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Writer's pictureCrystelLatchIBCLC

Combination Feeding: Which bottle to choose?

When it comes to bottle feeding a breast-fed infant does it matter what bottle we choose? Yes!

Does it matter the flow of the nipple? Yes!


So, what do we choose? We choose a bottle with a nice long nipple to stimulate the back of the palate, a nipple that creates a nice wide jaw opening, and a super slow flow similar to mom.


What bottles have a long nipple, a gradual slope, and a slow flow?

Theres several that meet this criteria. You'll see IBCLC's talk about these bottles in particular:

  1. Pigeon- nice long nipple, beautiful gradual slope, ss flow is very similar to the breast. Keeps the jaw nice and wide open.

  2. Evenflo wide- Very similar to pigeon. Slightly different tip of the nipple is smaller than the rest of the nipple with a gradual slope. SS flow is the same as preemie rate, which we compare closely to the rate of the human breast flow.

  3. Dr.Browns slim neck- Nice long nipple, slightly open jaw about 30 degrees ( we would like 140 degrees) and has more nipple sizes than you can dream of thanks to the frequent use in the NICU's across the country. I like to offer preemie nipples for Dr.Browns as long as the tongue is working appropriately the feed should take around 20-25 minutes.


    Bottles that I am NOT a fan of:

    1. Wide base bottles with a short nipple and no ability to keep the jaw open. I cannot say which bottles these include but it's basically every single wide base bottle on the market except pigeon and evenflo.


      The short nipple encourages the infant to keep the nipple right behind their gums and encourages a friction rub on the tip of the tongue on the nipples. They bite with their gums to hold on and flick the nipple for milk flow.


    2. Long nipples encourage the tongue to come down and out and use tongue elevation and cupping to create suction to pull the milk out. Of course much less stimulation is required at the bottle compared to the breast. Breastfeeding is the best exercise for the tongue.

      What about the brands that look like Pigeon or the new spectra bottles?

      1. Fill the nipple with water. You'll see what happens. These supposed "look alikes" unfortunately do not create a pace feed. These nipples drip on their own without suction. Pretty unfortunate. We can switch out many wide base nipples with pigeon except Dr.Browns wide base are too wide to switch out with pigeon. Make sure the nipple is on tight when you switch out the nipple with pigeon. Or just go ahead and buy a whole Pigeon bottle and nipple kit, They offer glass too which is great for us crunchy/scrunchy moms who are concerned with chemicals leaking into the milk including plastic particles.


    How do we bottle feed breast fed babies?

    We pace bottle feed. The NICU pace feeds with the baby laying on their side with the bottle horizontal. Most full term babies can sit upright like an adult on their parents leg while the parent supports the head/neck. The other hand will keep the bottle horizontal to the baby. This way the baby has to actively pull the milk out. He is in control of his eating, can slow it down, can pace and stop the flow with the tongue as needed. Then they are eating slower, digesting slower, and are not being force fed. The milk is delicious and if we lay them back and feed it to them like our grandma's did they have no control over the flow and they will cough and sputter.


    You will have to teach your spouse, your mom, your grandma, and daycare this. Emphasize the importance of the slow flow in relation to them returning to the breast at the end of the day. Bottles should take around 20-25 minutes.

    If its 10 minutes thats too short/fast.

    If its 45 minutes that is way too long, see an IBCLC and they may refer you to a ST/OT/PT/chiro if needed


    YES>>>>>>>> this is pace feeding



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    NOOO, this is not pace feeding.





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