I have studied this myself, conducted my own experiments. Flow rate is based also on the compressibility of the bottle teat and it's tendency to encourage that. Harder bottle nipples encourage compression and flow more rapidly. Softer ones collapse with compression and do better with suction. The average baby sucks at about 160 mmhg according to Hartmann research group on the breast. You put that much suction on most bottles and they will flow very rapidly-much faster than a breast. Also, teat holes enlarge with time. That's why it is hard to strictly recommend a brand of bottle nipple, and there is much variablity from teat to teat within a brand. It's a tough subject!
-----Original Message-----
From: Lactation Information and Discussion [mailto:[log in to unmask]] On Behalf Of Amy Peterson, BS, IBCLC
Sent: Tuesday, January 11, 2011 3:13 PM
Subject: Re: Favorite resource/handout for paced bottle feeding?
Hi, ladies.
I have read the various links to paced bottle-feeds. There are a few critical pieces of info missing that we need to share with moms rather than just sending them to an incomplete link.
First, a wide neck nipple isn't best for every baby. Sometimes a baby will just latch onto the nipple length, so the baby appears to be sucking a straw. This shape is an "abrupt transition," basically a 90 degree angle where the length of the nipple meets the base. (specifically, I'm thinking of the Avent or wide Dr. Browns or Playtex drop-in--these have abrupt transitions where many young babies will be unable to grasp the base) Different terminology would be choose a nipple with a gradual transition from tip to base, so the baby's mouth naturally opens wider as the nipple is drawn in deeper.
Next, babies should swallow and breathe as they do at the breast. One link mentioned pausing to let the baby breathe after 5 swallows--yikes. If the nipple is slow enough, the baby will have 1:1 swallowing, sometimes even 2-3 sucks per swallow (with normal breathing).
Pacing should match the suck-burst-cycle that naturally occurs at the breast. With the first let down, I usually see 20-25 swallows before a pause. *This* is what needs to be replicated with the bottle. As a feed goes on, suck-burst-cycles decrease. In my experience, once a healthy baby gets the hang of a nipple that is the correct flow, they will actually pace themselves, and usually pacing isn't required.
Lastly, I have formally studied the flow rate of 26 bottle nipples marketed as slow-flow. Between brands, one slow flow nipple flowed eleven (11) times faster than the slowest slow flow brand. Wow! And these are both marketed as slow flow. Appendix C of Balancing Breast and Bottle: Reaching Your Breastfeeding Goals lists the slow-flow nipples studied from slowest to fastest flow. (disclosure--I am co-author, but share the info on list because the posed question has an answer)
Warmly,
Amy Peterson, BS, IBCLC
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