From the limited information given, I would offer the theory that the infant has developed a nipple “preference” for the bottle over the breast. Additional questions I would want to pose are: 
•	Did the infant spend time in the NICU? 
•	Is mother supplementing with expressed breast milk or artificial baby milk?
•	Does the infant latch and suckle correctly and then get frustrated or does he/she have difficulty latching to the breast? 
•	How often is the mother pumping? 
•	How often is the mother offering the breast to the infant?
•	What amount of milk is she expressing via hand? pump?
•	Is this affecting the infant’s growth?
•	Has she previously used a shield?
•	What is her birth history? Did she breastfeed her 1st child? If so, what issues did she encounter?
•	On assessment, what do her breasts look like? Is there anomalies with her breast anatomy?

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