Dear Janet. (Jay)
Thank you for reading my post. If you get a chance to reread my letter you
will see that I made no mention of using shields with preemies or low milk
supply. I  stated that my work with shields is with babies that are already
on bottles and that I am in private practice and not in a hospital setting
unless called in by the nurses.

You state:
> Nipple shields have their place in the world of BF as do all these TOOLS.
 That is what they all are. TOOLS to help us do our jobs better, to help moms
succeed at breastfeeding their babies. >

So we agree.   : )

My point maybe poorly made in my letter was that  there are many times when
those  gadgets are used that a shield's use would have been much more
appropriate as a FIRST choice not last resort.  But we fear reprisal from our
peers ,LLL leaders, and even the moms themselves because the breasfeeding
literature is so slanted on nipple shield use. So its use is so often passed
 up when it may have been the best FIRST choice. The shield has sufferred
terrible prejudice in our field just because its predicessor the thicker
rubber shield really did interfere so badly with successful breastfeeding.
 And I am glad we are finally allowing the new thinner shields to come out of
the closet and assume their rightful place on the "alter" with our other
miracle gadgets and techniques.

In my type of practice and my humble opinion, the nipple shield should be
tried before suck training, cup or syringe in most of the cases I see. I
don't use shields exclusively -obviously!!  But I use them first before the
other gadgets when it comes to poor latch on or already on bottles as I said
in my first post.

The other gadgets are often expensive and difficult to use and to clean.
Compliance by parents is not as good as with the shield. Gadget use is
threatening for new parents. No one can deny that. just look at parents glaze
over and feel their pulses race  when they see anything being stuck in their
kids mouth or nose.

Success depends not only on what is BEST to use but what tool will parents'
 compliance and acceptance be the best. So that is my point I guess.

As far as suck training being annoying, invasive and threatening. --I stand
by those words.  Did you interview the babies? I have tried many many times
but they just cross their eyes at me. HOwever, I assume , that since I myself
wouldn't want those weird things in my mouth ,  why would a baby?.   I try to
think like a baby. "GEE this  is NOT my  Mom. It is not attached to my Mom
"etc etc. Now Mom's or Dad's finger to suck on in a leasurely manner with no
roughhousing by tongue wlking etc is logical too. Babies for the most part
have sucked on their own fingers or hands many times before and know the
taste and feel of human skin. Small gentle barely perceptible strokes with
the finger on the palate (or with some babies the tongue) can be a help.
 This is as far as I will go with suck training I share with parents. I never
call it training either. I tell parents they are giving their baby pleasure.
 Allowing the baby to suck on our finger is reminding them of the pleasure of
their mouth.  A pleasure the baby will want to repeat. And hopefully do it to
themsevles with their tongue and moms breast.I think that is more accurate as
what we are doing in their mouth does not fit the definition of 'training"
anyway. And as far as suck training goes.  The mere words suggest that the
baby must be stupid or horribly defective if he can't even suck right. (I
also hate the term nipple confused.  But that is another post.)

You mentioned bubble palates too. The shield is excellent for bubble palates.
 Though rarely appropriate for sore nipples. One of my most common uses is
with  these babies  who often can't stimulate their own palates with MOM's
nipple as the palate is so far up and away or too narrow. These baby tend to
stay on the shield a little longer. But none have continued past 21 days.
(interestingly enough that is how many days psychologists say it takes to
learn a new habit!!)  In preemies they stop use of shield by 21 days past the
time they should have been born. Seems to be a maturational level reached by
then that is necessary.  But remember READERS   when I say preemie I am
referring to babies that  are at home already and have been around the block
a few time. I am not in a hospital setting.

Ease of use,and less "technological" looking,  families are more accepting of
the shield then "suck training" and syringes for the most part.  I think  new
parents want to be parents not medical personnel with their new babies.   How
many parents do the suck training  "well" or consistantly?  I don't doubt
that some lactation consultants can do suck training well and successfully,
But are the LCs planning to moving into to babie's home?
Jay,
I am a little confused though that you said you used supplimental systems
(which we are not to supposed to name by brand name but you all know what I
mean.)  for helping babies with poor suck. Chele Marmet has made it clear on
many occaisions that  the supplimental systems  have no role to play in
helping a baby to learn to suck correctly. It's appropriate use in my opinion
is extremely  limited .  At least in my practice. But perhaps not yours. Can
you clarify what you meant here?
Thank y ou for your welcome and I look forward to continued dialogue on this
and other "HOT" topics.

I think we vary more in the type of practices we have that dictate what kinds
of cases we work with THAN we we actully differ in opinions on all these
approaches.  so our experiences by shear frequency of success and necessity
of use will alter our views too.

Shall I lurk again???  Thanks for your response.
Debby Saalfeld