I think shields were initially visualized and manufactured as a way to
protect/prevent sore nipples. The fact that they have been used for other
reasons and have been discovered to have more applicable clinical uses is an
ACCIDENT! It's what would be called in pharmacology, an "off-label" use of
the device. Since the mid-90's, there has been a little bit of research,
mine included, that looks at how shields work in these off-label ways. This
research has led some people to think more about how to refine the use of
the tool in the directions where it may do some good. This includes helping
the weakly feeding, small, ill, pre-term infant stabilize feeding (Meier,
Hurst, JHL 2000) and my own work in terms of helping babies locate the
nipple by increasing the sensation when moms have flat or inverted nipples,
and in bridging back babies who have imprinted on bottle teats (JHL, 1996).
There is more work to be done, some of which involves looking more closely
at these size issues. Shields are not a good tool for every problem, and
probably only work well when all the salient factors are controlled for.
I agree with Rachel that labels should describe how to put on a shield, and
I agree with her that the texture and consistency of shields matters. I
once thought the softer the material the better, but actually, the softest
ones collapse and are useless. I think that there is not so much negligence
involved with the labeling as that everyone is just catching up with the
rationales for the off-label use of the device.
This is another example of how we really need to be involved in research and
to publish. I think how to use shields should be a technical session at
conferences.
Barbara Wilson-Clay, BS, IBCLC
Austin Lactation Associates
LactNews Press
www.lactnews.com
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