Dear all:

I am always interested in why there are sometimes dramatic differences in practices -- and usually assume that it may be due to differences in the populations were are seeing.  Since I work out of the hospital, I usually only see either home birthed babies or babies who delivered in the hospital and are 3-4 days old.  So, perhaps there is something different about nipple shield size in hospital babies in the first 0-4 days and babies who are home delivered or once they get home.

I have about 7-8 years of clinical data and I can count on one hand, the number of babies I've seen who can transfer milk well with a 16 mm nipple shield.  And I actually do see a lot of babies who start on the 16 mm nipple shields because they appear to be handed out like candy to anyone who has an even remotely "flat" nipple.  Usually by the time I see the mom, the nipple no longer looks flat because her engorgement has subsided.   In many cases, I can get them off the nipple shield.  Among those babies who still need the nipple shield,  95% of them transfer more milk  with a 24 mm nipple shield.  I do turn the shield a little inside out before so that it grabs more areola tissue. I know that this is important to milk transfer.  But I am still scratching my head over the difference between what I've documented and the claims that smaller shields work better.  Is it the age of the baby?  the way we are using the shields? the type of problem we are using the shield to compensate for?  

Best, Susan E. Burger, MHS, PhD, IBCLC

             ***********************************************

Archives: http://community.lsoft.com/archives/LACTNET.html
To reach list owners: [log in to unmask]
Mail all list management commands to: [log in to unmask]
COMMANDS:
1. To temporarily stop your subscription write in the body of an email: set lactnet nomail
2. To start it again: set lactnet mail
3. To unsubscribe: unsubscribe lactnet
4. To get a comprehensive list of rules and directions: get lactnet welcome