I think the nipple shield confusion goes back to the old heavy type of "fire hat" shaped shields that had rough ridges inside. One of my children saw one, asked what it was, and said, "wouldn't that hurt?" She was right. The ridges probably did hurt! The soft silicone ones that are available now can be quite helpful when used appropriately. I find them to be useful to buy time and get over a hard spot. They preserve BF in the long run. We give them out sparingly and include a written instruction sheet with each one. I find that taping the shield to the breast using transpore tape makes using them much, much easier. Pardee Hinson, MPH, IBCLC Mercy Lactation Support Center Charlotte, NC [log in to unmask]