My experience using nipple shields with preterm infants recently sent home from the NICU closely matches Maureen Allen's. Feeding stability is increased by the fact that negative pressure from the first few sucks then holds the maternal nipple in an extended position inside the shield for the duration of the feed. This decreases the amount of work the baby then has to do to keep the nipple pulled into a teat. Also, milk tends to pool in the teat cavity and provides a reservoir of easily accessed milk. This gives a quick milk reward to the baby who is weakly sucking. Obvioursly, baby must be correctly positioned, milk supply may need extra support at first, and the right size shield must be employed. What is really frustrating to me is all the ph calls I get from distressed women who tell me hospital nurses gave them a shield, but immed. made them sign a scary looking consent form that lists a lot of dangers. Then the moms are told to stop using the shield almost immed. They can see the shield is working (if proper size -- the newborn small size -- has been employed). It compleletly confuses mothers to be given a piece of equipment and then to be told to stop using it or the baby will fail to thrive. It would be better to have the nurses and LCs had an understanding of how and why shields work and not be so ambivalent about it. If the appropriate clinical rationale is employed to select and intervention, then there is no reason to scare moms. Instead, provide accurate info about red flags for poor gaining (which should be standard operating proceedure with or without shields) and provide timely follow-up. Babies come off shields when they can access the breast and the miilk without the shield. Failure to follow up is a deficit of the health care provided to postpartum dyads, not of the shield itself. The shield is a low cost, effective clinical intervention in specific cases. There is good literature about how they work. Barbara Wilson-Clay BSEd, IBCLC Austin Lactation Associates http://www.lactnews.com *********************************************** The LACTNET mailing list is powered by L-Soft's renowned LISTSERV(R) list management software together with L-Soft's LSMTP(TM) mailer for lightning fast mail delivery. For more information, go to: http://www.lsoft.com/LISTSERV-powered.html