I love the web site lowmilksupply.org EXCEPT for its bottle-feeding info re:
teats/nipples. Please look at the age of the references on that page -- all
are way out of date and many of the products no longer exist. The flow rate
testing that a colleague and I did on a number of (labeled) slow-flow
teats/nipples within the last 2-5 years found that some of the teats/nipples
cited on that page as meeting certain criteria had too-fast-flow and one in
the "NOT" category was within the flow parameters we determined based on
data of typical milk transfer time during breastfeeding. However, even the
fairly recent flow rate testing data that we collected may already be out of
date for some or all of the teats/nipples tested! Unfortunately, there are
no standards for labeling teat/nipple flow rate, which means companies can
label their products any way they choose. "Slow flow" may simply mean slower
than the next level in that particular brand's teat/nipple hierarchy. A
teat/nipple that tests appropriately one year may not the next -- companies
are always wanting to "improve" or "update" a brand so may change the size
of the flow hole in a teat/nipple or may change teat manufacturers who make
changes.

There's little data that anything other than flow rate -- not teat shape,
length, material, etc -- affect suck-swallow. (A SLP-IBCLC colleague is not
a fan of orthodontic nipples due to their collapsibility, which interferes
with tongue grooving as well as flow but finds they may be useful for a few
special oral situations.) There's a fair amount of lit that flow rate
affects suck-swallow and we only have to think of ourselves the oral
adaptations each of us has to make when flow rate is too fast to understand
why that's so... (Doubt any of us want to be in a horizontal position when
drinking liquids either, yet how often are babies fed -- breast or bottle --
while horizontal?!)

Rather than depend on packaging or old data READ the baby -- not the
literature! The baby tells us if the flow is too fast (or too slow -- a
rarity)... Evidence-based obvious signs of flow rate distress include the
expected -- sputtering, coughing, choking, gagging... More subtle distress
cues include excessive drooling (a lowering of oral tone to lose some of the
bolus), clenching/biting on the teat/nipple, aversive body language --
(trying to) turn head away, use of arms to bat bottle away, etc or nasal
flaring (which can be a later cue, more of a problem yet more difficult for
parents to pick up on).

Personally, I'm not a fan of the term "paced" bottle-feeding, because the
term is used by other disciplines and usually refers to clinician-driven or
external pacing. If we're reading the baby, which I'd hope we would be, it's
more cue-related or infant-based or internal pacing.

Bottle-feeding while baby in the side-lying position is mainly used here for
preterm infants who have more respiratory issues during bottle-feeding and
more difficulty adapting to feeding-bottle flow rate -- side-lying allows
these babies to more easily get rid of too much bolus. Generally, a
full-term baby can adapt without side-lying when her/his head is
significantly higher than hips.

Swallowing and breathing always compete so feeding is always an airway
issue. IMO, all babies -- no matter how fed -- deserve a safe airway. There
are very, very few feeding-bottle teats/nipples labeled "slow flow" that
actually are, but those that are slow flow seem to be associated with fewer
reports of flow-rate distress behaviors, reflux, aversive body language,
etc. Most babies eventually adapt (or maladapt) to flow, but at what cost to
oral development, GI or respiratory health, emotional development, etc?

Karen G (stepping off one of her soapboxes)

On Tue, Jan 11, 2011 at 4:33 PM, LACTNET automatic digest system <
[log in to unmask]> wrote:

>
> Date:    Tue, 11 Jan 2011 15:27:22 EST
> From:    [log in to unmask]
> Subject: Re: Favorite resource/handout for paced bottle feeding?
>
> Re:  Favorite resource/handout for paced bottle feeding?
>
> There are some nice handouts out there, but it seems like only the website
> Lowmilksupply.org has a link that clarifies one important concept:
>
> All the  handouts say use a slow flow teat/artificial nipple, but many
> parents choose  "slow flow" based on the bottle's literature sayings it is
> slow,
> but  in reality, the flow is not slow. It may be slower than the same
> company's  other nipples ( like the newborn may be slower than the 3 month
> version) but  it still may not actually be slow. And often the most popular
> brands, and the  ones the hospitals send moms home with, are actually the
> worst
> choices. Also,  I noticed on a follow-up that a mom had switched back to
> the
> faster flowing  nipple ( and her baby was spitting up and her feeding
> skills
> were going  downhill) because "it looks just like the other one." It did
> kind of look  like it, but it sure did not function like it.
> Now maybe we are loathe to actually put into print the names of brands, so
> we don't seem to be recommending a product that  could undermine
> breastfeeding, but parents do need guidance, in my  opinion. This may be a
> debatable
> point, I understand, since I know  well-regarded IBCLCs who never discuss
> paced bottlefeeding at all, and  certainly don't discuss how best to
> accomplish
> it.
>
> Just some thoughts,
> Peace,
> Judy
>
>
>
>


-- 
Karen Gromada
www.karengromada.com/

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