Just from personal experience does mum have oversupply/fast flow?   
Perhaps the flow is reduced with the shield?
My second baby coughed choked spluttered on let-down and I had sore  
nipples too.  She was clamping down to reduce the flow and although  
she first attached deeply, she pulled back when flow started.  I'm  
sure she doesn't have a tongue-tie.  Latch was always good.
I had to trigger let-down, let it subside and then put baby to  
breast.  Also fed her in a semi-reclining position (not flat on back)  
like Suzanne Colson describes in Biological Nursing so she had the  
most head control and could allow some milk to come out of her mouth  
if she needed to.  She eventually grew into the flow (and it settled  
down, but it took a while) and is still nursing at nearly 2.

Does she need to get rid of the shield straight away?  Could she try  
attaching baby after the let-down has subsided to see what happens?

Hope this helps a little.  I'll look forward to what others have to  
say - this being a topic close to my heart.

Anita
ABA Counsellor, Australia

On 07/09/2009, at 4:17 PM, Julie Johnson wrote:

> I have an interesting case. Mom called me 5 weeks post partum. Has  
> severe sore nipples and about to quit. During consult, tongue looks  
> great. Extends great. Moves in all directions. No hump, no  
> concaveness. Actually appears normal to me. Latch looks awesome.  
> Does have a high palate but not too bad. There is no "band" under  
> the tongue. The loudest clicker I have ever heard. Mom mentions  
> that baby does great with bottle other than milk coming out sides  
> of mouth. But during let down the baby can't handle the flow. She  
> gulps very loudly and I almost would describe it as having a hard  
> time breathing. I have never seen a baby do this or react to  
> nursing in this way. She does come off after about a minute to take  
> a breath and just goes back to nursing. Mom says she does pull off  
> alot during feedings.
>
> I got mom in a laying down position to help the milk flow slower  
> and baby would not go for that one. We tried the clutch hold and  
> baby did better but the clicking was still present. When we really  
> try to get baby in deeply, clicking still there but lessened and  
> baby pulls nipple and comes off breast angry. This is usually a  
> very happy baby. Wants to nurse just keeps pulling off and on.
>
> So, we are now using a shield which takes the pain away and baby  
> has no clicking sounds. Baby appears happy. Mom reports that her  
> breasts appear drained since using the shield.
>
> So, what is this and how can mom get baby to nurse without shield.  
> She has all the classic symptoms of posterior tongue tie but the  
> tongue appears good. When mom takes the shield away during nursing,  
> severe pain and clicking returns and she has to fight baby back to  
> breast.
>
> Any suggestions? Thanks!
>
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