We have all sizes available.  What we find is large shields can cause some babies to pull back the tongue and bite.  After all, anatomically, the nipple is supposed to be drawn back onto the baby's tongue and the tongue to cup around the nipple without "humping".  WE try to fit the shield to the baby's mouth and avoid compressing mom's nipple.  If mom complains of pain with the use of the shield, we adjust.  I think an important concept is that milk is removed from the breast by mother ejecting milk.  The shield just helps keep the "hoses unkinked".  If mother doesn't have much milk or has delayed let-down, you might find problems with shield use.   

-----Original Message-----
From: Lactation Information and Discussion [mailto:[log in to unmask]] On Behalf Of Susan Lawrence
Sent: Monday, May 10, 2010 12:31 PM
Subject: nipple shields, size

As long as we're discussing nipple shields: Do any of you feel doctrinaire about sizes of shields? An LC I work with believes that any size smaller than 24mm should be locked up. (LC believes that a wide one makes babies open wide). Currently the 20mm ones are hidden/locked up --and the 16mm are only in the NICU, which is a floor and a universe away from the postpartum nurses (so effectively unavailable even to the LCs on the postpartum).
Kind of odd that there seems to be little written about choosing sizes of shields.
So what are your thoughts and practices??
Susan

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