>>  ...Although the flow rate of the Enfamil green ring nipple was slower by a few mls compared to the newborn (blue ring) and  the Similac newborn, some of the nipples did not flow at all (quality of disposable nipples isn't so great) and, when Karen Gromada and I did some preliminary videotaping with real babies, we found that the flow may still be too fast.  Some of the LCs in our hospital have gotten more positive feedback about babies being able to handle the flow rate better than with the newborn nipples, but this is not enough to base whether or not they are truly acceptable or safe. >>


I'd like to add a few additional comments to Lisa's... 
Being slower by a few mls/min can make a significant difference in terms of the bolus an infant receives and must coordinate with each suck. Not long after a RN procured several green-rings for us to test on the breast pump, a few boxe of said rings showed up at our office door. In addition to other strategies we gave several to various BF moms whose babies were having difficulty BF and who chose bottle-feeding to supplement with EBM or formula. (Probably in most cases these were for near-term newborns.) These parents are also taught a technique* for feeding that gives baby more control of the bolus and better reinforces BF behaviors. 

I was stunned when several parents within a few-day period asked if we could get them more green-rings because, per these parents, their babies did better with/demonstrated fewer signs of distress during feeding, these versus the "regular" ones provided. (Initially, the RNs did not know where we kept the green-rings.) I can't remember a parent ever requesting a particular bottle nipple previously -- even when given different ones to try. 

That said, the milk transfer results with this nipple via the breast-pump testing was still a few mls/min higher than for the few commercial brand nipples we now offer as a suggestion for post-discharge (if still having to supplement) -- based on the milk transfer testing and then parent feedback and now a few video clips. The baby we filmed using this nipple -- a clip that didn't make the presentation due to my pathetic skills re: cinematography -- had a horrible time controlling the bolus and became very distresed when using this nipple. 

So, is it "the best of the worst" re: in-hospital disposeable feeding bottle nipples? Would have to say the jury is still out. Reading the baby and not the bottle-nipple is still key.

* Re: Technique for bottle-feeding -- I'm going to confess I'm not a fan of the term "paced feeding" in the context we tend to use it with infants. It's a term used by other disciplines and for them it has a somewhat different connotation re: who "controls" the "pacing" -- therapist vs. infant. In reading other discipline lit, the therapist generally refers to pacing as something the therapist does for the sake of the infant. In some LC lit or film clips, I've gotten the same impression -- that the LC is controlling the pacing vs. the infant. (In film clips, I've watched the babies for signs/cues re: distress and don't always see, and it wasn't mentioned, as the reason to impose a break/pause in feeding.) 

I propose finding a different term, e.g. cue-based feeding/bottle-feeding or physiological feeding/bottle-feeding -- something that places emphasis on the infant's right to be the one to control his/her own feeding...

Karen G

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