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Subject:
From:
Barbara Wilson-Clay <[log in to unmask]>
Reply To:
Lactation Information and Discussion <[log in to unmask]>
Date:
Wed, 18 Apr 2001 11:23:23 -0500
Content-Type:
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With all due respect to Cheryl's opinions, data support that if the correct
size of nipple shield is employed, and if the baby is correctly latched,
unstable feeders can actually access significantly MORE milk with than
without a nipple shield (Meier, et al JHL 2000).  Nipple shields have been
demonstrated to be effective bridging devices for the breast-refusing infant
who has had many bottles, and are effective clinical tools in the
maintenance of breastfeeding when flat or inverted nipples are an
issue(Wilson-Clay, JHL 1996).  Data do not support significant inhibition of
prolactin stim. with the newer silicone shields (Woolridge, Early Hum Dev,
1980).  A risk of their use is they can contribute to increased mastitis.  I
think this can be minimized if they are appropriately cleaned and if some
postfeed pumping is employed during early lactation when shields are most
likely to be used.  The increased risk of mastitis may follow on from the
fact that shields are only appropriately used in situations where bfg is
already compromised.  If the baby is unable to nurse approp. without the
shield, their ability to adequately drain the breast may still be marginal
even with the shield in place.  Making sure that milk stasis is prevented
may reduce the risk of inflammatory sx.

Nipple shields are inexpensive, very useful in specific clinical situations,
but continue to be misunderstood and used without proper understanding by
some clinicians and by parents.  The goal of all therapy is to get rid of
the intervention asap and return to normal, which is defined for our species
as exclusive feeding at the breast.  Urging parents to get off shields
quickly sometimes contributes to stopping the intervention before it is
completed.  Then you still wind up with a non-functionally breastfeeding
baby, and people blame the shield, rather than the early discontinuation of
therapy.

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

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