I do not use the small shield for the same reason as you mentioned. I have
used the new middle size without problems. For the most part I use the
Regular size, for comfort and to promote a wide mouth and a correct latch.
Kate Y. Pierce RN, IBCLC
Lactation Station, Inc.
Maternity and more
527 Southland Dr.
Lexington KY 40503
859-277-2988
859-278-0880
----- Original Message -----
From: "Karen Querna" <[log in to unmask]>
To: <[log in to unmask]>
Sent: Monday, June 30, 2003 12:01 PM
Subject: Npple Shield usage
> Dear Lactnetters,
> When I use a shield on a mom I never use a small anymore- I think it
> promotes the infant using only its lips to suck, I personally feel that if
> the newborn or preemie cannot sustain its suck on a regular sized shield
> then either something else is going on (in a term infant is the sensitive
> gag due to over zealous oral suctioning at birth,) or in a preemie is it
> just to soon for it and we need to do more Kangaroo care instead of
pushing
> oral attachment to the breast..If an infant is on any shield and not
> transferring adequate milk for growth then is the nipple shield the
answer?
> I frequently will switch moms using the small shield to the larger shield
> and overwhelmingly their first remark is that "it does not pinch any
more".
> Makes me wonder how many moms using smalls are grinning and bearing it and
> if it hurts all the time or feels pinchy I wonder how long they end up
> breastfeeding., and it seems to me that the smaller shields are harder to
> wean because the infant is too used to sucking only with its lips.
Sooooo -
> I size to moms nipple not to babies mouth - That is what the baby needs to
> learn to manage, I have good intakes and growth and weaning from them..
Work
> in a Level 3 nicu with 25-40 babies, and a MBU with over 200 births a
> month. WE really need to coordianate and look at this more in studies.
> Thanks so much!
> Karen Querna, RN, BSN, IBCLC
> Spokane, WA
>
> >
> > Date: Mon, 30 Jun 2003 08:05:03 -0500
> > From: Barbara Wilson-Clay <[log in to unmask]>
> > Subject: nipple shield sizing
> >
> > I size to the baby's mouth, because if you size to the mother's nipple,
> you
> > may be using a diameter shield that prevents the baby from being able to
> > seal off around the base or from being able to compress the teat in half
> (as
> > the ultrasounds show does happen as the tongue presses the teat against
> the
> > hard palate.) The size of the larger shields mimics the size of those
> > maternal nipples without shields that pose a problem for some nursing
> > babies. If the shield is too large, it's length may also overwhelm the
> baby
> > by penetrating too deeply and activating the gag reflex, risking
creation
> of
> > a feeding aversion or teaching the baby to protect him/herself by
> shortening
> > up and perching out on the shaft of the shield. This means the baby
will
> be
> > poorly latched, which will affect both intake and breast emptying (hence
> > supply). I feel it is better to size to the baby. This means that
> > sometimes you will not be able to use a shield. No tool is always
> > applicable, and you can't always force solutions just because you want
> > something to work. The new Medela shield is a bit larger and expands
> > slightly the range of shield size choices, which is good. Of course,
the
> > larger the baby, the more shield the mouth can accommodate.
> >
> > I use an engineer's circle template to get an accurate size, however,
for
> > the most part, using coin size comparisons gives you a close enought
idea.
> > (In US coins) If a nipple is dime size or smaller, you can use standard
> > flanges and the small shields. If the nipple is nickle size, use the
next
> > largest shield and flanges, and if quarter size, I think a shield is
> useless
> > unless the baby is big. You need a large flange for the quarter size
> > nipples. There are occasional moms who require the blown glass shields.
> > Barbara Wilson-Clay, BS, IBCLC
> > Austin Lactation Associates
> > LactNews Press
> > www.lactnews.com
> >
> > ***********************************************
> >
>
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