Denise and others bring up lots of good points about shields -- again
bringing home that LCs are great theoretical thinkers, AND that we need more
actual research so that we really understand how our tools work.  When we
understand how tools work, we can use them more selectively and more
effectively.

One comment:  It is clear (and we present pictorial evidence for this in the
most recent edition of The Breastfeeding Atlas) that the nipple stays in an
elongated position inside thin silicone shields even after baby lets go in
spite of the holes in the end of the shield teat.

 Feeding is work.  It is, in fact, the only real work a baby does.  Some
infants have compromising factors that prevent them from being able to do
the work of feeding, and/or their mothers have factors (difficult to manage
nipples, for instance) that increase the work of feeding.  So the shield (if
made of the right material and sized appropriately for the mouth of the
baby) may decrease the work of feeding, making it possible for the unstable
feeder to remain at the breast and get adequate intake.  The milk supply may
still need extra stimulation, and some infants will need topping off via an
alternate feeding method until they stabilize to the point that they can
manage the work of feeding.  These just-a-little-early babies have thin
cheeks with underdeveloped fat pads.  This is a hugely compromising factor
and contributes to major feeding problems. Whenever I see those thin cheeks
I think:  Uh-oh.  It may even be that the way the shield "takes up room"
inside the oral cavity decreases the size of the space in which the baby
must create negative pressure.  This could be another reason why the shield
works for some of the smaller babies.

Barbara Wilson-Clay, BS, IBCLC
Austin Lactation Associates
LactNews Press
www.lactnews.com

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