Lynn writes
<Interesting idea. I tend to favor the Avent (or other wide based
nipples) for
this reason as the "lips flanged around the base" instruction, forces a
deeper grasp and also *looks* much more like breast positioning. What do
you
think?
I don't like the nuk either.>

Phyllis writes:

<I prefer the 'Avent-like' broad based nipple also, if only it were
available in my hosp.

On the occasions I find myself offering a bottle, I count baby's suckles.
Usually after 6-10, I pull the nipple out of baby's mouth. Usually, he
gives a big sigh or gasp of air and relaxes. I watch & wait, then tickle
his lips a little. When he opens, I take that as saying, "I'm ready now",
and slip the nipple in. Again, I count suckles & pull the nipple out.
Same
breath, but not so big. Slowly, baby learns to suck-swallow-breathe, even
on the bottle. I do have baby sitting as upright as possible & snuggled
close to my body while feeding this way.>

I have only within the last year begun thinking this through more and
more. I try to encourage the parents who must use or choose to use a
bottle to rethink what the baby is experiencing. I especially encourage
them to explain this to any grandparents or caregivers (day care)
involved.

I try to help them see that "chugga-lugging" should not be interpreted as
evidence of hunger, but as evidence of fright in trying not to choke, and
that some research has shown that at least in premies, this stress can
even cause the heartrate to slow. I encourage them to listen to the baby
for noisy eating/breathing, watch his fists and face, etc. for fear and
tension.

I try to get them to think of the pattern the baby needs to experience to
mimic the normal flow pattern of the breast: or "Surge, trickle,
trickle", not "constant firehose, firehose, firehose".

I encourage them to have the baby as upright as possible, held as close
to the breast as possible, and choose a slow-flow, wide base nipple (of
their choice), and hold the bottle just so milk "tips into the nipple",
not suspended inches above the baby's mouth.

I recommend they start out allowing the baby only 4-5 sucks, listening to
the sound and speed of breathing/swallowing, then tip the bottle downward
to empty the nipple for a minute till the baby's relaxes his fists,
catches his breath, etc. then raise it a little, and repeat the process
several more times.

(Believe it or not, due to well-taught artificial nipple advertising
propaganda, they often wonder "But what if he gets air in his stomach by
not having the nipple full??" I tell them "the throat is normally
supposed to takes turns allowing air through the nose and liquid through
the mouth to go to the right places. Air in the lungs, and NO MILK in the
windpipe is more important than any small amount of air the baby may
swallow.")

I encourage them to avoid overfilling the baby's stomach by taking
frequent burping, diapering, dawdling breaks to cuddle and talk calmly to
the baby. That way, the first ounce or so is not totally consumed till
about 15-20 minutes goes by, so the first few drops has a chance to
digest, enter the blood stream and signal the brain it's feeling
satisfied.

I frequently stop at the baby gizmo counters in all kinds of stores to
peruse what new gimmicks they have dreamed up. I remember being impressed
at the "adaptation possibilities" of the Johnson & Johnson reusable
bottle with the slow flow nipple (not the disposable sack kind).

If I remember, this one has a large base, medium length rounded end
nipple, and I can see how the bent design, used in a different way than
the manufacturer explains, could be held sideways to allow the baby to be
rolled further inward toward the breast with barely enough gravity behind
the milk  to keep the nipple just full.

I have found that if I can persuade parents (and their significant
others) to accept this different way of thinking, some aversive feeding
habits can be avoided or reduced. Coupled with teaching moms to soften
the areola and trigger the MER a few minutes before offering the breast
to a calmed down baby, this approach has served to modify or even "cure"
nipple confusion, which I think, is often really largely flowrate
confusion.

Jean
*********
K. Jean Cotterman RNC, IBCLC
Dayton, Ohio, USA

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