In reponse to Nipple Shield size.

I very rarely/almost never use anything smaller than the 24mm.  Years ago I
used to try the smaller sizes but mothers felt too much pain and pinching.
 In my experiance if the family is mangaged with good intstruction on
positioning, an assessment of intake on an appropriate gram scale after
lactogenisis, follow-up telephone support, encouragment to go to mom-baby
support group,  and minimal of weekly weight checks they will do fine. If
there is an issue on insufficient milk usually it is not because of the
shield but becuase of an underlying maternal issue.

Karen Querna, RN, BSN, IBCLC

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