I frequently come across babies who choke,gag, click, and gulp and have trouble handling the flow, begining in the second month and usually resolving by the end of the third month. If a nipple shield is helping with the pain and the baby is able to drain the breast without the shield and the mother is comfortable between nursing, then I would not jump to a conclusion of oversupply and I would defintely not move to block nursing until I established that it was oversupply for sure. I have seen women destroy lovely supplies by moving too quickly to block nursing. To diagnose oversupply I usually use a combination of test weights and pumping following feeds to determine the babies intake and the residual left behind.You could also look for oversupply by substituting pumping for a feeding and measuring what you get, but I think test weights and pumping give you better sense of the true picture. I have seen babies have trouble with their mother's let down in cases with absolutely normal supply.Especially since this baby is also having trouble with the bottle. I would also want to make sure that the bottle has a slow flow newborn nipple.I have seen parents using the level 2 nipple with newborns because they don't even realize that nipples come in different sizes and flow rates. It seems to me that the mother would be very happy to have pain-free nursing and why do we need to get rid of the shield? If she was on the verge of quitting and is now comfortable, I would just reassure her that she and the baby will use the shield until they can get to painfree nursing together and she can try intermittently to remove the shield. Or else someday her dog will eat it or she will leave it behiind when she is out of the house and she will discover she no longer needs it.Quite probably as this baby grows he or she will be able to drink the fast flow milk without needing to compress and lose suction so frequently. Then the clicking will probably stop and the baby will also not need to clamp down. I don't find it helpful to postition a baby struggling with flow deeper on the nipple and always point out to the mothers that if liquid were flying into your mouth at too fast a rate, would you want the container to go even deeper into your mouth - no way...you would want to protect yourself against that flow by staying shallow. I think it would feel like being waterboarded to be forced to go deeper onto a nipple that was flying out milk, that you can't stay on top of.Also, I am wondering if the clicking has stopped with the use of the shield - if is has, then it seems that the baby is able to maintain suction when the flow is at a level that the baby can handle and was releasing suction voluntarily so that he or she doesn't drown. Or else the baby needed the help of the shield to maintain suction and the job is being made easier for the baby. Either way, it seem to me that it is all good...I am also wondering if the baby was always clicking or if this has started more recently. If the baby was able to maintain a latch early on when there was a slower flow, without clicking and the clicking is more recent, then that would also point to difficulty with a newly forceful MER. I always try to use gravity to slow the flow and making sure that the baby's head is tilted back to enable swallowing, rather than shoving the baby even deeper onto the breast and if that doesn't work then move to a nipple shield. When I use a nipple shield in any situation, I do like to use a scale and make sure that the baby is able to transfer through the shield by doing test weights. I have seen babies suck very vigorously for half an hour and transfer less than an ounce per breast or sometimes virtually nothing. If a baby is losing milk on the bottle then the baby obviously doesn't have the easiest time in the world handling flow period, so that is a baby that I would want to be especially certain was able to transfer well with the shield. I find it fascinating to watch older babies and toddlers at the breast, because it seems to me that most dyads get to the point where they can effortlessly break every postioning rule in the book - forget the stomach to stomach, forget lining up belly button to nose, forget tilting head back, forget slowing or speeding up flow, forget deep latch. These babies are nursing with their head turned in the opposite direction from the mother, stretching her nipple clear across the room, shallow latches, even grinning while they nurse etc etc and the mother is just chatting away with a friend oblivious to what would have been agonizing at the early stages of nursing....But in the begining each pair does have to find their way to comfort. And nipple shields have saved more that one breastfeeding relationship for me!!!!! Kathy Lilleskov RN IBCLC (sorry about the length of this post) *********************************************** Archives: http://community.lsoft.com/archives/LACTNET.html To reach list owners: [log in to unmask] Mail all list management commands to: [log in to unmask] COMMANDS: 1. To temporarily stop your subscription write in the body of an email: set lactnet nomail 2. To start it again: set lactnet mail 3. To unsubscribe: unsubscribe lactnet 4. To get a comprehensive list of rules and directions: get lactnet welcome