Have you ever encountered a seemingly "normal" everyday problem that makes you feel 
like a brand new LC?

Recently I have encountered two mothers using, or trying to use shileds that have made 
me think I need a crash course in nipple shields. Both mothers presented to me fairly late 
(3-5 weeks postpartum)...

One mother definitely has fit issues..the nipple diameter is very large although the shaft 
is not too long...

The second mother has nipples that might have been a little too wide at the baby's birth 
for an easy fit, but the baby's mouth has grown enough that now the problem seems to 
be bottle-nipple preference...

Both babies cry when the naked nipple is presented to them but quiet down and begin to 
try to latch when they feel the shield is there...still they push the shielded-nipple out of 
their mouths with their tongues when they try to "feed", so the shield collapses inward, a 
latch is never achieved, and no milk gets transferred...

One mother has nursed a previous child, the other this is a first baby but both mothers 
have great technique so I don't feel positioning is the reason why the babies can't achieve 
a latch with the shields....

One baby has no visible frenum under his tongue at all...both can and do extrude their 
tongues well

While watching the baby where the fit issue should be resolved I get the feeling that if we 
could "splint" the nipple around its shaft making it firm enough to reach far enough back 
in the baby's mouth the baby would start suckling properly to draw the shielded-nipple 
into his mouth instead of pushing it out with his tongue...

I am kind of at a loss of what to do next...I had thought about using two shields- one on 
top of the other to increase the firmness (measuring the intake of course to make sure 
that two shields didn't affect milk transfer) but for some reason I'm hesitant to 
experiment...the only shields I have ever used are made by Medela.

I wish I had more variety in nipple shield width height and firmness to try...

Any advice or suggestions? Am I wrong to think shields can be a transitionary tool for a 
baby who associates the feeling of silcone with feeding?

Jen O'Quinn IBCLC

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