>I could certainly use some additional input...am working with a mom and her
>three week old son.  She was given a nipple shield (thin, silicone type) in
>the hospital (baby had a little difficulty latching) and discharged without
>follow-up instructions.  I saw them at 2 1/2 weeks postpartum, and baby is
>absolutely hooked on the shield; screams and pushes away if the shield is
>removed.  We worked with lots of calming techniques and were able to achieve
>several sustained latches.  But when mom tried the same techniques at home,
>all she experienced was a screaming baby.  Her nipples are very sore and she
>is now double pumping to bring up a dwindling milk supply (had only been hand
>pumping or hand expressing since discharge).

Kathy, how well did this baby latch while you were there? Was the mum in
pain once latched on? You mentioned she is very sore - has it been painful
when he sucks with the shield? Has she had to give formula to get enough
food into this baby? Did you get to watch what baby does when on the
shield? The pain and the low supply seem to imply to me that this baby was
not feeding successfully through the shield at all. The first thing I
usually check with nipple shield use is whether baby is sucking properly
and getting milk efficiently, or whether he is "bottle sucking" on the cone
section only (ie nipple confused). I have had success weaning some babies
off shields by squirting milk (EBM if possible, but formula at a pinch)
into baby's mouth just as he latches on, causing him to swallow. He is then
likely to follow the swallow with a correct suck. If mum's supply is low,
you may need to keep up adding extra milk via syringe or SNS. This utilises
the "suckle right or drown" principle (from Kittie Franz?). Sometimes mums
can continue this at home without the LC if they have a partner or friend
available at the next few feedtimes. Mum has to convince baby that he will
get food if he sucks directly at the breast.

 My suggestions were increased
>skin-to-skin contact, use of soft cup feeder (which a friend gave to her) or
>syringe/finger feeds, no artificial nipples, put to breast while sleepy or
>sleeping and after a feed.

 These suggestions sound good to me. Perhaps with the skin-to-skin contact,
she could try the "rebirthing/self-attachment" procedure, either in the
bath, or just in a warm room. I would think this baby is still young enough
to re-educate.

>Old information used to say try snipping away the shield over several days
>until the baby was nursing only at the breast, but I've heard that doing so
>with this shield will lead to fraying and possible ingestion of tiny pieces.

I hadn't heard of this risk, rather that the edges of the plastic can rub
and ulcerate the baby's mouth. I think there is no easy road here - just
lots of patience and perseverence. I think that if the baby is not
attaching properly and not getting the milk efficiently through the shield,
it is vital to get rid of it immediately - not try methods such as cutting
away, partial use, etc. If baby was getting plenty through shield (which
doesn't sound like it in this case), it is not so desperate to get rid of
it straight away - maybe could wean off more slowly.

Good luck, and let us know how it goes.

Joy Anderson IBCLC, NMAA Breastfeeding Counsellor
Perth, Western Australia (where nipple shields are, unfortunately, quite common)
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