First I   would say, never say never.

Second I would say, in a perfect world moms would be getting excellent, 
experienced breastfeeding help round the clock, and babies would never 
be sent home before they can effectively breastfeed.. In the real world 
an LC is there usually during daytime hours, and a lot can happen  the 
rest of the time. I think each mom/baby should be assessed individually 
and I can think of situations where a nipple shield might be 
appropriate earlier than the time frame of day 2-3. I would be hesitant 
to use one in the first 24 hours. But lots of our moms go home before 
day 3 and if I think a nipple shield is going to get a baby to feed, 
and avoid formula, I'm probably going to use one. I tell the nurses 
where I work - if it's a choice between formula and a nipple shield, 
definitely the nipple shield.

My biggest frustration with nipple shields is improper teaching on how 
to use them and the need for looking and listening for milk transfer, 
and to pump to ensure adequate stimulation.

Andrea Tran RN, IBCLC
Erie/Boulder, Colorado

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