Hi Ann,
Is the mom turning the nipple shield halfway inside out and pressing it
into her breast to draw a lot of breast tissue into it?  Have you
documented intake at breast with the shield?
If the baby's mouth is large enough, I like to use the regular newborn
size shield rather than the small, and make sure that baby gets all the
teat portion in the mouth and has her lips on the flat portion.  If the
baby can't move adequate milk with the shield, I don't use it, period.
 I have mom pump and "alternate device" feed while we work on the baby's
skills to prepare for breastfeeding instead.
Catherine Watson Genna, BS, IBCLC  NYC

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