Community Forum: General Discussion
Use this forum to discuss matters of interest to lactation professionals.
Teats as nippleshilds
Posted 5th Nov 09 By Joan Miller
I am some what hesitant to post because my question and comment is about something that used to be done and is old fashioned.
If a baby has started to refuse to go to the breast to feed and it is taking EBM from a bottle via a teat, WHY is it incorrect to use the teat at the breast.
I accept that all other options should be tried first and that old fashioned nipple shields were superseded by the ones we have now because they provided a more natural sucking action at the breast. But can someone help me with evidence for the reasons teats should NOT be used to encourage a baby who has decided the breast is not a nice place to be to change its opinion and be happy to breast feed again. I do understand about sucking mechanisms and possible reduction in milk supply but this would be only a temporary measure.
For the sake of discussion which would be the better option ( if these are the only two options) for a mother whose baby will not feed at her breast, A) Pump and feed EBM from a bottle or B) use a teat at the breast and transition to breast feeding when baby begins to accept breast again.
I really want to look at any research on this topic.
If a baby has started to refuse to go to the breast to feed and it is taking EBM from a bottle via a teat, WHY is it incorrect to use the teat at the breast.
I accept that all other options should be tried first and that old fashioned nipple shields were superseded by the ones we have now because they provided a more natural sucking action at the breast. But can someone help me with evidence for the reasons teats should NOT be used to encourage a baby who has decided the breast is not a nice place to be to change its opinion and be happy to breast feed again. I do understand about sucking mechanisms and possible reduction in milk supply but this would be only a temporary measure.
For the sake of discussion which would be the better option ( if these are the only two options) for a mother whose baby will not feed at her breast, A) Pump and feed EBM from a bottle or B) use a teat at the breast and transition to breast feeding when baby begins to accept breast again.
I really want to look at any research on this topic.
Re: Teats as nippleshilds
Posted 11th Nov 09 By Joan Miller
I really need some feedback on this if anyone has any information about using teats at the breast instead of nippleshields as written above.
Please help as I cannot find any research.
THANKS
Please help as I cannot find any research.
THANKS
Re: Re: Teats as nippleshilds
Posted 11th Nov 09 By Denise Fisher
Hi Joan
I'm sorry I didn't notice your posting earlier.
Firstly you need to look at the problem you are trying to treat - baby will suck on bottle teat, but not latch to breast; with the goal to get the baby back to direct breastfeeding.
There must be a reason the baby won't go directly onto the breast. It may be that the baby has imprinted onto the shape and feel of the bottle nipple now, but why was the baby put onto a bottle originally? Are you trying to treat damaged nipples - why: poor positioning/latch, tongue tie, bubble palate, flat nipples, etc. Or was it breast refusal - why: forceful milk ejection, oral insult (suctioning, etc), head forced onto breast, birth trauma, nipple preference from early bottle feeding, etc. It is essential that this is diagnosed and a management plan to treat or avoid the original cause is a part of your solution.
It is not normal under any circumstances for a baby to not want to breastfeed - their newborn reflexes are all primed to find the breast, latch on and feed. There's got to be a reason.
The next question to be answered is what is the best method to encourage the baby back onto the breast that avoids or treats the initial problem, while ensuring the baby continues to receive adequate milk. It will depend a lot on what the original cause was.
If you feel the answer is a nipple shield then using a bottle nipple/teat, even though that is what the baby is now used to, is not the best solution. Firstly the transfer of breastmilk is virtually non-existent. For milk transfer to occur the MER must be stimulated and once stimulated the baby must be able to create sufficient negative pressure in their mouth for the milk to leave the breast. That negative pressure must be transferred to the mother's nipple. You may get a little milk transfer with the first milk ejection, but it's unlikely to continue.
Because milk transfer is so restricted the mother's milk supply will rapidly decrease unless she continues to pump as well.
The baby is not learning the appropriate sucking action.
If the baby isn't being well rewarded at the breast with the bottle teat then he's unlikely to want to stay there.
Is this treating/avoiding the original cause of the breast refusal?
