Choosing A Bottle For Your Baby
With so many bottles on the market, and a thousand opinions on the internet, it’s hard to know where to start when considering what bottle you will use. Especially when you’re a new parent, a parent to a preemie, a breastfeeding mom who’s is concerned about introducing bottles, or already knee deep in feeding difficulties.
As a certifed neonatal therapist who specializes in infant feeding, it’s my job to know how to help parents choose the right bottle for their baby.
Here I will outline all the things I consider when educating parents on bottles and how they impact feeding.
Nipple Flow Rate
Although “flows” are labeled on the packaging, this doesn’t always accurately represent the true flow.
Companies market their products to sell. So even though a brands “slow, newborn, preemie, or breast like” might actually be the slowest nipple they offer, compared to another brand, it could be way faster. This is important to know, because this is one of the main things that should be considered when choosing a bottle. When we give a baby a flow that is too fast, it requires more energy to eat, they have to swallow more rapidly which means less time to breathe, and they may alter their sucking patterns in an effort to slow the flow. Some healthy full term infants might be able to handle any flow you provide, but most babies, especially those who are breastfeeding, will benefit from a true slower flowing nipple.
What happens when a nipple flows too fast?
Well, research has shown that faster flow nipples may cause infants to swallow more rapidly to protect their fragile airway. (Imagine laying back and trying to chug a gallon of milk with your mouth around the whole opening. ) This can lead to incoordination of their suck-swallow-breathe pattern, and it can increase the risk for choking on their milk. This can also cause an infant to use abnormal sucking strategies, such as compression only sucking (chewing on the nipple), or spilling of milk, to help slow the flow.
Do slower flow nipples make it harder to suck?
No. Somewhere along the line, before there was research being done on infant feeding, people thought that when babies couldn’t eat enough to gain weight it was because they had weak muscles and it was too hard to suck milk from a bottle. This resulted in creation of fast flowing nipples for preemies “to make it easier to suck.” This mentality DID NOT take into account the impact flow of milk would have on breathing.
Research has shown that slower flow nipples do NOT require more suction and they will not make your baby more tired. They just deliver a smaller amount of milk with each suck, essentially giving your baby a “smaller bite of food,” so they can learn how to manage the milk in their mouth and learn to breathe at the right time. Breathing easier will help babies to use less energy and stay awake longer.
This is especially important for new feeders!
Nipple Shape
I recommend to families I work with to choose a round nipple shape because it encourages correct oral motor patterns such as tongue cupping/ with nipple stripping which promotes oral motor development and more efficient feeding. Using a flat nipple promotes a baby to use a flat tongue, which is an atypical oral motor patterns, and may also make it more difficult to extract milk.
You can choose a wide or narrow bottle and either will be fine, even if you are breastfeeding. However, you want to be sure baby has their lips flanged, with a 360 degree seal wide part of the nipple.
Venting systems
A bottle with a venting system can be a really great tool for the baby who is struggling to eat because venting systems help the flow of milk to remain at a constant speed. When a bottle is properly vented there will not be any negative pressure build up inside the bottle. This is important because when a bottle isn’t vented properly in some way, it can make it progressively harder to withdraw milk with each suck. This might make your baby tired and cause difficulty even more difficulty for a baby who is just learning to eat. A vent can also decrease air intake, making for a more comfortable feed and less gas.
Common Myths
Breastfeeding is harder.
This is not true. In fact, although for some, breastfeeding may not have an easy start, once it’s established, it’s often easier for a baby. The difference is that baby controls the breast, and caregivers control the bottle. When a baby is bottle feeding, especially in a laid back position, gravity will cause milk to flow no matter what. This will cause an infant to swallow repeatedly in order to maintain a clear airway, possibly making it harder it even preventing the ability to stop and breathe. This can lead to large amounts of milk and air intake at one time. It may look like and infant is doing better, but they might actually be passively feeding or even struggling to keep up and breathe.
When at the breast, baby has complete control over when they drink and when they don’t because they are bringing milk into their mouth with each suck. The only time milk may flow a little faster would be during a let down, and at the begging vs the end of the feed.
Using a co regulated feeding approach with the bottle can help to give control baby to baby and make it more like breastfeeding.
Nipple confusion
It may not be nipple confusion at all but rather, flow confusion.
When an infant is fed on a bottle that is faster flowing than their mothers breast, this can make it difficult to switch between the two successfully. This is because with faster flows, infants may alter they way the suck to help slow the flow so they can breathe easier. These new sucking patterns may be less effective on the breast, or even painful. When the flow rate of the breast and bottle match as close as possible, this can help an infant to transition between the two because they will use a similar sucking pattern on both bottle and breast.
If you plan to bottle feed when you return to work, Its a good idea to introduce the bottle at about 4-6 weeks at least 1x a day. This can help baby learn and become used to the bottle, reducing the likelihood of bottle refusal later.
Here are my most recommended bottles for new parents and preemie babies.
Dr. Browns Preemie/ Dr.Browns Preemie Wide/ Dr. Browns Transition Nipple
Advent NATURAL No Drip “1”/ Advent NATURAL Level “2”
Even Flow Balance Bottle - Slow Flow- Term baby
Feeding Red flags!
*If you observe your infant doing any of the following, they may need a slower flow nipple. If your child continues to have difficulty feeding from a bottle, has difficulty transitioning to a bottle once home from the NICU, or is unable to complete full feeds, you should immediately discuss with your child’s pediatrician to request a feeding evaluation from an Occupational or Speech Therapist who is knowledgeable in infant feeding.
Coughing/Choking
Inability to finish amount needed for weight gain
Excessive Gulping/Hard swallows
Gasping for breath
Excessive Spilling of milk
If your child is receiving therapy, please continue to follow the recommendations of your child’s therapist.
I hope these tips helped you to understand a little more about bottles and feeling confident in knowing how to choose the best bottle for your baby!
References
Eishima, K. (1991). The analysis of sucking behaviour in newborn infants. Early Human Development, 27(3), 163–173. doi: 10.1016/0378-3782(91)90192-6
Fucil, S., Gisel, E., Schanler, R. J., & Lau, C. (2009). A Controlled-flow Vacuum-free Bottle System Enhances Preterm Infants’ Nutritive Sucking Skills. Dysphagia, 24, 145–151. doi: 0.1007/s00455-008-9182-z
Pados, B. F., Park, J., & Dodrill, P. (2019). Know the Flow. Advances in Neonatal Care, 19(1), 32–41. doi: 10.1097/anc.0000000000000538
Ross, E., & Fuhrman, L. (2015). Supporting Oral feeding skills Through bottle selection. Perspectives on Swallowing and Swallowing Disorders, 24
*Disclaimer: All content and information on this website is for informational and educational purposes only. It does not constitute medical or therapeutic advice, does not replace any therapeutic intervention, and does not establish any kind of client-therapist relationship by your use of this website. These opinions are my own. I’m not receiving any compensation for products mentioned