By Lisa Kleinz, M.A., SLP/L, CLS, CNT, Account Manager/Clinical Liaison, Dr. Brown’s® Medical
When traveling around the country as an Account Manager/Clinical Liaison for Dr. Brown’s® Medical discussing feeding with feeding therapists, I often ask the question, “Do you currently use our products?” A great deal of them respond, “Yes, with our problem feeders.”
As a NICU therapist for over 20 years, my current goal is to help them see why Dr. Brown’s bottle systems are beneficial for many infants, especially fragile feeders, and not just “problem feeders.” In the NICU, this usually means the baby doesn’t use the Dr. Brown’s bottle until a Feeding Therapist has been called in after the baby has not tolerated standard hospital nipple flows. For these fragile feeders, as well as for breastfeeding infants who require supplemental bottle feedings, why not use Dr. Brown’s Natural Flow ®bottles from the beginning? We now know there is evidence that the development of an infant’s oral feeding is a neurobehavioral skill and the individual infant’s feeding experiences during their stay in the NICU can affect skill development which continues post discharge (Ross et al, 2015). In addition, through the pioneering research of Als, Altimer, and Coughlin, we now understand that providing infants with neuroprotective, family-centered, individualized supportive care is essential to improve neurodevelopmental outcomes in this population (Altimer and Phillips 2013; Coughlin et al 2014; Als 1982)
One of the components of this type of caregiving is providing all infants with positive oral feeding experiences. At Dr. Brown’s® Medical, we believe the use of the Dr. Brown’sNatural Flow® bottle system can provide this level of support to every infant at each feeding from their first bottle feeding in the NICU to their bottle feedings after discharge. This can be facilitated by 1) the effects of a natural flow (vacuum-free) bottle system, and 2) providing consistent and reliable nipple flow rates with Dr. Brown’s® silicone nipples.
Researchers have demonstrated the use of a natural flow, vacuum-free feeding system when feeding infants with oral feeding challenges related to immaturity has clear benefits:
1. Facilitates overall transfer and rate of milk transfer thereby shortening oral feeding duration (per feeding) in VLBW infants (Fucile et al 2009).
2. Reduces the infants’ energy expenditure by enhancing feeding performance without increasing sucking effort (Fucile et al 2009).
3. This type of system eliminates the build-up of positive pressure inside the infants’ bottle system, allowing the infants to have more control over the flow rate (Lau et al 2015).
4. In addition, if an infant is presented a feeding system with a flow rate that is too fast, infants may exhibit disengaged suction, flattened tongue shape with decreased lingual border elevation resulting in decreased lingual cupping, loosened cheeks, and loss of fluid (Eishima 1991).
The other component of a positive feeding experience is that Dr. Brown’s® nipples are consistent and reliable -which supports learning the most complex motor task of a human infant. The two most recent research articles published by Pados, et al., 2015 and 2016, reveals the results of lab studies testing milk flow rates of the most commonly used nipple brands on the market today. Results indicated rates of variability among flow rates of specific nipple categories across brands (i.e. slow flow, newborn flow, cross cut). Only 10% of the 45 nipples tested were found to have low variability. Dr. Brown’s® standard silicone nipples were identified as the most consistent brand with 6 of their nipples having the lowest variability by comparison.
All of the above information is crucial to us as care providers feeding infants. As Catherine Shaker states, “Every feeding experience matters.” What do we want our infants to learn about feeding? Do we want them to learn that each feeding is unpredictable and potentially stressful, or do we want them to learn feeding is pleasurable and safe, a way to improve their skills, and that they can have some control of the process? Do we want infants to receive such variability in their bottle nipple flows each time they feed by using “standard hospital nipples”? Or is it more neuroprotective to provide a consistent, individually-recommended flow rate to help emerging feeding skills and protection from stress during feeding? Let’s remember that feeding is a pathway in development, and we have the chance to derail or to guide that path!
If you have any questions regarding Dr. Brown’s® Medical products and feeding, please contact me at firstname.lastname@example.org.
Lisa Kleinz has been working in level III and IV NICUs for over 20 years as a speech-language pathologist and a Developmental Care Specialist She has also worked in outpatient feeding clinic and developmental follow-up clinic. Her career has been focused on providing individualized, developmentally supportive care to infants and families and working with staff to create change in the NICU. She is certified in NIDCAP, N-CAST, Brazelton, and is a Certified Neonatal Therapist, a Lactation Specialist and NANN-designated Developmental Specialist. She has presented locally and nationally and also teaches a course with Education Resources. She is a member of NANT, and a board member of the Neonatal Therapy National Certification Board. Lisa currently works as an Account Manager/Clinical Liaison with Dr. Brown’s Medical/Handi-Craft Co.