At the risk of sounding (again) like the Queen of Silicone, may I point out several things about the use of tools? First, you have to understand how and why a tool works, and under what circumstances it might be the RIGHT tool for the job. Second, you have to exercise reasonable diligence during its use to monitor if and how it is working. Thirdly, it is necessary to monitor outcomes to see if your results justify continuing to fool with it. Selection of ANY tool should be based upon a specific rationale arising from the situation of the individual dyad being assessed. The fact that nipple shields are randomly tossed at mothers with non-nursing babies is a condemnation not of the tool, but of the poor training and supervision of the population serving breastfeeding women. It testifies to the absolute poverty of our investment in really having breastfeeding specialists whose province is the dyad presenting with non-robust, abnormal feeding behavior. It argues eloquently for more theoretical education of lactation consultants, RNs and whoever else is involved. That tools are carelessly selected and outcomes go unmonitored is intolerable scientific and intellectual laziness with profound ethical implications. Physical Therapists are FEEDING specialists. We are supposed to be BREASTfeeding specialists. If we present ourselves to consumers as such, we have a moral responsibility to try to understand what we are doing. That includes EDUCATED use of therapeutic tools. Barbara Wilson-Clay BSEd., IBCLC Private Practice, Austin Texas Visit the "LactNews-On-Line" Web Page http://www.jump.net/~bwc/lactnews.html