The newly revised (2003) Breastfeeding Answer Book does not explicitly state
that nipple shields don't decrease milk supply.  Rather, the information
given is that "Although it was once thought that nipple shields caused more
problems than they solved, in some situations they can be a useful tool to
help preserve breastfeeding.  The thicker rubber nipple shields available
some years ago were found to reduce milk supply and alter babies' sucking
patterns (Wooldridge 1980), but many have found that in certain situations
the new thinner, flexible silicone nipple shields can help a baby
successfully transition to the breast (Bodley and Powers 1996; Brigham 1996;
Clum and Primomo 1996; Elliott 1996; Meier 2000; Sealy 1996; Wilson-Clay
1996; Woodworth 1996).  If the usual strategies don't work, nipple shields
may be helpful for:

*  the premature baby who is no yet fully effective at the breast (Meier
2000).
*  the baby having latch-on problems (Wilson-Clay 1996),
*  the baby with tongue thrust, a retracted tongue, neurological problems,
or a weak suck,
*  the mother with inverted nipples."

The 2003 Breastfeeding Answer Book also suggests several strategies for
weaning from the shield, advising that the length of time required for this
weaning may last from a few feedings to a few months.

Like many things in lactation, we must weigh the risks and benefits of using
a particular device or strategy.  My interpretation of the 2003
Breastfeeding Answer Book is that it reflects the idea of newer types of
nipple shields having been proven effective as a way for *some* babies to
transition to the breast, possibly outweighing risks associated with their
use.

Sara Dodder Furr, LLL Leader
Lincoln, Nebraska USA

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