You ask about research about this. To the best of my knowledge there is none; however there was research done on the old 'mexican hat' type of nipple shield and the older thicker shields which all showed major problems with milk transfer and high failure rates - and these would all have been better than a bottle teat.
So many interventions in breastfeeding came about because someone thought they'd be a good idea, and were never scrutinised for effectiveness. This wouldn't happen in any other field. Every intervention should have to meet the "first, do no harm" criteria, and then show that it's actually an advantage. I'm sure the reason no one researched this intervention is because it would not have met the first criteria.
I'd love to hear from others for ideas for Joan to try to transition this baby back onto the breast.
Denise
I'm sorry I didn't notice your posting earlier.
Firstly you need to look at the problem you are trying to treat - baby will suck on bottle teat, but not latch to breast; with the goal to get the baby back to direct breastfeeding.
There must be a reason the baby won't go directly onto the breast. It may be that the baby has imprinted onto the shape and feel of the bottle nipple now, but why was the baby put onto a bottle originally? Are you trying to treat damaged nipples - why: poor positioning/latch, tongue tie, bubble palate, flat nipples, etc. Or was it breast refusal - why: forceful milk ejection, oral insult (suctioning, etc), head forced onto breast, birth trauma, nipple preference from early bottle feeding, etc. It is essential that this is diagnosed and a management plan to treat or avoid the original cause is a part of your solution.
It is not normal under any circumstances for a baby to not want to breastfeed - their newborn reflexes are all primed to find the breast, latch on and feed. There's got to be a reason.
The next question to be answered is what is the best method to encourage the baby back onto the breast that avoids or treats the initial problem, while ensuring the baby continues to receive adequate milk. It will depend a lot on what the original cause was.
If you feel the answer is a nipple shield then using a bottle nipple/teat, even though that is what the baby is now used to, is not the best solution. Firstly the transfer of breastmilk is virtually non-existent. For milk transfer to occur the MER must be stimulated and once stimulated the baby must be able to create sufficient negative pressure in their mouth for the milk to leave the breast. That negative pressure must be transferred to the mother's nipple. You may get a little milk transfer with the first milk ejection, but it's unlikely to continue.
Because milk transfer is so restricted the mother's milk supply will rapidly decrease unless she continues to pump as well.
The baby is not learning the appropriate sucking action.
If the baby isn't being well rewarded at the breast with the bottle teat then he's unlikely to want to stay there.
Is this treating/avoiding the original cause of the breast refusal?
You ask about research about this. To the best of my knowledge there is none; however there was research done on the old 'mexican hat' type of nipple shield and the older thicker shields which all showed major problems with milk transfer and high failure rates - and these would all have been better than a bottle teat.
So many interventions in breastfeeding came about because someone thought they'd be a good idea, and were never scrutinised for effectiveness. This wouldn't happen in any other field. Every intervention should have to meet the "first, do no harm" criteria, and then show that it's actually an advantage. I'm sure the reason no one researched this intervention is because it would not have met the first criteria.
I'd love to hear from others for ideas for Joan to try to transition this baby back onto the breast.
Denise
Re: Teats as nippleshilds
Posted 11th Nov 09 By Anne Burton
I'm sorry I have never heard of using "teats" at the breast? Do you mean a nipple shield? If so, yes in some circumstances, where the mum maybe thinking about weaning, a nipple shield maybe be an option.
Re: Re: Teats as nippleshilds
Posted 11th Nov 09 By Bridget Ingle
A long time ago... there used to be a hard plastic open-ended nippleshield with a rubber teat attached to the end - so it was this long device which was put onto the nipple and it stuck straight out from the breast. So essentially, the baby would feed on the teat, with no contact with his mother.......... most of those babies failed to thrive or became dehydrated and/or the mother's milk supply decreased to droplets.
Denise has explained about the rubber Mexican hat (named because they looked like a sombrero) - they were a think, non-pliable rubber nippleshield. The studies that were performed on those after several years on the market, showed that milk transfer was reduced by up to 70% (different brands gave different results - even the early silicon nipple shields noticably reduced milk transfer ) Most (not all) modern silicon nippleshields are very thin and pliable and (most) have adequate number and size holes in the end to allow milk transfer - but the benefits and disadvantages of this type of shields is still a contentious issue.
