I recently had an upsetting experience at work, and wondered your opinions.
When bottle feeding, how do you go about choosing a nipple type? For example, for a premature baby, I prefer to try and use a slow flow nipple. For a baby that is breastfeeding at times, I prefer to bottle feed with a slow flow nipple.
I recently cared for an ex 25 weeker corrected to 42 weeks on 2 liters of oxygen, bottle feeding six times a day when her respiratory rate was less than 70. She had an echo four days prior that showed mild pulmonary hypertension. The night nurse told me the baby spilled milk out of her mouth the entire feed and the feed was a struggle with the baby arching and crying. I decided I wanted to try and feed this baby with a slow flow nipple in an elevated side lying position. However, the baby had a physician order stating only a standard nipple was to be used. When the speech language pathologist arrived, I explained my concerns to her stating I was concerned the baby could be aspirating (since she clearly couldn't handle the milk flow as evidenced by her spilling the milk out the front and sides of her mouth while eating. The SLP stated that if she was spilled the milk out of her mouth, she was not aspirating it. She told me she was more concerned with the baby's pulmonary hypertension being exacerbated due to "having to work harder to get the milk out with the slow flow" than potential aspiration from the standard flow nipple. It should also be shared that this SLP covers the entire adult hospital and RARELY comes into the NICU. I think I have seen her twice now in over four years working in this NICU. She also told me it was a myth that using a slow flow nipple will help a baby transition to breastfeeding in the future.
I'm curious. What do y'all think? Do y'all use slow flow nipples? Would you have been concerned about aspiration and potential pulmonary hypertension exacerbation? Do you think it's odd to have a physician order stating you cannot use a slow flow nipple? Thank you for your input!
