Great question, Betsy. I hope lots of folks respond. My take on bottles &
nipples is that it's not so much the nipple, but the rate of flow, that
screws up the breastfeeding when a bottle is introduced. YMMV. I try to
teach all the parents, including the bottle-feeding ones, the paced feeding
techniques. One effective demonstration is to take the formula bottle, hold
it upside down over the sink, and show the parents how the liquid drips out.
I do this in home visits in my private practice, also.  Even the touted
'slow flow' nipples still drip quickly.  When supplementing is warranted in
the hospital, and mom has no expressible colostrum, I really encourage as
small a supplement as we can get away with.  Talking about the
physiologically normal amounts for intake days 1 through 5 sometimes helps
as well. Of course, you always run into the moms bragging that their one day
old just swilled down 2 oz of formula. Cringe. Like the poor kid had any
choice:-(

If you need refs, try Wolf, LS & Glass, RP. Feeding and swallowing disorders
in infancy: Assessment and Management. Tuscon, AZ: Therapy Skill Builders,
1992).
Barbara Wilson-Clay has also written on this extensively; you could check
the archives or her and Kay Hoover's Breastfeeding Atlas. Austin, TX:
Lactnews Press, 2002).

No financial interest in either, btw:-)

Warmly,

Anna Swisher, MBA, IBCLC
Abundant Blessings
Austin, TX

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