I have found that babies with thrush don't feed as well as they did before
they had the sore throat that accompanies thrush.  Often the first call to
me is about how, all of a sudden, baby is feeding for short periods and
frequently. They aren't on the breast long enough to get enough fats.

When the thrush treatment begins, baby returns to deep, long sucks and
longer feedings.  Think about a sore throat.  You drink a little at a time.

So, this baby may have been taking in less in the last few weeks because of
the thrush.  I wouldn't hurry right now to get baby off the shield.  Give
him some time to feel better before getting him to try a "new" way of
feeding. Mother's milk supply is probably down because of the low transfer
of milk. Herbs and pumping can restore the supply.

>(1) what are some good strategies to encourage the baby to attach well
without the shield? (2) Is it inevitable that supply will drop if they
continue to use the shield?

I have not found that a drop in supply is inevitable with a nipple shield.
If mom's milk supply gets under what baby needs, there will be a slowed
weight gain, whether there is a shield or not. Of course, the goal is to
get baby to the breast without the shield.  Assure the mother that this
_will_ happen.

I have had several clients within the past couple of years whose babies
were using shields and all of them learned how to feed at the breast.  The
switch happened at different ages, but I encouraged the mothers to keep
"inviting" baby to the breast, and to not give up on them.  I assure her
that her baby can learn this in his own time.  When the mothers stop
worrying about _when_ it will happen and just enjoy their babies, there is
less pressure on both of them.

I have had a couple of Peds who have told mothers that the babies will not
gain well with a shield, but they have shown the Peds that that is not
always the case.  The fear that their babies will not be healthy with a
shield creates great anxiety and a sense of urgency, along with self
judgement of their own incompetence.

I will add that I do follow these mothers and babies regularly--wet
diapers, adequate bms.

As to the question of how to get the baby to take the breast without the
shield, I have a few suggestions.  Others will give more.

First, don't make it a battle. Having mother relax about the timing helps
here.  It is an invitation, not an order.

Skin to skin, for enjoyment not just as an assignment, helps a lot too.

Then frequent invitation--before feeding, several times during a feeding,
after the feeding seems to be finished and when baby is just waking up.  If
the mother remembers that her baby was born with a longing for her breast
instead of silicone, she will not take her baby's frustration as rejection.
 It is just a statement of "I don't know how...yet." She can verbally
assure him that he will soon learn. And, while she is assuring _him_...

You didn't say what you mean by "baby's weight gain has dropped off in the
last few weeks." Is he still gaining, but at a slower rate?  How much was
he gaining before this time? What is his gain now? If it was the thrush
that affected his feeding, that should turn around soon.  If it was
fighting with him to get him to the breast, a relaxing of this urgency
should help him return to feeding well with the shield, for now.

If his weight is truly of concern she can do the following for a time: With
her pumped milk, she can refrigerate it and make up a bottle with added fat
skimmed off of other bottles, creating a high fat treat.  Let mom know that
this is a temporary boost of fat calories, not something that she will have
to continue.

So I would say: some herbs and pumping to boost supply, a few high-fat
bottles if that is truly an issue, an assurance that babies can thrive on a
shield but that they really want to be at the bare breast, and that with
gentleness and encouragement, he will find the breast a wonderful place to
be.

I think that I shared this with Lactnet befor. A mother called when her
3-month-old was finally at the breast, to share the joy and to say that so
often she considered giving up trying to get her baby to feed at the
breast.  But she would remember that Pat said, "Your baby will learn this
one day, and if you give up on her, it might be tomorrow that she would get
it."

Pat Gima, IBCLC
Milwaukee, Wisconsin

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