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Nipple shield use does not impact sucking dynamics in breastfeeding infants of mothers with nipple pain


Nipple shields (shield) may reduce pain during breastfeeding, but the impact on infant sucking dynamics is not known. We examined the effects of shield use on sucking dynamics, milk removal and nipple pain in two groups of breastfeeding dyads: pain group (PG): shield used for nipple pain; comparison group (CG): no breastfeeding difficulties. Twenty PG (6 ± 4 weeks postnatal) and 28 CG dyads (8 ± 6 weeks postnatal) attended 2 monitored breastfeeding sessions with shield use randomised. Within-subject outcomes were compared. PG: shield use did not affect intra-oral vacuum (peak p = 0.17, baseline p = 0.59), sucking frequency (p = 0.20) or milk transfer (40 mL vs 48 mL, p = 0.80; percentage of available milk removed (PAMR) 55% vs 57%, p = 0.88), and reduced McGill pain scores (p = 0.012). CG: shield use increased non-nutritive sucking (10% more, p = 0.049), and reduced nutritive sucking (18% less, p = 0.017) and milk transfer (63 mL vs 31 mL p < 0.001, PAMR 65% vs 36% p < 0.001). For both groups, feeding duration increased by 2 min (p < 0.0001) and non-nutritive portions of the feed increased with shield use.

Conclusion: Nipple shield use improved maternal comfort and did not impact milk removal or sucking strength in PG, but significantly reduced milk transfer and nutritive sucking in CG.

What is Known:

• Mothers report that nipple shields reduce nipple pain and enable continued breastfeeding.

• Concerns that nipple shield use may reduce milk transfer and alter infant sucking patterns are based on limited published evidence.

What is New:

• Nipple shield use is associated with a 25% reduction in pain scores in breastfeeding mothers with chronic nipple pain.

• Milk transfer is not reduced in dyads that regularly use a shield for chronic nipple pain.

• Intra-oral vacuums are not impacted by nipple shield use in mothers experiencing pain.

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Fig. 1

Data availability

All datasets generated or analysed during this study are available from the corresponding author on request.



Comparison group


International board-certified lactation consultant


McGill Pain Questionnaire


Non-nutritive pause


Non-nutritive sucking

NP :

Nutritive pause

NS :

Nutritive sucking


Percentage of available milk removed

PG :

Pain group


Visual Analogue Scale


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VSC received a scholarship from Science without Borders, Government of Brazil. The salaries of SP, CTL and DG are paid from an unrestricted research grant paid by Medela AG to The University of Western Australia.

Author information

Authors and Affiliations



VSC designed the study and performed data collection, interpretation of the data and writing of the manuscript. SLP designed the study, assisted with data collection and interpretation and reviewed the manuscript. CTL assisted with data extraction and analysis. MD and AR provided statistical analysis. DTG designed the study, provided data interpretation and reviewed the manuscript. All authors reviewed and approved the manuscript prior to submission.

Corresponding author

Correspondence to Sharon Lisa Perrella.

Ethics declarations

Conflict of interest

VSC received a scholarship from Science without Borders, Government of Brazil. The salaries of SP, CTL and DG are paid from an unrestricted research grant paid by Medela AG to The University of Western Australia.


The funding bodies were not involved in the study design, collection, analysis and interpretation of data, writing of the manuscript and the decision to submit the manuscript for publication.

Ethical approval

The study was approved by the Human Research Ethics Committees of the Women and Newborn Health Service (2016124) and The University of Western Australia (RA/4/1/7863).

Informed consent

Written informed consent was obtained from all individual participants included in the study.

Consent to participate

Written informed consent to participation was obtained from all individual participants included in the study.

Consent for publication

Written informed consent to publication was obtained from all individual participants included in the study.

Code availability

Not applicable.

Additional information

Communicated by Peter de Winter

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Coentro, V.S., Perrella, S.L., Lai, C.T. et al. Nipple shield use does not impact sucking dynamics in breastfeeding infants of mothers with nipple pain. Eur J Pediatr 180, 1537–1543 (2021).

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