What Nipple Flow Should I Use for My Baby?

By Marina Macleod

November 5, 2019

Marina is a Registered Nurse with over 14 yrs of experience, a Mama Coach in Calgary, AB and area and a Mama to 2! She offers prenatal education, newborn and post-partum support, lactation counseling, infant & child CPR/Choking workshops, as well as sleep education programs based on science, empathy & support.

Just as breastfeeding can take time, practice and patience, so can learning to bottle feed. It would be great if there was a gold standard of age to flow rate for bottle nipples, however, that is not the case. The choice is vast and the variability is astonishing! In hopes of decreasing the confusion (a teeny bit), this article will go over some of the common nipple flow rates and ages they are recommended for (according to manufacturers) as well as some tips for helping you to choose a nipple for your baby while bottle feeding. 

Nipples

So. Many. Choices. Try not to get overwhelmed when looking at ALL the choices. Start basic and change the nipple as needed. Some characteristics that differ between bottle nipples are:

  • Materials (latex vs. silicone)
  • Texture (soft and pliable vs stiff)
  • Flow (extra slow, slow, medium, fast, variable, y-cut, crosscut, thick feed, paced feed)
  • The shape of tip (rounded, domed, angled, bulbous)
  • The shape of base (narrow, wide abrupt/gradual, “breast-like”)
  • Shape and length of the whole nipple (long, short, contoured, hour-glass) 
  • Holes in tip of the nipple (1-3+)
  • Vents/Valves in the nipple (for adjusting the flow rate and to aid relief of colic)

So how do you choose?

The answer is you have to try a few until you find one that works for your baby. Like many things with babies, nipples and bottles are not “one fits all” and what might work for one babe, might not be a good fit for another. Research shows that there can be a significant difference between nipples described as the same flow rate, but also a significant variance in flow rates of the exact same nipple! There are also other considerations to take into account like prematurity, heart/lung disease or cleft palate that will play a role in making the best choice too. For these situations, it is best to consult with a healthcare professional. 

Average Flow Rates

Most bottle nipples are rated in Stages 0-4 or Drip/Flow Rate of extra slow to fast. On average the flow rates are as follows:

Stage 0 or Extra slow flow: for premature babes or small newborns or 0+ months
Stage 1 or Slow flow: 0-3+ months
Stage 2 or medium flow: 3-6+ months
Stage 3 or Fast flow: 6+ months
Stage 4 or Y-cut, Cross-cut, Thick feed flow: 6-9+ months or for thicker formulas/milk

Finding the Right Drip/Flow Rate Nipple

In general, it is always best to start with a softer more pliable slower flow nipple and move up from there. It is also a good idea to start with a nipple that is rounded on the tip and gradually becomes wider at the base. 

If you are noticing that your baby is struggling to pull milk out, the nipple is collapsing or caving in, baby is pulling away from the bottle, crying and fussy during the feed and/or feeds are taking a long time, then it is likely the flow rate is too slow and you should move up a stage. 

Alternatively, if your sweet little bottle feeder is taking in more milk than they can swallow, spilling or dripping milk from their mouth, having problems swallowing and appears to be gagging/coughing or sputtering with feeds then it’s likely that they need a slower flow rate. Drinking milk to fast from the bottle can result in baby taking in too much air and lead to a fussy/gassy child. As well, if the baby is not transferring and swallowing milk effectively a burst of milk could end up in their airway, so it’s important to find a flow that works best with your baby.

You want to look for your baby to have a wide-open mouth with lips flanged out nicely on the nipple base (just like on a mother’s breast when latching) and watch for a suck/swallow pattern. When babies are feeding, they are trying to coordinate breathing, sucking and swallowing in one smooth motion. You should see the jaw moving with “sucks” and see pauses for the “swallows”. If you listen closely, you will also hear the swallows of milk! 

Pro Tip…

A great way to help mimic breastfeeding more closely and allow baby to control flow is to hold baby in a more upright position and hold the bottle in a more horizontal position. This will allow baby to suck and “pull” the milk into their mouth at their pace rather than having them laying down and the bottle upright where gravity helps to drain the milk into their mouths. Another great bottle feeding technique for slowing feeds down and helping to avoid overeating is Paced Bottle Feeding. Make sure to always burp baby halfway through a feed to expel any extra air swallowed. 

If you are currently breastfeeding and wanting or needing to introduce bottle feeding, then be sure to read this article: Bottle feeding Your Breastfed Baby  It goes over some great tips on how to introduce a bottle, and what to do if it’s not working! 

Have questions? Reach out. The Mama Coach is always here to support you in meeting your feeding goals! 

 

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