Catherine writes: Last year there was some discussion about preemies, nipple
shields and
milk transfer (improved with nipple shield).  I'm thinking that if baby
is *already* nipple confused, that a nipple shield would be fine and
dandy b/c at least mom could (theoretically) ditch the bottles and
pumping (which is *extremely* time consuming) and have baby at least at
the breast (while of course simultaneously getting baby off the nipple
shield).

I think this is an absolutely reasonable plan of attack. Baby should be able
to latch onto a nipple shield, milk transfer may be improved, and intake can
be monitored by test wts. It is certainly an opportunity to get the baby back
to the breast.  I would advise the mother to position the infant exactly as
she would for bfdg without a shield, to wait for a wide root and to pull the
baby on for a deep latch. If the other baby is nursing at the same time this
can facilitate a good flow for the nipple confused one.  I have seldom had a
premie (with a mother with latchable nipples) have
trouble being weaned from a nipple shield.  I've found that just about
corrected term age or a little after they are able to nurse without the
shield and because they have been held and positioned the same way each time
they do it effortlessly.  It also, of course, keeps the baby at the breast.
Good luck.

Kathy Boggs, RN, IBCLC

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