I’m not an OT or an expert on premies. But I have some thoughts and questions (mostly questions):

First of all, a type 4 posterior tongue-tie can look like there is no frenulum at all, but really it’s hidden behind the mucosa. Are they really sure about this baby's lack of frenulum? Also, why is a longer bottle nipple recommended when there's no frenulum? (sorry if this is obvious to everyone but me)

Second, is baby thriving and growing with the current setup? Is there any **need** to change to a longer shield, other than extrapolation from what the OT recommends w/r/t the bottle? And how is changing to a longer shield (if one exists) going to help mom reach her goal of direct BF? Her nipples aren’t going to grow any longer in the meantime!

Why is it considered “impossible” for mom to BF without the shields? Has she tried? Has she been supported and guided in skin to skin (I would hope so, with a preemie!) and biological nurturing positions? If I understood correctly, baby’s adjusted age is about 3 weeks. Is there any reason that the usual methods of helping a newborn to latch cannot be used now?

I used nipple shields with 2 of my children, and I can certainly sympathize with the desire to get rid of them. I applaud this mother for persevering with shields and the SNS for so long.

My nipples are flat. I don’t think I’m exaggerating when I say that the shields are probably 10 times longer than my actual nipples. But when my babies were ready to latch without the shields, they latched on fine, despite the huge discrepancy between the shields and my nipples. I know a sample size of 2 doesn’t prove anything, and they weren’t premies, but many babies latch on directly after using a nipple shield, and no woman’s nipples are exactly that shape, and most aren’t as long, either.

Am I missing something important here? Unless baby has some condition or issue that wasn’t mentioned in the original post, I don’t see why the focus should be on the size or length of the nipple shields, rather than on all the other techniques in our toolbox that can be used to get a non-latching baby to the breast.

Jennifer (Long Island, NY)

Studying for the IBLCE exam and suddenly feeling very motivated to take the online course about “Breastmilk, Breastfeeding, and the Preterm Infant”

On Feb 19, 2010, at 9:00 AM, Pamela Murphy, PhD, MS, CNM, IBCLC wrote:

> I am posting this on behalf of one of my colleagues:
> 
> This is a case of a mother nursing an ex-preemie (31 wk) who has been using an SNS and nipple shield with nearly every feeding for 3 months. The infant is now 3 months of age. I referred this case to OT, who determined that the infant had nearly no frenulum at all. Given the near absence of the frenulum, a longer bottle nipple is recommended for this baby. The mother wants desperately to wean from the shield and breastfeed without it, but this is likely impossible with a shorter maternal nipple. My question is "Are there any nipple shields available with longer nipple tips?"
> 
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