There's not a lot of systematic study on choosing the size of nipple shield.  But if a baby is learning to work with an inverted nipple, the baby has to learn to hold a deep, wide wedge of breast tissue, to draw the nipple in deep enough to trigger a suck..  So I tend to use as large a nipple shield as the baby will tolerate, and even small babies can can often manage a fairly large shield.  The 16-mm size doesn't seem, in many cases, to draw in enough breast tissue for good milk flow -- it seems to strangle even a small nipple.   I can't imagine a smaller nipple being helpful.

How old is the baby?    she can feel on common ground that many mother/baby teams are figuring out how they "fit" together.  If this is a small baby, probably gaining strength, and with a sensitive gag (high palate?  recessed chin? restricted tongue?) the size of the nipple shield might not be the only issue.

You're right to keep encouraging her to practice without the shield, just to keep the skin familiar. to help with transitioning off the shield.  To compete with the shield's strong oral signal, she may really need to exaggerate and "sandwich" up the breast.  And even more right in encouraging her to treat the pump like it's a fussy baby, and build the supply.  She can't battle the baby about the breast, and it's easier to woo a baby into learning to breastfeed if there's easy flow.  When the baby is a pound, or a kilo, bigger, the baby will have more strength to draw in the mouthful.

She sounds wonderfully motivated, getting out there and trying the various shields and seeking out your help.  But she has avoid panicking that it's all over if the baby doesn't latch *today*.  So share with her some stories  about babies who took some weeks to get breastfeeding started, and if she protects the supply, and give the baby some pleasant experiences at the breast, she can buy the baby some time to learn.

Margaret Wills, IBCLC, Maryland





> Date:    Fri, 16 May 2014 20:31:41 +0200
> From:    Coudray Françoise - IBCLC
>         <[log in to unmask]>
> Subject: XS nipple shields?
> 
> Hi to all of you,
> 
> With permission, my patient has truly inverted nipples, small breasts, 
> and her baby is really small and around 2.5 kg. (she was born on term)
> 
> The mom had bought several packs of nipple shields - she and the dad 
> bought the whole stock, in several sizes;
> She had tried the smallest: S; but it is struggled and struggled the 
> baby couldn't latch.
> 
> So she contacted me.
> 
> I wonder where I could get Xsmall nipple shields, because those Small 
> ones are too long;
> I also have a problem: the mom has small breasts, and all the more that: 
> she "lost" her milk last week by expressing only 3 times per day, one 
> breast only;
> 
> So: we find no volume for the chin to touch the breast in order to latch 
> on, and anyway the tip of the nipple shield is too far because this 
> model is too long. It is too long for the mouth of the baby, all the 
> more that the baby seems to gag very early.
> We also tried "natural" on mom's nipple, it does not work;
> 
> 
> Challenge is getting very small nipple shields, thus avoiding the time 
> needed to elongate the nipples + baby grows.
> 
> I am in France, I precize it because some trademarks are not sold in 
> France, even in Europe sometimes.
> 
> Breast regards,
> 
> Françoise
> 
>    

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