title: The Use of Nipple Shields: A Review.
abstract: BACKGROUND
  A nipple shield is a breastfeeding aid with a nipple-shaped shield that is positioned over the nipple and areola prior to nursing. Nipple shields are usually recommended to mothers with flat nipples or in cases in which there is a failure of the baby to effectively latch onto the breast within the first 2 days postpartum. The use of nipple shields is a controversial topic in the field of lactation. Its use has been an issue in the clinical literature since some older studies discovered reduced breast milk transfer when using nipple shields, while more recent studies reported successful breastfeeding outcomes. The purpose of this review was to examine the evidence and outcomes associated with nipple shield use.
  
  
  METHODS
  A literature search was conducted in Ovid MEDLINE, OLDMEDLINE, EMBASE Classic, EMBASE, Cochrane Central Register of Controlled Trials, and CINAHL. The primary endpoint was any breastfeeding outcome following nipple shield use. Secondary endpoints included the reasons for nipple shield use and the average/median length of use. For the analysis, we examined the effect of nipple shield use on physiological responses, premature infants, mothers' experiences, and health professionals' experiences.
  
  
  RESULTS
  The literature search yielded 261 articles, 14 of which were included in this review. Of these 14 articles, three reported on physiological responses, two reported on premature infants, eight reported on mothers' experiences, and one reported on health professionals' experiences.
  
  
  CONCLUSIONS
  Through examining the use of nipple shields, further insight is provided on the advantages and disadvantages of this practice, thus allowing clinicians and researchers to address improvements on areas that will benefit mothers and infants the most.
authors.affiliation: Toronto East General Hospital , Toronto, ON , Canada.
authors.forename: Selina
authors.initials: S
authors.lastname: Chow
authors.affiliation: Toronto East General Hospital , Toronto, ON , Canada.
authors.forename: Ronald
authors.initials: R
authors.lastname: Chow
authors.affiliation: Toronto East General Hospital , Toronto, ON , Canada.
authors.forename: Marko
authors.initials: M
authors.lastname: Popovic
authors.affiliation: Sunnybrook Health Sciences Centre , Toronto, ON , Canada.
authors.forename: Henry
authors.initials: H
authors.lastname: Lam
authors.affiliation: Health Services, Division for Intellectual and Developmental Disabilities, Ministry of Social Affairs, National Institute of Child Health and Human Development , Jerusalem , Israel.
authors.forename: Joav
authors.initials: J
authors.lastname: Merrick
authors.affiliation: Quality of Life Research Center , Copenhagen , Denmark.
authors.forename: Søren
authors.initials: S
authors.lastname: Ventegodt
authors.affiliation: Toronto East General Hospital , Toronto, ON , Canada.
authors.forename: Milica
authors.initials: M
authors.lastname: Milakovic
authors.affiliation: Sunnybrook Health Sciences Centre , Toronto, ON , Canada.
authors.forename: Michael
authors.initials: M
authors.lastname: Lam
authors.affiliation: Toronto East General Hospital , Toronto, ON , Canada.
authors.forename: Mila
authors.initials: M
authors.lastname: Popovic
authors.affiliation: Sunnybrook Health Sciences Centre , Toronto, ON , Canada.
authors.forename: Edward
authors.initials: E
authors.lastname: Chow
authors.affiliation: Toronto East General Hospital , Toronto, ON , Canada.
authors.forename: Jelena
authors.initials: J
authors.lastname: Popovic
keywords: breastfeeding; lactation; nipple shield