Wendy, I completely agree that nipple shields can absolutely save breastfeeding for a dyad. They are sometimes that magic wand that we wish we had for all circumstances. A mother overwhelmed by a baby who can't latch and all the pumping and the stress, puts on this lovely little device and ta da....problem solved. But the OP was about guidelines to be offered moms when the nipple shield is offered in the hospital, often before there is any milk to evaluate its efficacy and before the mother and baby have had a chance to explore this whole breastfeeding dance and get it up and running. So a mom is discharged, with potentially no evaluation of the shield.  She is at home now,,,,somewhere in day 3 to day 5....she feels the milk arriving. She thinks she hears swallowing, she sees some residual milk in the shield and assumes all is fine. I know that this can be a false assumption, because even I as an experienced private practice LC, I can believe I hear swallowing of milk, when I do not, see the reserves in the shield, which are just a little leftovers from an MER and I am the one who has to deliver the very sad news to the excited mom, that this is not working, because according to my scale there has been no or minimal transfer of milk. If I can't always tell whether a nipple shield is working after 23 years of working with breastfeeding moms, how can we expect a new mom to do so, without a lot of guidance before she is discharged. The OP wasn't about having a guideline that says "Don't give out shields" though I think Anne's approach is far safer than just dispensing them with inadequate guidelines. The point is, what do we tell moms going home with these contraptions that will allow us to accomplish the big 3: feed, protect and fix....in that order!

Kathy Lilleskov RN IBCLC

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