Wanted to mention to those of you who do work with moms who use nipple shields that they can be an ENORMOUS hassle.  Moms may not be able to articulate that without feeling like they're wallowing in self-pity (I know I couldn't at the time), but it was a royal pain to find a clean one and try to secure it on while my infant's impatience escalated (and I did keep multiple ones in strategic places around the apartment).  Repeating that around 12-18x/day, without being able to nurse in a sling or even lying down, and drawing all manner of curious stares when attempting the feat in a public place was really remarkably trying.  

My 34-wkr with dysphagia needed one until he was about 5 mos old in order to manage the flow -- he was never able to handle the other side so I EP'd that and supplemented him 3-4x/day for nearly a year too, in addition to the hours spent breastfeeding directly.  He was also attached by a long cord to an apnea monitor for 7 mos that would frequently alarm to alert me that he was nearing the need for CPR or atropine (prolonged problems with episodes of profound apnea and bradycardia).  And I was on a very restrictive low-allergen diet per the pedi gastroenterologist's recommendation.  Even with all that, guess what caused the most persistent frustrations for me on an hourly basis?  That blasted NIPPLE SHIELD.

All that is to say that moms who are becoming concerned about using a nipple shield may just be getting burnt out.  It may *seem* to be an insignificant extra little step, but for a mom who's already struggling to breastfeed it can really be a true obstacle at the same time that it's keeping the little one nursing.  Reassure her and acknowledge the hard work that she's putting into it, and help her find ways to make it easier.  Glibly telling her that all babies eventually give it up may not be the most helpful.

-Sarah Reece-Stremtan M.D. 
(pediatric anesthesiologist-to-be in Washington DC, with a still dysphagic yet still breastfeeding 2yo)

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