE) supports breastfeeding initiation and duration. Challenges to breastfeeding may undermine BFSE, but second-line strategies including nipple shields, syringe, cup, supply line and bottle feeding may support breastfeeding until challenges are resolved. The primary aim of this study was to examine BFSE in a sample of women using second-line strategies for feeding healthy term infants in the first week postpartum. A retrospective self-report study was conducted using the Breastfeeding Self-Efficacy Scale - Short Form (BSES-SF), demographic and infant feeding questionnaires. Breastfeeding women who gave birth to a singleton healthy term infant at one private metropolitan birthing facility in Australia from November 2008 to February 2009 returned anonymous questionnaires by mail. A total of 128 (73 multiparous, 55 primiparous) women participated in the study. The mean BSES-SF score was 51.18 (Standard deviation, SD: 12.48). The median BSES-SF score was 53. Of women using a second-line strategy, 16 exceeded the median, and 42 were below. Analyses using Kruskal-Wallis tests confirmed this difference was statistically significant (H = 21.569, p = 0.001). The rate of second-line strategy use was 48%. The four most commonly used second-line strategies were: bottles with regular teats (77%); syringe feeding (44%); bottles with wide teats (34%); and nipple shields (27%). Seven key challenges were identified that contributed to the decision to use second-line strategies, including: nipple pain (40%); unsettled infant (40%); insufficient milk supply (37%); fatigue (37%); night nursery care (25%); infant weight loss > 10% (24%); and maternal birth associated pain (20%). Skin-to-skin contact at birth was commonly reported (93%). At seven days postpartum 124 women (97%) were continuing to breastfeed. The high rate of use of second-line strategies identified in this study and high rate of breastfeeding at day seven despite lower BFSE indicate that such practices should not be overlooked by health professionals. The design of this study does not enable determination of cause-effect relationships to identify factors which contribute to use of second-line strategies. Nevertheless, the significantly lower BSES-SF score of women using a second-line strategy highlights this group of women have particular needs that require attention.
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    Scandinavian Journal of Public Health 12/2005; 33(6):424-31. DOI:10.1080/14034940510005923 · 1.83 Impact Factor
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    ABSTRACT: Nipple shields have become commonplace in the United States for a wide range of breastfeeding problems. This article is a summary of the current literature describing the evidence for nipple shield use. The authors reviewed all available articles on nipple shields and selected 13 studies for inclusion. The studies were organized into three categories: physiologic responses, premature infants, and mothers' experiences. This review concludes that current published research does not provide evidence for safety or effectiveness of contemporary nipple shield use.
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