8.5 Breastfeeding Devices and Tools

Devices Are Adjuncts, Not First Steps

A recurring IBCLC exam theme is that a device is rarely the first action. The standard sequence is: optimize positioning and latch, identify a clear indication, choose the least restrictive tool, monitor milk transfer, and wean the device once it is no longer needed. Items that jump straight to a gadget while skipping latch correction are usually wrong.

Nipple Shields

A nipple shield is a thin silicone cover worn over the nipple during a feed. It is an indicated tool, not a routine convenience.

• Indications: flat or inverted nipples that the baby cannot grasp; helping a preterm or late-preterm baby latch and transfer (the firmer shape gives a target); a baby transitioning from bottle to breast; and select nipple-trauma situations where it allows continued feeding while tissue heals.
• Risks/cautions: potential reduced milk transfer if fit or technique is poor, which can lower supply; dependence; and masking an underlying latch problem. Use the correct size, confirm transfer (weights, output, audible swallowing), and protect supply (express if transfer is uncertain).
• Weaning off: as latch matures, start the feed with the shield then slip it off mid-feed, or begin some feeds without it; monitor that intake stays adequate as you reduce use.

Breast Shells

Breast shells are rigid domes worn inside the bra between feeds. They serve two different purposes: protecting sore or healing nipples from friction by holding fabric off the nipple, and applying gentle, steady pressure to help evert flat or inverted nipples over time. They are not worn during the feed — a common point of confusion with nipple shields (remember: shield = during the feed; shell = between feeds).

Because shells can trap milk and warmth against the skin, any milk that collects in a shell should be discarded, not fed to the baby, and shells should be cleaned between uses. The eversion benefit is modest and the evidence mixed, so shells are an adjunct to good latch work, not a cure for a deep-seated latch problem.

Scales and Test Weights

Objective intake measurement uses a test weight (weigh-feed-weigh):

1. Weigh the clothed, dry baby on an accurate scale before the feed.
2. Feed without changing the diaper or clothing.
3. Weigh again immediately after under identical conditions.
4. The difference in grams estimates the milliliters transferred (1 g ≈ 1 mL).

Accuracy depends on a sensitive scale (typically 2 g resolution) and keeping everything constant between weights. Test weighing is the most objective way to document transfer when intake is in question.

Supplementers and Collection Devices

• Supplemental nursing systems (SNS): deliver a supplement at the breast (covered in 6.4) — listed here as a device requiring fit, cleaning, and a weaning plan.
• Silicone collection cups (e.g., haakaa-style): attach by suction to the opposite breast to catch let-down/drip milk during a feed, or express by suction. Useful for building a small stash without active pumping; not a high-volume pump replacement.
• Milk-collection shells/cups: passively collect leaked milk between or during feeds.

Emerging Treatments — Awareness Only

The IBCLC should be aware of adjuncts marketed for nipple pain, plugged ducts, or wound healing (for example, low-level laser / photobiomodulation, therapeutic ultrasound, and various topical products and ointments). The exam expects you to know these exist, that evidence quality varies widely, and that an IBCLC stays within scope — evaluating evidence and referring for treatments outside lactation-consultant practice rather than prescribing them.

Note too that current guidance for plugged ducts and inflammatory conditions has moved away from aggressive deep massage and toward gentler measures (lymphatic-style light massage, cold for swelling, anti-inflammatory care, and normal milk removal); an exam item that recommends vigorous pounding or pumping to "clear" a plug is usually the wrong answer. The throughline is humility about device claims and respect for scope: recommend what is evidence-based, refer what is not yours to treat.

A Framework for Evaluating Any Device

When a parent asks about a product, evaluate it with a consistent checklist:

• Indication — is there a clear clinical reason, or is it being used to skip latch work?
• Evidence — what is the quality of support for the claim?
• Safety/fit — correct size, clean use, no harm to supply or the infant.
• Transfer monitoring — how will you confirm the baby still gets enough?
• Exit plan — how and when will the device be weaned?

Example: A mother with truly flat nipples and a late-preterm baby who cannot stay latched is fitted with a correctly sized nipple shield, which lets the baby latch and transfer. The IBCLC confirms transfer with a test weight (weigh-feed-weigh) showing about 45 g ≈ 45 mL intake, protects supply by tracking output, and sets a plan to wean the shield as the baby matures — device used for a clear indication, transfer verified, exit plan in place.