I see a very different picture with results of nipple shields than most of you in the lactation field.  I see Failure To Thrive, low to no milk supply, babies with habits of shallow latch to nipple shields that is very difficult to break and I can, hyperbil levels over 20, and I can continue.  How about 7 to 8 week old babies with naked weights 1 to 2 lbs under birth weight?  The bottom line that keeps me from advocating use of nipple shields is that, in the western Pennsylvanina area, families willing to pay for lactation services is very low.  If patients are provided a nippleshield at a delivering hospital or at any time for that matter, there should absolutely be a commitment on the part of the parents to follow up closely, monitor supply and weight gain.  I do not see this happening.  The parents accept the nipple shield and they are on their own.  Some are educated appropriately and others are not.  Most that are using appropriately DO have follow up scheduled with the professional that recommended.  I am very confident that if I/we provided shields, there would not be follow up.  Angie Kirkwood BSN IBCLC RLC

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