I have found that when a mother has told me that she waited a few days at home to "settle in" before continuing breastfeeding, that she most likely will not succeed.  I ask my mothers to continue breastfeeding at least 2-3 times a day so that the baby doesn't "forget" how to do it.  Sometimes they think that they will be too overwhelmed at home to try.   I do also tell them what other mothers have told me as far as their experiences at home.  
Maureen Allen RN, BSN, IBCLC
Boston, MA
 
-----Original Message-----
From: Kathy <[log in to unmask]>
To: [log in to unmask]
Sent: Mon, 12 Sep 2005 20:18:07 -0500
Subject: Nipple shields and premature infants


I only see babies after they are long gone from the NICU. My perception is that having a baby at the breast with a nipple shield with appropriate follow-up is way better than having them exclusively bottle-fed...which is what I see most frequently. In my experience, if a baby leaves the NICU removing some milk on his own at the breast, it seems they have a much better chance at long-term breastfeeding. If they are exclusively bottle-fed until they come see me at 2-3 months of age, it is sometimes impossible to convince them to take the breast. (I should say I can usually coax them into staying on if I squirt milk quickly behind the shield the entire time, but many parents will not do this at home.) 
 
The keys to success as I see it would be: 
 
-being sure the baby is on the breast itself, not just the tip of the nipple shield 
 
-pumping as long as needed to optimize supply if it helps baby mostly get food at the breast 
 
-making sure the baby always opens WIDE before getting on the shield (this really helps when time to wean off shield, AND helps wqith getting baby on farther) 
 
-follow-up frequently with naked weight checks and pre/post weights until SURE the baby is flying solo. 
 
Kathy Leeper, MD, IBCLC 
Lincoln, NE  
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