I can't imagine they don't have Pur and Medela soft silicone nipple shields
in most pharmacies.  If you take a metric ruler you can measure the teat
height.  Pam Morrison is using a great height shield with a 1.5  cm teat,
and I can get similar good results from one with a 1.9 cm height.  Medela's
newborn STANDARD, however, is too tall.  The newborn SMALL size is the one I
like.  The baby perches out on the teat cavity if the shield is too long or
tall or however you want to phrase it.  If a weak or un-stable baby is
sucking like crazy to try to fill a huge  teat cavity with mother's nipple
this is too exhausting.  If the baby is able to do that and mother's nipple
is elastic enough to fill the teat why ia a nipple shield being used in the
first place?  Shields are used when you can't get the baby to breast any
other way and you are going to lose the lactation if you don't do something
to assist the baby to breast.

 Breast refusal, like all other behaviors, occurs for some reason.  What is
the reason?  The reason determines your clinical choice of a technique,
modality or tool to try to bring about a return to normal, which is defined
as baby nursing unassisted at breast.  Sometimes this cannot be achieved
without bridging through some intermediate steps during a  period which
allows for recovery or remediation of the presenting problem.  The shield is
a crutch.  Crutches are useful.  You get rid of them as soon as you can.

Barbara Wilson-Clay, BSEd, IBCLC
Austin Lactation Associates, Austin, Texas
http://www.jump.net/~bwc/lactnews.html

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