Many infants are more willing to accept the change from nipple shield to breast after the initial milk ejection reflex (let-down) and a pause in the suck pattern occurs. Gently slipping the shield off the breast and encouraging the infant to latch on to the breast is often what the infant needs to successfully make the transition back to the breast. Other infants need a partial feeding at one breast before they might be willing to attempt to breastfeed at the other breast without the shield. Following the infant's cues will help the mother to know when to attempt removal of the nipple shield in her situation. It can be helpful to encourage the mother to attempt breastfeeding without the shield in place at every feeding. Whether this is done at the beginning, middle, or end of the feeding will depend on the individual mother and infant. The Leader needs to stress to the mother that these attempts are learning opportunities for the infant, not intended to pressure either mother or infant to perform.
Older lactation texts may advise gradually trimming the tip of the nipple shield back with scissors until the infant transitions to the breast without the shield. Using this method with a thin silicone shield leaves sharp edges that can lacerate the infant's mouth or the mother's nipple, increasing the breastfeeding problems and weaning potential. This technique should never be used with a silicone shield.
During the process of weaning from the nipple shield, it is essential for the mother to stay in close contact with the infant's health care provider in order to monitor the infant in terms of weight gain. Ask about adequate wet and soiled diapers, the mother's nipple discomfort and milk supply. Those infants who are healthy, alert, and gaining weight well may transition directly to exclusive breastfeeding. However, infants who are experiencing slow weight gain, weak or ineffective sucking, and/or neurological or physical challenges may need additional supplementation at the breast. The individual infant and family situation will determine what is appropriate.