I size to the baby's mouth, because if you size to the mother's nipple, you
may be using a diameter shield that prevents the baby from being able to
seal off around the base or from being able to compress the teat in half (as
the ultrasounds show does happen as the tongue presses the teat against the
hard palate.) The size of the larger shields mimics the size of those
maternal nipples without shields that pose a problem for some nursing
babies.  If the shield is too large, it's length may also overwhelm the baby
by penetrating too deeply and activating the gag reflex, risking creation of
a feeding aversion or teaching the baby to protect him/herself by shortening
up and perching out on the shaft of the shield.  This means the baby will be
poorly latched, which will affect both intake and breast emptying (hence
supply).  I feel it is better to size to the baby.  This means that
sometimes you will not be able to use a shield.  No tool is always
applicable, and you can't always force solutions just because you want
something to work.  The new Medela shield is a bit larger and expands
slightly the range of shield size choices, which is good.  Of course, the
larger the baby, the more shield the mouth can accommodate.

I use an engineer's circle template to get an accurate size, however, for
the most part, using coin size comparisons gives you a close enought idea.
(In US coins) If a nipple is dime size or smaller, you can use standard
flanges and the small shields.  If the nipple is nickle size, use the next
largest shield and flanges, and if quarter size, I think a shield is useless
unless the baby is big.  You need a large flange for the quarter size
nipples.  There are occasional moms who require the blown glass shields.
Barbara Wilson-Clay, BS, IBCLC
Austin Lactation Associates
LactNews Press
www.lactnews.com

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