Dear All,
I am dismayed by all of the interest in using nipple shields for premies 
and for babies in the first few days in the hospital.
I will be publishing a few articles on nipple shields in Breastfeeding 
Medicine in the next few months, but I want to emphasize that there are 
very few studies done on nipple shield use. Only 2 studies look at milk 
transfer in a healthy nursing infant with and without a shield, and in 
both studies, there was significantly less milk transfer with a shield. 
So any use of the shield must be accompanied by pumping afterwards. 
Which lead to the question of why use a shield when 
nursing,pumping,bottle feeding is 3 steps, and pumping and bottle 
feeding is 2 steps, while baby practices infant-led latch.
There are only 2 studies done on premies, and both are chart reviews, 
one of which is Paula Meiers. Paula's study was done on premies who 
demonstrated lack of ability to nurse effectively f_or at least a couple 
days before the shield was used_. This is very important to 
understand...in no way does her study validate the practice of slapping 
on a nipple shield before a premie even gets a chance to demonstrate 
his/her skills at the breast first.
There is no proven safety record of nipple shields use in terms of their 
effects on milk supply, infant growth, and duration of breastfeeding. 
Remember, do no harm and recognize that you may not have any idea what 
will happen with that mother-infant dyad if you provide or recommend a 
nipple shield, and you are not following up that mother.
Yes, I do use nipple shields infrequently, but never in the first few 
hospital days. In 20 years I have never seen a reason to do this.
Anne

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