I would not clip back shields. Silicone edges are too sharp and may scratch
baby's palate.  Once the initial problem is corrected (ie short nipples
everted, baby grown stronger and more able to pull out nipples and maintain
latch, oral-motor function more coordinated, etc) baby should be able to
latch without shield.  The trick is to figure out what the problem is which
prevents normal feeding and also to discern when it's getting better.  Then
you can begin to pull off shield a few min. into the feed, or to stuff a
tiny piece of damp cloth up under shield before putting it on.  Baby sucks
unsuccessfully with shield on, breasts is offered with (hopefully) abundant
supply and is more accessible.  Try nursing strike techniques:  darken room,
quiet environment, baby sleepy, not too hungry, relaxed.  Side lying, etc.
But until the baby recovers or the nipple issues are compensated for or
remediated, baby may not be able to nurse normally.

If the bottom jaw recedes and the tongue is short, I would try to tip head
back more, jamming the jaw into the breast so baby gets more of the tissue
below the nipple in a deep latch.  I don't know and rather doubt that a
shield would help this problem.  The tongue is used to press the nipple up
against the hard palate to press the bolus of milk toward the throat.  It
must also be able to trough and organize the milk so it doesn't spill over
and cause choking.  If the tongue is short, it cant do those things and I
don't know why elongating the nipple would help compensate for that.  Anyone
else got any ideas on this one?  This I would handle by altered positioning
and hoping baby grows and tongue does too.  If it's tethered, maybe a
frenotomy would help it extend.
Barbara

Barbara

Barbara Wilson-Clay, BS, IBCLC
Private Practice, Austin, Texas
Owner, Lactnews On-Line Conference Page
http://moontower.com/bwc/lactnews.html