Veronica, I have worked in two settings as an LC. One a hospital where any staff member had access to nipple shields and could give them out. No training required. Now I work for WIC and we just inserviced our Peer Counselors and professional staff on how to use them. They will have some in each clinic to try, especially for the tons of bottle preference cases we get. We'll see what happens.

I inserviced the staff using LLLI's handout on Nipple Shields. There is also good information (meaning very current) in the 2003 BREASTFEEDING ANSWER BOOK. I passed around copies of the revised Breastfeeding Atlas at the photo section to show them what a properly fitted nipple shield looks like. I took one Medela regular size and carefully applied it to one of those stuffed cloth nipple/breast demonstrator things to show them. If you do it just right, by turning it halfway inside out and applying it to pull up the "tissue", you can get a small bit of suction to pull up the cloth nipple out into the shield (hold the shield on tight with fingers on the base or it falls off). I demonstrated the "plop it on" method to show how this often doesn't work well, and the halfway inside out method that usually works better. 

I discussed why use one (on the handout), how to apply it, fitting one to mom and baby, baby's proper latch on, active sucking, cleaning, and weaning. Medela's have instructions in English and Spanish and we instructed our staff to pull out the instruction sheet and go over it with mom. Each staff member also got one of the LLLI handouts. 

Kathy Eng, BSW, IBCLC
Houston

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