Hi Micaela,
Yours are excellent questions! You ask <<How can a nipple shield help
correct the mismatch between large nipple and small infant mouth? As far
as I understand, the shield must fit comfortably on the nipple (and
small shields are very difficult to apply anyway). If this must be, how
can it help the baby with a small mouth to latch properly? if the shield
is large in order to accomodate a large nipple, how can the baby latch
properly beyond the shaft?>>
I admit I have tried this on rare occasions. I think it is done somewhat
out of desperation. My reasoning was, without the shield, the baby
mostly landed on the large nipple which was quite distinct from the
areola. With the shield, the nipple was shortened somewhat when put into
the shield, making the transition from nipple to areaola (or the
demarcation of nipple to areola) was more gradual with the shield, so
baby sometimes could land on the right spot on the areola. I don't think
this usually works from all the reasons you cite above. You do have to
have a large enough shield to fit over mom. Typically these are moms who
really want to bf, and babies who are trying their hardest, and no other
risk factors. So, I think, for me, it is very hard to counsel a mom to
express and feed her milk, when there is something that you haven't
tried that *might* work. Sort of a last resort.
Next, you ask <<How does it work the idea of the nipple shield aiding
babies with weak suction to extract milk from the breast?>>
My understanding is that for a premie, with weak muscle tone and low
buccal fat, can have a hard time holding mom's breast in his mouth. The
firmer shield is easier for them to grasp and hold on to, and once the
milk starts flowing, the suction on the nipple within the shield can
keep the milk flowing a little (would this be the negative suction), and
there is milk in the shield for the baby to taste at the next suck. Sort
of like a siphon, once the flow starts it may keep going.
Micaela, I'm glad you asked, because what I am saying is in the first
instance, it may be a foolish thing to try, but the second instance
makes more sense to try, but maybe I do not know exactly the mechanics
of why it works.
Laurie Wheeler RN MN IBCLC, Mississippi USA
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