Whether by breast or bottle, nipple flow rate can make a big difference in an infant’s feeding success. Some babies may need to pull away from the nipple to take a breath break if the nipple flow is too fast; otherwise you may observe coughing, choking, gulping, or significant liquid loss down the baby’s chin. (Think about a time when you have chugged a liquid to quickly and needed to cough or take a breath break to protect your airway). Although we want efficient eaters, there is such a thing as too fast.

Breastfeeding Position

If your baby is showing signs of difficulty during breastfeeding, positional changes such as the laid back (also called down under) position can help a great deal. This type of position removes gravity as an additional milk speed factor and gives baby more control. Here’s a picture of this position from La Leche League International.

Laid Back Position – from La Leche League International For more information on positioning for breastfeeding visit https://www.llli.org/breastfeeding-info/positioning/

Bottle Position

When it comes to bottles, the milk tends to continue dripping (or shooting out) even when your baby has paused to take a breath break. The recommended bottle posture is holding the bottle as horizontal as possible with the teat still full of enough milk to avoid sucking air. The more a bottle is held vertically and upside down, the more of a funnel it becomes and is commonly an unconscious flow rate escalator. Position changes can also work for a bottle fed baby to slow the flow. However, a simple nipple change can also be effective without disrupting the cozy position you and baby have grown accustomed to.

Photo by Rainier Ridao on Unsplash

Comparing Nipples

Unfortunately, choosing a nipple based on the package label is more challenging than meets the eye. What’s the difference between a Dr. Brown’s Preemie bottle nipple and a Similac Premature nipple (other than shape and price)? How about a Playtex NaturaLatch 0-3m nipple and a Philips Avent Natural First Flow nipple? It turns out the nipple flow rate of milk through bottle nipples is not standardized between companies. A recent research study (by Pados, Park and Dodrill, 2019) compares the Medela Wide Base Slow flow nipple and Similac Slow nipple. The study found that the rate differs by 13.99mL per minute despite the label titling them both “slow flow” nipples. That equates to over 2 ounces in 5 minutes!

(This does not guarantee that a baby will take the study equivalent. Baby’s speed and suction may differ from the breast pump used in this study and babies will often adjust both according to flow rate.)

Signs of Struggle

Perhaps surprisingly, faster nipple flow – whether breastfeeding or bottle feeding – does not always equate to larger intake volumes. It’s important to watch out for signs of difficulty during any mode of feeding such as: coughing, choking, watery eyes, change in vocal quality, respiratory difficulty, etc. If you notice any of these and recently switched bottle brands, the flow rate may have significantly changed. Simply returning to a slower nipple flow may resolve the issue. If these signs are chronic, let your doctor know. A referral to a speech language pathologist who specializes in feeding could be warranted.

By: Barbara Hancock, M.A. CCC-SLP, CLC, CBS Barbara is a speech-language pathologist for a pediatric hospital where she primarily treats infants and children with feeding disorders. This career choice makes sense, because for her, food is one of the best simple pleasures, medicine, and promoter of social connectivity available. She believes that feeding a child is more than just calories and that those connected moments stay with us forever. She strives to provide research and facts regarding the gold standard, but never chooses for a family because the parents always know their child best (even on day one).

Reference: Pados, B., Park, J. and Dodrill, P. (2019). Know the Flow. Advances in Neonatal Care, 19(1), pp.32-41.