What kind of bottle nipples do you use?

elizabells, BSN, RN · Nov 14, 2008

Depending on whether it's Enfamil or Similac time, we use their standard and slow-flow nipples. Generally preemies and cardiacs get a slow-flow until they can handle the standard. We also always have Nuk orthodontic nipples around. Our feeding specialist carries a few of the more specialized ones around with her for the problem kids.

preemie69 · Nov 14, 2008

Does everyone use disposable nipples or do you have parents bring in their own?

elizabells, BSN, RN · Nov 14, 2008

We never have parents bring in their own. Sometimes the feeding specialist will bring out a Dr Brown's, and we wash and reuse that bottle/nipple. Also if she gives us any of her special nipples, we'll reuse it. But for the most part, we toss 'em.

iyqyqr · Nov 14, 2008

Dear Preemie69,

Our unit struggles with this aspect of care, also, and I so wish their was more EBP research on the topic!! According to our feeding protocol we are to try to breast/tube feed only for breast babies in order for them to learn one method of sucking (how one sucks breast/bottle nipple differs). This rarely occurs unless parents are adamant and want this because parents are told that bottle feedings will get their baby home sooner. Once bottle feedings are instituted for breast babies we are to use the Othodontic NUK nipple first, however, in mine and many other nurses' experience 32-36 weekers can not exert enough suction to get milk out of that nipple. So many are put on the slow flow which nurses love because the babies feed faster on it. Problem is that our LC's then see babies who were doing well at breast do poorly, despite high volume of milk supply. We seem to be caught between what is best outcome, which should be baby fully fed at breast at home, and the need for all nipple feeds to get baby discharged ASAP for insurance.

I and other experienced staffers plan of care for breast babies is to encourage breast/gavage only for as long as possible. If we must bottle

feed we use the slow-flow, but keep trying the NUK as baby matures to better develop his sucking muscles. We want to discharge baby on NUK/breast with a clear plan for mom on how to wean off pumping/supplementing to full breast feeds. (Once breastfeeding is well established I truly believe that a baby can handle almost any type nipple that mom wants to use. Our only options in our unit are straight yellow and NUK.)

For formula feeders we use slow flow nipples when feedings are begun for preemies and then progress them to straight yellow nipples as their SSB normalizes and matures. We start straight yellow nipples for 36 week and beyond and use it unless they indicate to us that flow is too fast.

I do believe that there is a place for slowflow nipples, but I need to see the evidence that all babies whether hospitalized or at home require them.

The Nov/Dec Neonatal Network has an excellent article on feeding plans that you may find helpful. :yeah:

MegNeoNurse · Nov 14, 2008

Similac nipples - Regular Flow, Slow Flow

Pigeon nipples for the CL/CP babies.

Speech therapy will cross cut nipples for kids that need them, they use the regular flows for that.

In my vast experience in the nicu (haha i graduated in May '08) I've only seen parents bring nipples in once. It was a big chronic baby that was CGA 5 months and had big issues with eating, swallowing, aspirating, etc. They were so frustrated with everything they bought this Dr. Brown's system and some special sterilizer, and of course their little girl still arched, screamed, pitched a fit and would not PO feed. Very sad, and a waste of money apparently.

littleneoRN · Nov 15, 2008

We never use the straight yellow fast flow nipple. We generally use the Gerber slow flow nipple, which is designed for newborns 0-3 months of age. We also stock the medium flow nipple, so that if an infant has difficulty transferring milk with the slow flow, we have another option. However, this isn't really age-appropriate for even full-term newborns because it is designed for infants 3-6 months old. I feel like it increases the choking risk on kids who are already higher risk. In addition, with the medium flow nipple, less effort is required for "the reward" as compared to breast feeding, which can make transitioning between the two more difficult. In my mind there is no such thing as nipple confusion, but there can be preference and impatience if infants have become accustomed to a faster easier flow. We also stock NUKs but rarely use them. Parents sometimes bring in Dr. Brown or other special systems, but that's relatively uncommon. We wash all our nipples with warm water and Ivory and then reuse them.