Lynn asks: I CAN see their place in a NICU setting with a small =
premiebut am wondering if the flow restriction, seemingly inherent to its
use, =
is an issue there as well.

Actually, I use the small shield in the NICU setting with small premies quite
often with very good results--even in the situation where the shield seems
too small for the mother's nipple. I have found that premies, even if we can
get the large shield in their mouths, do not start or sustain sucking,
probably because there is just no room in the oral cavity to allow for any
jaw excursion. With the small shield a deep latch is, of course, important. I
also find that it is very important to get mom to really tuck baby's chin
in--just slight refinements in positioning can get a flow going. With term
babies I often test both shields with mom and baby to see which one works the
best.   And I have seen small shields work well with term babies.

Kathy Boggs, RN, IBCLC
Mountain View, CA 94040

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