The July/August 2016 issue of MCN: The American Journal of Maternal/Child Nursing presents an eye-opening study testing the milk flow rates and variability in flow rates of bottle nipples used after hospital discharge. As many of you can probably substantiate, infants who are fed by bottle early on can prefer the faster flow that takes less effort on their part. This action can then lead to mothers not meeting their own self-set breastfeeding goals. Here in the US, a large majority of new mothers must return to outside employment after delivery, some as early as 2 weeks and most by 3 months.
Authors Pados, Park, Thoyre, Estrem, and Nix set out to research milk flow rates, that is, the rate at which "milk moves from the bottle nipple into the infant's mouth during bottle-feeding" (p 237). Faster slow has been shown to interrupt the respiratory process during feeding, and has the potential for aspiration of liquid by the infant. "As milk flow increases, the rate of swallowing must increase, and therefore, the degree of respiratory interruption increases" (p 238). Many infants try to compensate for this too-fast flow by elevating the posterior tongue and pushing the milk out of their mouths. Those babies can quickly figure out how to compress the bottle nipple between either their gums or the tongue and upper palate, effectively stopping or greatly slowing the flow to allow for breathing. This biting behavior has the potential to be used at the breast also, which is non-productive for infant milk transfer, and painful for the mother.
"Medically fragile infants, such as those born preterm, with congenital heart disease, neurologic impairment, or other medical needs that require hospitalization beyond the typical postpartum hospitalization, must achieve a certain proficiency in oral feeding skill...using hospital acquired nipples (e.g., Similac or Enfamil brand)...[which] are not easily accessible by parents for use after hospital discharge" (p 238).
Pados, et al., tested various bottle nipples, representing 15 common (US) brands as well as price and availability. Using an over-the-counter electric breast pump, they produced an average negative pressure of 110 mmHg to draw artificial infant milk through each of the nipples . The eye-opening results may be cause for concern, as they found a variance from the slowest flow of 1.68 mL/min to 85.34 mL/min! I literally gasped aloud at that last figure...that is almost 3 full ounces in 1 minute. The baby will feel like he's drowning! Even one commonly used premie brand nipple poured close to 10 mL/min.
"Nipples for this study were purposefully chosen to reflect variation in price per nipple and store locations sold in order to make these findings useful to parents of varying socioeconomic status. Clinicians caring for fragile infants can use this information to guide parents in selecting a nipple for use at home that will be supportive of the safety and success of the infant's oral feeding" (p 242).
I feel this study reinforces what the Baby-Friendly Hospital Initiative emphasizes...that bottles should be the last choice for supplementation of the breastfed infant. You might want to locate and copy this article for teaching purposes.
Kathy Parkes, MSN-Ed, BSPsy, RN, IBCLC, RLC, FILCA
Professional Development Educator, Step 2 Education International
Pados, B. F., Park, J., Thoyre, S. M., Estrem, H., and Nix, W.B. (2016). Milk flow rates from bottle nipples used after hospital discharge. MCN 41(4): 237-243.
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