I have encountered uses for silicone nipple shields that sometimes
capitalize on  their potential to create a barrier between the breast and
the baby.  This is not typically a desireable thing to do, of course, but in
certain situations, can assist.  I have not personally used them for
teething problems because a baby with teeth could probably still hurt the
mother through them as the silicone shields are thin.  However, I can see
that it might be worth a thought if all else has failed.  I recommend the
Hylands teething preps, having had good success with them personally, but
have no knowledge of the other herbal remedies suggested, and would hesitate
to venture into territory about which I know little.  Being an herbalist is
a skill some LCs have been trained in and as such may augment their LC
practice, but it is not within the scope of our practice per se.
Consequently, an LC who lacks such skills might well look to what she has at
hand for a solution. My motto in such situations is:  There is more than one
way to be right.

 The mother in Chris Hafner-Eaton's situation did what she had every right
to do, which was seek another opinion, and it sounds as if she was very
satisfied by the help Chris provided. Going beyond that specific situation
to the broader discussion of shields, I've found that propaganda that brands
them as unequivicably evil can make it difficult for parents to trust the LC
who occasionally recommends them, even if she has a reasonable clinical
rationale for doing so.  And I think that it also inhibits the discussion on
how to use tools when there is such a risk of being criticized if you admit
to trying a new technique.  I received hate mail for publishing research
about shields, so I am sensitive to this.

Yesterday I saw a 3 month old baby girl with birth wt.of 6lb5 oz .  She had
surgery at 2 weeks for a prolapsed umbilical problem, with good recovery and
normal results on bloodwork evaluations that have been done monthly to try
to discover why she she is growing so poorly.  She has not had a swallowing
study, which I am going to recommend if my intervention doesn't work.  Her
current weight is 8lb 15 oz.  Baby typically goes to breast for about 5 min.
and then pulls off and refuses to nurse any more. She either pulls away
crying or shuts down and goes to sleep. She refuses bottles, finger feeding,
spoon feeding.  Her facial tone, reflexes and movement seem normal, as does
her oral anatomy.  She is not spitting up.  She is responsive, well-attached
to her mother (who is a 2nd time exper. nurser who bfed 1st child 7 mo.)
The baby interacted well with me, making eye contact and smiling.  Seems
healthy as per pedi's assessment, just very thin with a clinical dx of
Failure to Thrive.

Watching mom nurse, I was struck by her letdown.  She has not been pumping,
and is concerned about low milk supply, yet her left breast sprayed streams
of milk that projected a foot away from her body!  Baby pulled off, went
back on briefly, but pulled off a min. later.  Breast was still spraying.
Went on; pulled off again.  Breast still spraying.  Baby fed for approx 3
min. then refused to go back to breast.  Test weight indicated she took in
44 ml.  At breast, I observed normal nutritive sucking with 16
suck-swallow-breathe bursts prior to a pause, but the baby preferred to
maintain a weak lip seal so that she could spill milk to protect herself.
For many weeks postpartum mom soaked towels across her abdomen to catch
spill from her breasts.  Mother reports enough nasal stuffiness that she
uses saline nose rinses every other day to evacuate accumulated debris, so
I'm assuming baby aspirates enough during feeding to require this.  Mother
states that what I observed is the typical pattern of a feeding. She feeds
8x/24hrs at a minimum. She normally would have put baby to the other breast
as soon as baby would accept it, for another short feed.

Mom has been well supported by other capable LCs and worked closely with a
very bfg friendly pediatrician.  Dr. wanted me to evaluate the situation,
set up an SNS, or find another  way to deliver supplemental calories.
However, in my opinion, an enhanced milk flow rate is precisely the opposite
of what this baby needs.  She had a terrible time with the bottle (the only
one in the house had a fast flow rate), and wouldn't accept spoon feeding.
She is very wary and aversive of liquid, and tremendously defensive of her
oral space when fluids are involved.  She loves to suck on her pacifier,
which I can see is the only safe sucking experience available to her.   I
really hate to take this baby away from the breast, which she still accepts,
tho tentatively and briefly -- for just long enough to stay hydrated.

 So here is the nipple shield part.  I put a nipple shield on the mother to
act as a physical barrier between the spray and the baby, and the baby
relaxed, and willingly consented to nurse again.  Weights confirmed she
consumed an additional 35 ml from the breast.  This is still a bit shy of
what I would have liked for a feed, but I am going to give this plan a few
days to see whether her acceptance of the breast continues with a physical
barrier in place.  If we can get her to nurse longer and better with a $6.00
piece of plastic that protects her from drowning, maybe we can get something
other than foremilk into her.  I hope to help restore her trust in the
feeding process, and improve her growth.   I am of the opinion this baby's
situation very closely parallels the Woolridge and Fisher article about
over-supply sometimes resulting in FTT at the 3 month mark.

I offer this brief case study as a plea to consider that tools are just
tools, and that often LCs are doing the best they can to try to think
outside the box in their efforts to help a mom.

Barbara Wilson-Clay, BSEd, IBCLC
Austin Lactation Associates, Austin, Texas
http://www.lactnews.com

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