I agree with Susan Burger that we don't need to make blanket recommendations for pumping when mom uses a nipple shield, just like we don't want to make blanket recommendations about pretty much anything without a good assessment, and then we individualize our recommendations accordingly. I too use test weights to confirm whether a baby does well with the shield or not, and I don't let moms keep the shield if it didn't work well. In my most impressive case, a baby with torticollis and a very asymmetrical mandible (it was at a 45 degree angle to the maxilla on the shorter side), the baby transferred 0 without the shield, and 3 oz (85 ml) from one breast with it! If we made that poor mom pump, she would have developed an oversupply. Moms using nipple shields do require careful counseling. They need to know to watch baby's behavior and diaper output, and how to intervene quickly if baby needs more milk to avoid their milk production dropping. They can be taught to count stools and watch baby for excessive sleepiness or fussiness and start pumping and giving extra milk immediately, and come back in for a follow up as well, if they see adverse signs. The big problem with the 'medicalization' of lactation consulting is that there is a push to 'protocolize' everything. Natural systems that involve two individuals have so many variables that this is difficult to counterproductive. While it is vital to understand the system design, function, and interactions, it's not possible to have a one size fits all solution for each potential problem. Just one more reason why it takes a long time to develop true expertise in this field, and why our mentoring programs are so valuable. Catherine Watson Genna, BS, IBCLC NYC *********************************************** 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