I prefer to do suck training with my finger in the early days after birth and
rarely resort to a shield in these early days of life.  Deb's baby weaned off
of the shield rapidly and she follow-ed up with the mom/baby; also teaching
mom how to wean off of shield.  I feel strongly that shields are an effective
tool when used appropriately, and can cause harm when used ineffectively.  Let
me tell you of my client from a few days ago.

Mom given shield in hospital for difficulty latching baby onto breast.  No
pumping initiated.  No follow-up planned.  Baby's birthweight 7lb.5oz.  Baby
gets seen at office by PNP at 2-1/2 weeks of age and now weighs 6lb.5oz.

What went wrong?  I see several problems with this case.  1.) No pumping -
teaching mom about insurance pumping - meaning pumping 2-3 times in 24 hrs. is
absolutely essential for maintaining a milk supply.  2.) Wrong size shield -
it's absolutely essential that we properly fit a shield to baby and use the
smallest size possible. Baby was switched to size small.  3.) No follow-up - as a
result, no volume checks and no weight checks.  Also, no ongoing assessment of
the latch problem.  Thus, mom didn't persist with suck-training, and baby
never learned proper suck.  As a result, baby presents to me with an ineffective
suck, poor tone, and failure to thrive.

My interventions:  1.) Feed the baby!  This baby didn't suck adequately with
the small shield, so I removed the shield.  Even the bottle feeding was
difficult, but I taught mom how to properly feed and assessed the bottle feed.  2.)
Get mom pumping on an electric hospital grade pump.  Mom's supply was
diminished by the lack of stimulation resulting from the ineffective suck at breast.
3.) Reiterate suck-training techniques.  Switch off nuk pacifier and get
gerber one for suck exercises.  Motto:  Feed the baby and preserve the milk supply
as we work on fixing the problem - dysfunctional suck.

Follow-up: 1.) Baby gained 4 oz. in 2 days.  Alert, active.  2.) Mom's supply
increasing gradually from 1 oz. pumped every 3 hours to 1-1/2 to 2 oz. 3.)
Baby still exhibiting dysfunctional suck.  I believe it was extenuated by the
early nipple shield use and lack of follow-up to identify the real problem.
Baby exhibiting inability to finger-feed.  Referral made for CST, suck-training
exercises reiterated, and PNP notified of plan of care.

Hope this summarized scenario helps!  Gotta get the kids off for the 1st day
of school!
Carol Chamblin, RN, MS, IBCLC
Breast 'N Baby Lactation Services, Inc.
St. Charles, IL

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