There are many, many factors that contribute to dysfunctional feeding. No
normal nursing situation calls for a nipple shield. Mavis Gunther wrote in
the 1950's in "Instinct and the Nursing Mother" (Lancet) "...there is often
one point, clearly recognisable to the mother and her attendant, when the
baby changes in responsiveness. This change occurs when the baby first
experiences the filling of his mouth right to the palate and the dorsum of
the tongue with a nipple, or nipple substitute of the right shape. The full
action of the jaws, tongue, and cheeks is evoked, and from then on the baby
can almost put himself on the breast. It has been noticed that where the
mother's breasts were sufficiently well-formed for the baby to hold the
nipple in the lips but not protractile enough to evoke the full feeding
response, the baby was apathetic. He settled on the nipple quietly and was
not interested. The nurses described him as lazy or like a premature baby
in behavior. The pediatricians look for infection."
Gunther goes on to describe the phenomenon of "sign stimulus". This is the
range of stimuli babies are programmed to respond to in terms of intitiating
feeding behavior. Nipple protractility is a sign stimulus. Lack of
sufficient triggering of the stimuli that preceed feeding behavior can be a
significant issue in the nursing infant.
There are all sorts of individual variations in nipple tissue, nipple
diameters, compressibility, degree of inversion, and the confounding
variable of nipples that appear to invert, but which are functionally
everted under reasonable levels of neg. pressure. There are similar
variations in infant palate configuration, stamina, level of neuro-muscular
maturity, health, size, lip, tongue, cheek, and jaw stability.
Additionally, there are degree of dexterity in latch technique, levels of
experience, confidance, social support etc. in the mother.
Tool use is a sophisticated business. I agree that it is irresponsible to
toss a shield at someone with no understanding of how they work and no
follow-up. I also feel that it is our ethical responsibility to learn how
and why and WHEN tool use can assist. The literature on this subject, and
on the related issue of nipple confusion, is fascinating reading.
Winnie asks about diameters of shields at base. Measuring on an engineers
template, I've figured the Medela small to be around 16 mm and the larger to
be about 23-24mm.
Barbara Wilson-Clay BSEd, IBCLC
Austin Lactation Associates
http://www.lactnews.com
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