Have you ever played Bingo at a baby shower? One of the first items I always remember to put on my card is “bottles”. What Mom HASN’T registered for bottles? Even Moms who plan to nurse will register for bottles, so that another caregiver can feed the baby on occasion. But, how can we POSSIBLY tell what kind of nipple this baby is going to be willing to drink from? When you are standing at the “Great Wall of Bottles” at the baby supply store, it can be overwhelming! And if you haven’t even met your baby yet, how can you possibly know what to purchase! Remember back to “When Baby Won’t Take a Bottle”…my Sarah refused the bottle altogether! I spent more money on bottles than I could afford, just trying different nipples out for her, until we finally found one.

So, that brings up the big question: How do we choose a nipple? I reached out to our staff Occupational Therapist, Lindsey White, OTR/L, for some advice… Here’s what she had to say:

Bottle Nipples

 First and foremost, it generally takes some trial and error to find a bottle nipple that works for each baby. The goal is to find a fit that results in the baby being able to achieve an efficient sucking pattern.

Some of the main things to consider with examples:

• size- long vs short
• shape- flat, traditional, orthodontic (bulb with flat part to rest on tongue)
• material- latex, silicone
• flow- preemie, slow, moderate, fast, variable flow (each brand is different, one brand’s slow may be faster than another’s)
• firm vs soft material

It is usually recommended to begin with a preemie or slow flow for newborns. As they get older and their suck becomes stronger, more efficient and they eat more you can try progressing to a faster flow nipple. Most packages will have general age recommendations, but families should not worry if their child is not following these guidelines- each child will be different. Fast flow is recommended for thickened formula or breast milk, and for a weak suck. Slow flow is usually recommended for babies who are having difficulty pacing, coughing, choking, leaking liquid.

Some of the common things to think about when considering nipple types that might help guide the decision:

•  fatigue- Is my baby becoming too tired to finish a bottle? Does it take longer than 20-30 minutes for my baby to finish a bottle? Maybe the flow is too slow or too fast, or maybe the nipple is not a good fit for your child to get a good cupping and stripping to efficiently suck (the actions our tongue make when sucking) and they are working too hard suck or working too hard to manage the liquid.

•  gagging- The nipple is likely too long, may try a short soft nipple or a broad flat nipple

•  coughing, choking, spitting- this usually is a sign that the flow is too fast and the baby is not able to coordinate a suck, swallow, breath pattern to manage well enough. May try a slower flow, medium-slow flow.

•  using thickened breast milk or formula- to enable the thicker liquid to come out with ease, the hole will need to be larger, so may want to try a cross cut or Y cut nipple, fast flow, firmer nipples.

The tricky part about choosing a nipple, is that it is finding the right combination of not only flow, but shape, size, firmness, etc. Parents should remember that it may take a few trials of nipples to find the right fit, and try not to become too stressed (I’m sure this is MUCH easier said than done). It is important to remember that babies will pick up on this stress and it can impact their feeding. We want the feedings to be a positive experience for the feeder and baby, a bonding time!

Also remember that there are other things we can do to help a child’s success with bottle feeding that are perhaps just as (if not more) important than finding the right nipple.

• Consider the environment and set-up. As children get older they become more aware of their surroundings and may get distracted more easily. We may need to feed in an environment with fewer distractions, try calming music, or singing a rhythmic song to help the suck, swallow, breath pattern.
• Some babies benefit from cheek and jaw support for just a little extra help to efficiently suck.
• Adequate positioning is also essential to remember when feeding little ones. We want them to be able to focus on sucking, swallowing and breathing, not worrying about holding their heads or sitting in the right spot- so we take care of that for them (at least while they are young).
• Others may benefit from a brief pre-bottle routine that includes oral preparation such as vibration to the mouth or nuk brush (with direction from a therapist), or even kisses to their cheeks and lips (probably the most fun way to prep the cheeks and mouth for caregivers). Just to get their mouths ready to work to eat.

I just LOVED her suggestions, and I hope that you can share with other Moms out there that are on the hunt for that perfect bottle nipple! What has your experience been with bottle feeding and nipple types? Please share! We love to hear from you! And thank you, Lindsey!

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