Kim, I am not sure what setting you are using nipple shields in.  If it is 
inpatient but you have the ability to follow up with at least a phone call 
within a few days after discharge, I think you are fine.  I always 
documented my teaching with a nipple shield including it is a short term 
measure and pumping should be included after every feeding (with a 
hospital grade pump or a good manuel pump-not a mini electric).  Also, 
know who the follow up peds is and if they have a Lactation Consultant in 
their office & document.  I have even called a peds office to be sure this 
mom and baby are seen within a few days after discharge and not lost in 
the appointment shuffle of "we're busy". 
If you are seeing these moms outpatient then you of course can see them 
again for weight checks and follow ups.  Again, document.  
I currently work in a NICU where we use nipple shields after several STS 
breastfeeding attempts.  Many of out 32-33 weekers have mouths too small 
for their moms, but we don't go straight for the shield.  Before 
disacharge, many of the babies "grow" into the nipple and don't need a 
shield depending on what age they are discharged and other medical 
diagnosis they may have.  
Catherine Katz RN,IBCLC,RLC 

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