For years I have hated the red nipples ( and the blue ones) we used to
use in NICU. Both of these are high flow nipples and pour out the feeding
to the baby. I never understood the rationale for using them with preterm
infants who historically have difficulty coordinating suck/swallow/breath.
Yeah- you can get a ton of milk into a baby using these but if you observe
them during a feeding, most of these poor babies demonstrate significant
distress signals. Rapid flow nipples may often contribute to apnea or
bradycardia during feedings since these babies have to swallow frequently
to keep up with the volumn therefore decreasing the amount of time
available for breathing.  Thanks heavens we finally have trashed them out
of our system here. If we have a baby that requires a higher flow than
regular nipples we use a Haberman or a NUK. I prefer the Haberman since we
can adjust the flow to the babys cues ( the NUK is just a standard High
Flow)
 Another problem with these nipples (red and blue) is that they tend to
promote poor oral motor strength and with their shortened length, promote
inappropriate suckles due to inadequate contact between the tongue and
nipple. In most cases using a "term" nipple instead also helps fill the
oral cavity providing positional stability.
 I assume you baby is a term kiddo, recovering from being ill. If it's
already spitting up large volumns of EBM, I doubt a high flow nipple would
improve this.
IMHO I would suggest using a different technique to feed this baby via
bottle. I see more spit ups when we try and feed a breastbaby with a bottle
in the old fashioned manner- you know- put nipple in, let baby suck down a
half an ounce, burp, repeat. I have had better success permitting baby to
only take 2-3 suckles on the bottle , then removing it ( pause) reinsert
and remove again after 2-3 suckles. I have parents try and take at least 15-
20 minutes to feed 1-2 oz in the beginning and use the old reminder that
its like their mother told them- chew your food 20 times before you take
the next bite. For me , doing this, my mom's have less complaints of "pukey
babies". and  babies seem to transition better back to the breast. They
didn't get the "plunger affect" during feedings away from mom I guess.
Good luck-
Lisa Jones RN CLE IBCLC

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