I agree with your great points, Jan.  

In addition to the education on how to apply the nipple shield, offering education to parents on how to visually evaluate baby's latch and milk transfer while using a nipple shield is important.  Parents are surprised when I share that one of the downsides to nipple shields is that they may decrease pain with a poor latch.  Pain is often an indication that the latch is not optimal and if this is not experienced then the mother may not think to adjust.  

I have supported numerous nursing pairs who have come to me already using a nipple shield.  Very frequently with assessment and practice during the consult, baby is able to latch and do well without the nipple shield in the office.  Nonetheless, if they have been using a nipple shield at home I provide education on how to ensure they are doing well with this tool also.  My hope is they will never return to it, but I realize that in a moment of panic or pain they may.  

Echoing many others, there is no tool that is all bad or all good.  There are so many points to consider in choosing a breastfeeding tool and I do offer nipple shields at times, discuss the pros and cons and provide education and support.  I've seen babies of all ages transfer milk beautifully through a shield.  I've also seen significant damage to nipples due to improper nipple shield use.  Education is the key.  While I hesitate to add any gadget, sometimes a nipple shield is a stepping stone to breastfeeding success.

Ellen

Ellen Rubin, MA, IBCLC, LLLL

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