Dear all:

I have documented that the size of the nipple shield can make a tremendous difference in milk transfer.  My most extreme case was a baby who took 45 minutes to drink 1 oz with a 16 mm nipple shield.  When we switched him to a 24 mm, he took an additional 3 oz in five minutes.  I find that the 16 mm sits on top of the breasts of most women and won't allow much milk transfer.  I've found that even many 4 pounders will do fine on a 24 mm.  However, as with all tools, I look at the individual because every now and again that 16 mm works like a charm.

Best, Susan Burger

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