Hi to all, 
Thanks Nikki for your thorough run down of the issues with nipple shields and your fascinating case history. I too have cases I wish I could look at again with my experienced eyes! 
My input isn’t much different. When it’s a tool used thoughtfully and with appropriate follow up, it’s great. Otherwise it doesn’t help at all and so many parents hate it. 
My one suggestion to all families I give a shield is to take it off at the end of all daytime feedings and let the baby’s mouth be on the nipple directly for some time, ideally 10-15 minutes. I believe it sets the table for the baby to connect with not needing it in the future and try without it at the beginning every few days when the baby isn’t starving. 
I also look for any underlying issues that might be causing the baby to need it and work toward repairing those as appropriate.
I have even gotten the feedback in a grocery store from a family that used it happily for about two weeks and then removed it and went on the breastfeeding they wanted.

Janet Dombro, IBCLC 

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