Bottle Nipples that Minimize Nipple Confusion or Flow Preference
It seems that all bottle nipple manufacturers claim that their nipples are the "closest to breastfeeding." They all seem to have innovations and special features. How, then, can a mother know which nipple is really going to least likely to cause nipple confusion or flow preference?
When choosing an artificial nipple for bottle supplementation of the breastfed baby, it is important to use one that allows baby to use the same tongue and jaw motions that he uses at the breast. When a baby is nursing at the breast, he has complete control and is able to stop and start when he wishes. His mouth is open wide and full of breast tissue. He extends his tongue and cups it around the nipple and areola. His lips are open, wide, and relaxed. Bottle-feeding the breastfed infant is most successful when the bottle is used in a way that closely approximates these aspects of breastfeeding.
The nipples that appear to work best for breastfeeding babies have:
- A wide base that slopes gradually toward the nipple
- A short nipple
- Most women's nipples are short and the latest ultrasound research shows that nipples do not elongate in baby's mouth as much as previously thought
- A round nipple
- Ultrasound studies by Smith revealed that round nipples with a broad base, as opposed to the "orthodontic nipples" with flattened tips, best facilitate tongue and jaw motions similar to sucking at the breast(1)
- Although orthodontic nipples such as the Gerber Nuk are frequently recommended for use by nursing mothers, they seem to teach the baby to retract his tongue and hump it up in the back of his mouth during feeding.
- This creates problems with breastfeeding, since babies must flatten their tongues and extend them forward to get milk from the breast. In addition to reducing milk transfer, this type of tongue movement can cause severely abraded nipples.(2), (3)
- A slow flow rate
- Most brands offer nipples that flow at different rates, often labeling them as “1” for “slow-flow” or “newborn” and “2” and higher for “fast flow” and older babies. However, not all “slow-flow” nipples are created equal; you can test and compare them by turning them upside down and seeing how fast milk drips out. With most babies, it is important to use the slowest flowing nipple in order to maintain a similarity to the more variable rate of flow from the breast. This will help minimize the risk of flow preference.
- Made of a soft, easily compressible, thin material
- Iit is best to use a nipple that is silicone, rather than latex, to protect the baby from latex allergens
There are several nipple products on the US market that meet these criteria:
- Gerber ComfortLatch (pictured above)
- Evenflo Ultra and Elite
- Playtex NaturaLatch
Nipples that do NOT meet these criteria are:
- Dr. Brown's
- Playtex Natural Action Nipple
- Any orthodontic nipple, including the one included in Medela products
- The standard nipples provided at hospital nurseries
Note: We do not have any financial interest in commercial products, including the nipple products discussed on this webpage.
(1) Smith, W., Erenbert, A., Nowak, A. Imaging evaluation of the human nipple during breast-feeding. Am J Dis Child 1988; 142:76-78.
(2) Smith, W., Erenbert, A., Nowak, A. Imaging evaluation of the human nipple during breast-feeding. Am J Dis Child 1988; 142:76-78.
(3) Nowak, A., Smith, W., Erenberg, A. Imaging evaluation of artificial nipples during bottle feeding. Arch Pediatr Adolesc Med 1994 Jan; 148:40-2.