The NEED for a device SIGNALS the fact that things are not normal.  That is
the first thing to assess prior to throwing things at the problem
willy-nilly.  However, my experience is that nipple shields can be used to
bring the non-nursing baby to breast.  The newborn small sized shield (which
is what I use almost exclusively) has a
short teat cavity so the baby doesn't have to suck excessively to draw up
the mothers nipple inside the teat.  But it does extend the mother's own
short or inelastic nipple to the rear of the tongue and palate where it will
trigger the reflex to suck.

While my goal is to abandon the shield use as quickly as possible, I have
had some infants using shields for days, weeks, or even months.  The longest
was an infant whose mother had very "meaty" inverting nipples.  Little
elasticity to the tissue, very rubbery texture, and stubbornly retracting.
This baby couldn't get a latch without a shield for 6 months.  When he was
able to get a latch without the shield, he discontinued on his own and
nursed without it another 4 months.  It is necessary to watch weight gain
with babies on shields (just because they are by definition in the
not-normal category of activity.) They may have OTHER ISSUES which may
impact gaining, and which may need managing.  If the only problem relates to
mom's flat or inverting nipples, then usually weight gain is not an issue.
I have never had a baby on a shield lose weight.

An attendee at the recent Rush conference on preemies told me that there is
new data which supports the idea that some preemies actually take in more
milk through a shield when transitioning to breast.  I have used shields
with struggling preemies and seen the same phenomenon.  I also saw a baby
yesterday (5 mo.) who has been stuck on spoon feeding for the entire time,
and what a mess!I can't tell whether she can't use her tongue normally
because she has never had anything to suck on, or whether there was a
primary swallowing disorder which caused her current  inability to tolerate
things in her mouth. Mom's spoon feeding technique is horrific:  She holds
baby with arms pinned, head reclined, and shovels full spoonsful of milk
into baby as fast as she can.  Baby looks agonized, as if drowning.   It
takes one hour of kicking and fighting to get 4 oz into baby, who is only 13
lbs. No way in the world do I think this is preferable to sucking on a
bottle or a shield.  It has not accomplished getting this (probably
dysfunctional) baby to breast, and feedings are a nightmare.  Mother asked
me "Do you think my baby hates me?"  I have described situation fully to
pedi, who is referring on to do barium swallow study and to an OT.

I stick to my guns on the fact that it is more desirable to have the baby
doing something at breast than not, even if there are other forms of
supplemental feeding coinciding.
Shields are imperfect tools, but they do bring some infants to breast.  And
mothers need to know a whole lot earlier on that a baby who can't eat
normally is BY DEFINITION in need of a good assessment.

Barbara

Barbara Wilson-Clay BSEd., IBCLC
Private Practice, Austin Texas
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