Hi all,
Since we have been going round and round with the discussion of nipple
shields over the last few days (I have learned a lot!), I thought I would
share my 2 experiences with them just in the last wk. as I think these cases
offer a fair representation of "what I see" with their use.
Case 1. (yesterday) I saw a 6wk old, 51/2lb, former 32 wk premie, hospital
D/C one wk ago taking feeds of EBM via bottle, shield (introduced in hosp.)
and attempts at breast. Baby had relatively benign premie course. Mom called,
crying, because baby is "making no progress at breast".
On exam baby has high arched palate, difficulty eliciting wide root with
finger persisted with assisted attempt at breast and despite prolonged
attempt baby would not open wide enough. Attempt/assist was then made with
the shield. Again, no success. Despite ability to now place the nipple in her
mouth and despite much compression she didn't take ENOUGH of the nipple into
her mouth to elicit milk tx thus would repetitively suck, with no milk.
Case 2. I have been working for the last few wks with a Mom of 4wk old twins.
Mom has been tandem nurisng them since my first visit (1wk of age) but has
much difficulty latching "the girl" with varying success. Current regime is
she latches "him " first then moves to attempt with her and continues to try
until either Mom or baby or both end up in tears, then bottle fds. She
latches "him" first because "she" takes too long and he would be frustrated.
Mom is very reluctant to try the obvious suggestions ie. establish "her" at
the breast for a day or so by nursing "her" alone on her
schedule because she doesn't want to change the 10-2-6 feeding times that she
thinks are manageable and necessary for her to care for twins. My suggestion
then was for her to try a shield. In this particular instance I think this
Mom and baby are good candidates. Baby can successfully feed at breast but
Mom "needs" for her to be as efficient as her brother.

In the case of the first baby, I obviously left the Mom with ideas on how to p
roceed but would appreciate some input from the group regarding the lack of
wide root issue. I instructed/demonstrated oral stim techniques to encourage
this ie. stroking mouth with finger or bottle nipple, not placing bottle
nipple in mouth til baby has opened wider but am looking for more
ideas......???
Thanks!
Lynn Shea Rn, Bsn,Ibclc
Franklin,Massachusetts

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