Bottle Nipple Sizing for the Breastfed Baby
You will see on social media comments from people that read like badges of honor that they never needed to use anything but a preemie flow nipple until their child was weaned from bottles at a year. Is that the right thing to do? What do you need to know about nipple size for bottle feeding?
Choosing the right nipple size is essential to helping your baby comfortably eat from a bottle as well as preventing flow preference in the baby who is both nursing and bottle feeding. Most of the advice out there is aimed at helping parents of very young babies safely bottle feed by saying choose the slowest flow of nipple.
So, do you never need to change nipples with a breastfed baby?
We recommend the slowest flow bottle nipple to start with in order to make sure your baby can adequately cope with the milk flow as they do not have much control over bottle feeding. Many bottle brands’ versions of “slow flow” nipples are actually still really fast, so recommendations for a preemie nipple or ultra slow flow are often made.
If your baby is doing fine with the preemie or slow flow nipple over time, there is no particularly compelling reason that you would need to size up.
Doing well in this context would mean baby…
happily accepts the bottle.
finishes appropriately sized feedings.
doesn’t cause the bottle nipple to collapse.
is latched properly to the bottle with cheeks not collapsing in.
Some babies will need a higher flow nipple as they grow to accommodate the suction they generate when feeding. This is not a concern for a breastfed baby as it is stepped up based on baby’s behaviors, not simply by age. Paced feeding principles can still be used with an older baby even with a higher flow nipple. The goal of paced feeding is to extend the feeding until baby can determine if they are full, and slow flow nipples help with that, but they may not be right for an older baby.
Pro tip: Vented bottles like the Dr. Brown’s Originals may prevent nipple collapse with slower flow bottles with older babies, and they may be a great solution to managing baby’s needs at the bottle while preserving a nursing relationship.
Signs you may want to consider sizing up:
Baby is suddenly not finishing the bottle but is hungry again very shortly after. A nipple that is too slow is like sucking a milkshake through a straw and may fatigue the baby quickly.
The bottle nipple is collapsing as the baby’s suction is too strong for the ability of the milk to flow. If this is happening with a baby younger than 3 months, reach out to a skilled IBCLC, this could be a sign of oral restrictions generating excessive suction.
Baby is making an adorable fishy face at the bottle. Totally charming - not at all a good sign for a bottle feed. I frequently have seen this with parents using a preemie or size 1 nipple with a much older baby where they fear the bottle nipple size will doom the breastfeeding relationship. If this is happening, we either need to size up or change bottle styles. This is again when a skilled IBCLC comes in quite handy.
Bottle feeding that supports breastfeeding involves being as responsive to the baby’s needs with a bottle as we are at the breast. With careful management and consideration of baby’s feeding habits and oral abilities, we can easily maintain a breastfeeding relationship long term while using the bottle to meet baby’s feeding needs outside of nursing.
If you need help with bottle feeding and breastfeeding, book a consultation today! You will walk away feeling more confident in your abilities to support breastfeeding and bottle feeding and know that your baby is being well fed!
