Dear Ann,
Your mother's use of a nipple shield should not be a cause of the baby
gaining poorly in of itself.  If a shield is applied correctly and the baby latches
onto it correctly, there should be just as much milk transfer as to the bare
breast.
Has this mother been supplementing at all during this 3 weeks?  Why did she
start with the shield?
When a shield is indicated the weaning cannot occur until the problem for its
indication has been resolved.  This could mean a few days to several months.
Why was a shield given to this mother?
I would suggest you observe the mother nursing with the shield.  Does she
turn it part way inside out before applying it so her nipple can be drawing into
the shield?  Does the baby have an asymmetrical latch with the shield deep
into the mouth?  Is there a 1:1 suck/swallow ratio while on the shield?
I think your plan to have the mother pump right now will be helpful but I
would look to the questions I asked to evaluate why this baby does not gain well
or there may be another problem here.
Ann Perry RN, IBCLC
Boston, MA

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