Dear Lactnetters,
When I use a shield on a mom I never use a small anymore- I think it
promotes the infant using only its lips to suck, I personally feel that if
the newborn or preemie cannot sustain its suck on a regular sized shield
then either something else is going on (in a term infant is the sensitive
gag due to over zealous oral suctioning at birth,) or in a preemie is it
just to soon for it and we need to do more Kangaroo care instead of pushing
oral attachment to the breast..If an infant is on any shield and not
transferring adequate milk for growth then is the nipple shield the answer?
I frequently will switch moms using the small shield to the larger shield
and overwhelmingly their first remark is that "it does not pinch any more".
Makes me wonder how many moms using smalls are grinning and bearing it and
if it hurts all the time or feels pinchy I wonder  how long they end up
breastfeeding., and it seems to me that the smaller shields are harder to
wean because the infant is too used to sucking only with its lips.  Sooooo -
I size to moms nipple not to babies mouth - That is what the baby needs to
learn to manage, I have good intakes and growth and weaning from them.. Work
in a Level 3 nicu  with 25-40 babies, and a MBU with over 200 births a
month. WE really need to coordianate and look at this more in studies.
Thanks so much!
Karen Querna, RN, BSN, IBCLC
Spokane, WA

>
> Date:    Mon, 30 Jun 2003 08:05:03 -0500
> From:    Barbara Wilson-Clay <[log in to unmask]>
> Subject: nipple shield sizing
>
> I size to the baby's mouth, because if you size to the mother's nipple,
you
> may be using a diameter shield that prevents the baby from being able to
> seal off around the base or from being able to compress the teat in half
(as
> the ultrasounds show does happen as the tongue presses the teat against
the
> hard palate.) The size of the larger shields mimics the size of those
> maternal nipples without shields that pose a problem for some nursing
> babies.  If the shield is too large, it's length may also overwhelm the
baby
> by penetrating too deeply and activating the gag reflex, risking creation
of
> a feeding aversion or teaching the baby to protect him/herself by
shortening
> up and perching out on the shaft of the shield.  This means the baby will
be
> poorly latched, which will affect both intake and breast emptying (hence
> supply).  I feel it is better to size to the baby.  This means that
> sometimes you will not be able to use a shield.  No tool is always
> applicable, and you can't always force solutions just because you want
> something to work.  The new Medela shield is a bit larger and expands
> slightly the range of shield size choices, which is good.  Of course, the
> larger the baby, the more shield the mouth can accommodate.
>
> I use an engineer's circle template to get an accurate size, however, for
> the most part, using coin size comparisons gives you a close enought idea.
> (In US coins) If a nipple is dime size or smaller, you can use standard
> flanges and the small shields.  If the nipple is nickle size, use the next
> largest shield and flanges, and if quarter size, I think a shield is
useless
> unless the baby is big.  You need a large flange for the quarter size
> nipples.  There are occasional moms who require the blown glass shields.
> Barbara Wilson-Clay, BS, IBCLC
> Austin Lactation Associates
> LactNews Press
> www.lactnews.com
>
>              ***********************************************
>

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