Jaye asks:

it has been suggested to use a nipple shield with this little one.  How does
that work??  How does using a nipple shield work better than just the
breast?

It's contrary to everything we've always believed, isn't it, but in actuality
many premature babies breastfeed much more effectively with a shield.  These
little ones lack fat and muscle in their cheeks and although they may be able
to maintain a latch it takes more  strength than they have to elongate the
nipple and hold it in place, so they either lose the latch or do not have the
stamina to milk the breast effectively.  With the shield the baby does not
have to use muscle strength to hold it in place and can use energy to suck.
Babies born at 24 weeks often have narrow grooved palates from the
endotracheal tube and sometimes don't get enough stimulation from mom's
nipple to start them sucking; the more firm shield also helps with this.
Many premies begin bfdg much earlier if they use a shield. We always try
first without, but the majority of very small premies do better with it.
Paula Meier has published a study on this.  It is important for mom to have a
good milk supply and good flow for the shield to be effective.  Even without
the shield a borderline or low supply makes bfdg much more difficult for a
premie.  They do so much better when that milk comes easily.

Kathy Boggs, RN, IBCLC
Mountain View, CA

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