I was wondering if the shield used was the small or the regular.

I practically never use the small, even for the tiniest preemie due to the
concern of "filling" it with breast tissue.  Also - is it being turned
inside out before placing it on the nipple - the breast needs to "wear " it
rather than putting it on like a hat.  Usually I can get this done if mom
is not engorged.  If she is engorged, i put it on the best we can, have
baby suck and soften the breast a bit then take baby and nipple shield off
and put shield off deeper onto the breast.  

Another trick on those tiny mouths is usually "making faces" in which I
tell Dad (or older sibling - they love this "assignment") to play with the
baby saying OPEN while sticking their tongues out and down.  It's amazing
how babies seem to imitate what they see.  We then celebrate when baby does
OPEN.

Yes, watching this baby's diapers and weight is essential.

Jeanette Panchula, BSW, RN, IBCLC, LLLL
Puerto Rico
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http://netdial.caribe.net/~prlacta/