In a message dated 11/14/02 6:25:21 AM, [log in to unmask] writes:

<< I attended a conference with Dr. Evelyn Jayne a couple years ago.  She
suggested the use of shields for Mom's with large or long nipples and babies
who could not accommodate them until the baby's mouth grew.  I asked her how
this would work if the nipple was larger than the shield and she said that
the nipple tissue could handle being compressed into the shield and this was
a better compromise than trying to get the baby to handle the nipple.  This
makes sense to me but what have others found or tried?
I do like to use shields in my practice but I fine their use for sore nipples
not that helpful and this is the reason used to market them in the stores.
Ann Perry RN, IBCLC
Boston, MA >>

Ann,
This is exactly what I do with premature infants, especially those who have
been intubated for any period of time. They tend to have narrow, grooved
palates from the endotracheal tube. Often because of the groove they are not
able to sense mom's nipple in their mouths.  Also these small premies cannot
accomodate a large shield in the small oral cavity, so Just for the heck of
it I started stuffing large nipples into small shields and to my surprise if
a mother has a good milk supply and a good MER it often works.  I also
expected mothers to complain of pinching pain and sometimes they do, but a
lot of times they don't--maybe because of the relatively weaker suck of the
premie.  I have the mother form the nipple-shield complex (how's that for
made up terminology) into a nipple sandwhich and work for the deepest latch
possible.  Of course these babies are still in the NICU and are having their
intakes assessed by test wt. so are not lost to follow up. It's a technique I
tried in desperation when there was no other way to get these tiny, or ex
tiny, premies to breastfeed and it often works.

Kathy Boggs, RN, IBCLC
Mountain View, CA 94040

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