What nipple do you use for thickened formula

katierobin23 · Oct 15, 2013

We used to do that, but it was decided that it was too inconsistent and dangerous, so we switched to the avent with the variable flow nipple. It works well because some babies do better with the thickened milk than others, so it's easily customizable. I think it's really messy and most babies don't get the greatest latch, but it works. We've also used Dr. Brown's if the parents bring it in and want us to try it. It works okay, but the milk gets stuck on the vent tube some.

NicuGal, MSN, RN · Oct 15, 2013

We use the cross cut nipple. It's not safe to cut the regular nipple. Our OT will occasionally try the Advent if the parents bring them in but they like the cross cut too.

RainDreamer, BSN, RN · Oct 19, 2013

We don't thicken breast milk. With thickened formula we use a fast flow or a crosscut. We also use the VentAire bottles for thickened feedings, as it doesn't take as much work to bring down the formula .... works great!

notsosupernurse · Oct 25, 2013

Although I am new to the NICU, I can say that I have observed the cross cut being used with formula thickened with rice cereal to prevent further reflux on a particular baby. I also observed nurses and speech therapy using a razor to cross cut the slow flow nipple or cutting the cross cut nipple a little further for this particular baby who had a very high palate from being vented for so long in the past. I know you say that the practice seems outdated and dangerous, but seemed necessary for this particular baby. It was what got her to complete the PO feeds independently without the NGT and a faster discharge. So maybe this particular practice should be used on an individual basis.

NicuGal, MSN, RN · Oct 25, 2013

The thing is that if you do this, teach the parent to do this at home you could be liable if say they cut the hole too big and the baby aspirates. This is why we are no longer allowed to cut them, years ago we did teach parents this and it came back to bite us in the butt. The parents files suit 10 years later after someone told this was not an appropriate intervention. Sure enough, nothing in our protocol to back it up, hospital settled.

notsosupernurse · Oct 25, 2013

Wow, that's a good point. I wonder why the nurses and speech therapy continue to even do such a practice....

milkglass · Dec 11, 2013

Our unit also uses a cross-cut (can't think of the brand except it's not Similac like our other nipples). We also use a scalpel or scissors to cut the cross cut or regular nipple open wider. We taught this all the time and naturally someone pointed out that it is inconsistent (which I agree with) so we got an email saying "stop doing this" with no actual solution. We don't cross-cut the nipple for the heck of it, it's because the thickened feed won't come out otherwise! So most nurses have continued cutting it, because the current nipple as-is simply does not work.

I haven't heard of this advent bottle. Do your hospitals stock it? Is it the type that if you turn the nipple, the size of the hole changes?

Also, I spoke with a Similac rep about this issue who said they have a "spit-up" formula that is the same consistency of regular formula so it can go through a normal nipple, but thickens once it hits the stomach. Does anyone use this formula yet?

NicuGal, MSN, RN · Dec 11, 2013

We have used that formula but it doesn't work as well as rice. And the parents have to bring in anything that is not our normal bottle/nipple stock .

milkglass · Dec 13, 2013

NicuGal, what brand is your cross-cut? Your thickened formula actually passes through it fine without altering?

Our brand is Enfamil. I've tried even a 1/2 tsp per ounce of oatmeal or rice and it still gets clogged. We usually give babies 1-2 tsp per ounce.

NicuGal, MSN, RN · Dec 13, 2013

Ours are Enfamil. We haven't had issues with the rice, we don't use oatmeal. We don't alter the nipples because you shouldn't be showing the parents how to do that for liability reasons.

A lot of parents will bring in nipples that are for older babies as the holes are bigger and flow faster.

katierobin23 · Dec 13, 2013

Yeah, the hospital stocks the Avents. It has three settings, the one that is pointing to the baby's nose is the one it's "on". I is the slowest, II is medium, and III is fastest. We also use 3-hole and 4-hole nipples for breastmilk because they are slower than the variable on I (since MBM doesn't thicken as well).

This is the one we have, in the 5 ounce size.

http://m.usa.philips.com/m/avent-baby-bottle-feeding/1-classic-11oz-variable-flow-nipple-scf686_17/prd/en/

We have the "spit up" formula too, ours is Enfamil AR...I agree with NicuGal that it doesn't work as well. I don't see it used very often. The other consideration with it is that it's a full-term 20 cal formula, and most babies in my unit are on premature 22-24 cal which means we have to mix it differently (and no pre filled bottles)...could lead to mistakes.