Health professionals' attitudes and use of nipple shields for breastfeeding women

Objective: No professional guidelines exist regarding nipple shield use for nursing women. This study was done to determine health professionals' most common reasons for and concerns regarding the use of nipple shields for breastfeeding women. Methods: In June and July 2009, a web-based anonymous survey was advertised via internet listservs to physicians and other allied health professionals specializing in breastfeeding management. Subjects were asked about their most common reasons for using nipple shields, their most common concerns about nipple shield use, and what they typically hear from breastfeeding women who have used nipple shields. Results: Four hundred ninety participants completed the survey, with 92% having used nipple shields in their practices. Ninety-five percent of respondents who were board-certified lactation consultants used shields versus 80% of those not board-certified, although those using nipple shields used them in the same manner. The most common reason to use nipple shields among all respondents was to help the <35-week infant latch and nurse. Thirty-eight percent of respondents used nipple shields in infants >35 weeks of gestation and <3 days of age. Respondents rated "lack of follow-up by those introducing the nipple shield" as their greatest concern about nipple shields. The maternal response most frequently expressed about nipple shields was that "they are helpful." Conclusions: Nipple shield recommendation is very common among health professionals who work with nursing women, although many concerns regarding their safety exist. Guidelines should be developed to ensure that nipple shields are used in an evidence-based and safe manner.