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 *********************************************** The LACTNET mailing list is powered by L-Soft's renowned LISTSERV(R) list management software together with L-Soft's LSMTP(TM) mailer for lightning fast mail delivery. For more information, go to: http://www.lsoft.com/LISTSERV-powered.html