But isn't it hugely important that they were good nursers. On average it seems entirely possible that for good nursers nipple shields would decrease transfer, but isn't the idea that the shield is being given to babies who are NOT good nursers. In fact they are generally given to babies who are not nursing at all. So if you studied that population, you would have to find an increase in transfer since some is better than none. Of course there are babies who will not be able to get anything through the shield, but the mean would have to show an increase not a decrease in milk transfered. Good nursers are not the target population of the nipple shield.
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