Barbara,

I have found that using the larger nipple shield has worked 
for me because more of the breast is drawn into it - allowing 
the baby to milk the breast instead of just sucking at the
tip of the nipple shield.  I also like the fact it causes
the baby to open the mouth wide and makes it easier to make the
transition to the breast.  

I only use the smaller nipple shield with the very small 
babies - and usually find I need to change them to the larger 
shield if mom has a large (normal, but large to the preemie) 
nipple.

Interesting how two LC´s have different experiences...
Makes it that much harder when we´re trying to teach - now
I´ll have to say - well, I´ve found this - but other LC´s
find this...  

This is similar to the debate on hands-off LC assistance 
that people like Chloe Fisher and others advocate, which is 
very different from me - I am a ¨hands on¨ type of LC, but 
realize that there are others who are not and are very 
effective...

I guess just like Breastfeeding is an ¨art¨,  so is LC´ing...

Jeanette Panchula, BSW, RN, IBCLC, LLLL
Puerto Rico
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