So to return to the question at hand about using a bottleteat over the nipple to breastfeed - it may seem like a good idea because we calculate it in our terms ie - the baby will suck on a teat, so he will suck on that teat if we put it on the breast... and then he will breastfeed. This does not address the reason why the baby is sucking on the teat in the first place and the other suck issues that the baby may have. The baby probably will be happy to suck on the teat at the breast and it may appear that the baby sucks and swallows and falls asleep. This would be very short-lived - think about how a baby bottlefeeds - the bottle is tilted and the teat fills with milk; the baby SUCKS (not suckle) or chomps on the teat and milk is delivered into his mouth. Let's look at what would happen if the teat was placed over the nipple -- the teat will protrude a long way past the tip of the nipple; the silicon of the teat is thicker than a nippleshield; the baby will SUCK on the teat creating a vacuum inside the teat which would be AROUND the mother's nipple , the baby's gums will compress AROUND the mother's nipple . THere may be some milk transfer into the teat during MER (if the mother tends to spurt milk), but after that, the baby will have to exert a lot of effort and suction to attempt to draw milk into the teat and then transfer it through the holes and into his mouth.
So, if it did "work", it may do so only for a few feeds, then it would be of danger to the baby to continue.
There are so many issues here - sometimes, TOO many things are tried in an attempt to get the baby to the breast; or the baby is over stimulated and his innate responsed become suppressed and confused. I wont go into all that in this posting. However, the supervised use of a nippleshield would be a better option than using a bottleteat on the breast.
I hope that helps your ponderings.
breast wishes
Bridget
Denise has explained about the rubber Mexican hat (named because they looked like a sombrero) - they were a think, non-pliable rubber nippleshield. The studies that were performed on those after several years on the market, showed that milk transfer was reduced by up to 70% (different brands gave different results - even the early silicon nipple shields noticably reduced milk transfer ) Most (not all) modern silicon nippleshields are very thin and pliable and (most) have adequate number and size holes in the end to allow milk transfer - but the benefits and disadvantages of this type of shields is still a contentious issue.
So to return to the question at hand about using a bottleteat over the nipple to breastfeed - it may seem like a good idea because we calculate it in our terms ie - the baby will suck on a teat, so he will suck on that teat if we put it on the breast... and then he will breastfeed. This does not address the reason why the baby is sucking on the teat in the first place and the other suck issues that the baby may have. The baby probably will be happy to suck on the teat at the breast and it may appear that the baby sucks and swallows and falls asleep. This would be very short-lived - think about how a baby bottlefeeds - the bottle is tilted and the teat fills with milk; the baby SUCKS (not suckle) or chomps on the teat and milk is delivered into his mouth. Let's look at what would happen if the teat was placed over the nipple -- the teat will protrude a long way past the tip of the nipple; the silicon of the teat is thicker than a nippleshield; the baby will SUCK on the teat creating a vacuum inside the teat which would be AROUND the mother's nipple , the baby's gums will compress AROUND the mother's nipple . THere may be some milk transfer into the teat during MER (if the mother tends to spurt milk), but after that, the baby will have to exert a lot of effort and suction to attempt to draw milk into the teat and then transfer it through the holes and into his mouth.
So, if it did "work", it may do so only for a few feeds, then it would be of danger to the baby to continue.
There are so many issues here - sometimes, TOO many things are tried in an attempt to get the baby to the breast; or the baby is over stimulated and his innate responsed become suppressed and confused. I wont go into all that in this posting. However, the supervised use of a nippleshield would be a better option than using a bottleteat on the breast.
I hope that helps your ponderings.
breast wishes
Bridget
Re: Teats as nippleshilds
Posted 13th Feb By Helen Williams
The new, very thin and pliable shields work as the breast can receive stimulation, but a bottle teat is not a suitable option. Why not try giving this baby lots of skin to skin contact, let baby nuzzle and mouth at the breast whenever he/she wants and never force baby onto breast. This can be done in the bath, warm water washing over baby will make him.her think they are back inutero. It may take time, but don't use a bottle teat on the breast.
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