>I wrote a week ago about a baby who was sent home from the hospital
>finger-feeding.  When I saw her she had not taken the breast in 4 days and I
>asked whether you all would recommend trying a nipple shield.  The consensus
>was - try it.
<snip>
>Ped told mom baby will get plenty of milk through the sheild.  I'm doubtful.
> I'm concerned because mom has flat nipples and her nipples certainly do not
>fill the nipple portion of the shield.  Baby is still not opening her mouth
>and is nursing on the nipple.  I doubt baby is going to get much this way.

Cynthia,
You are right to be cautious about the shield here. I have had quite a bit
of experience with shield use, and don't recommend them unless baby shows
she can draw the breast right into the shield and milk the sinuses
correctly through it. This doesn't sound like this is happening here. If
baby is just sucking the raised portion of the shield, she is doing no
better than on a bottle teat. Fortunately for this baby, at least she was
getting milk through the sns.

I have had a very similar client dyad in the last week - slightly prem baby
girl, mum with flat nipples, baby given heaps of bottles from first days in
hospital, now won't attach, but guzzling mum's expressed milk by bottle. We
tried her on a shield to see what would happen and she sucked alright, but
didn't get any milk through it. She wasn't reaching the sinuses with her
little mouth. This is one I wouldn't recommend a shield for, at least not
yet anyway. We tried cup feeding, but the parents were not very keen on
this idea. A couple of times the parents have succeeded in getting her on
the bare nipple after giving her the dummy to suck first, but most times
this has not worked. So they know she can do it. The only way I can think
of to go here is to give it 'tincture of time', lots of skin-to-skin
contact, keep up the milk supply by expressing, keep trying and giving baby
opportunities to attach, and keep feeling positive that baby will get there
in the end.

If anyone else has suggestions for Cynthia, please post to the list as they
may be useful for my client also.

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Joy Anderson B.Sc. Dip.Ed. Grad.Dip.Med.Tech. IBCLC
Nursing Mothers' Association of Australia Breastfeeding Counsellor
Perth, Western Australia.   mailto:[log in to unmask]
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