Feedings with Dr Brown’s nipple sizes - T too fast?

[mzglass]

My 33 weeker (now 38) has been exclusively bottle feeding using Dr Brown’s anti-colic bottles with the “P” preemie nipple since he came home. It’s been a few weeks and he has dramatically upped the demand of how much he eats daily (I posted before - he’s eating like a monster). With the size P nip he has recently been taking much, much longer than usual to finish his feed (well over 30 mins) and falling asleep midway through only to wake up a few minute later still hungry. I switched to the “T” nipple thinking that would be the little change he needed - but now he’s gulping, sputtering, and choking during feedings. It’s stressful for us both.

I’m at a loss - P is now way too slow for his needs but T seems too fast for him at the moment. What do we do? Is there a learning curve for him and we should stick it out with the T’s or power through with the P’s until he’s more coordinated? I don’t want him falling asleep halfway through his bottle as it’s frustrating for both of us but I also don’t want feedings to become a stressful event because he is overwhelmed. I’d appreciate any experiences!

 

[jonbradford]

@mzglass My guy spluttered on every new size the first few times we increased the size. No real choking but definitely a lot of spluttering. Turns out the new amount of milk coming out felt really weird to him at first, and also he would still suck as vigorously as before so he got a whole lot more in one suck. We would do more of a paced feed, burped an extra time and maybe did 10 minutes of food, diaper, another 10-15 and his bottle would be empty in 30 minutes max. After a good 2 days he would just munch without spluttering so we were super lucky he paced himself to a perfect amount.

(Always bottle fed, even the breastmilk, so pacing was something we did kind of automatically but we never knew to always do, since we were never told about it.)

 

[mzglass]

@jonbradford All good ideas! We pace still because honestly I’m just too afraid to do a high cradle feed and it’s more comfortable to side feed on a boppy where I can really keep an eye on him. Since he’s choking I’m going to give it more time before we make the switch - if I still see sputtering I think a mid bottle diaper change makes a lot of sense to help him reset.

 

[justinrudd]

@mzglass I don’t have advice to add beyond what others said but want to validate you — we went through the same thing with our 34 weeker several weeks ago and had to go back to the preemie nipple. I think a week and a half to two weeks after that we switched to the transition nipple with success that time. It can all be confusing and frustrating!

 

[mzglass]

@justinrudd Thanks for the solidarity! We also switched totally back to the preemie nip for now - little guy just isn’t developmentally ready for the T even with paced feeding, breaks, etc. I think giving it a try in another week or so is a great idea as he’ll be just that much stronger and (hopefully!) a little more coordinated.

 

[mzglass]

@justinrudd Hey! Coming back to say that we gave it another week and a half-ish and now he’s doing great with the T! Thanks for the advice. In the future I’ll keep that in mind if we ever need to bump up a size.

 

[justinrudd]

@mzglass So glad to hear!! Thanks for the update. It seems to be this way every time we up a nipple size. We’re in an awkward Level 1 and Level 2 phase right now

 

[mzglass]

@justinrudd Trying to remind myself that one day there won’t be any more bottles! Good luck!!

 

[justinrudd]

@mzglass For sure. Same to you!

 

[brethrenfund1]

@mzglass I think it’s better personally to eat a little too slow than be gulping and choking. You could perhaps do a combination? Like start off with one flow and change to the other depending on how he eats. Like maybe he eats really vigorously at the beginning and could handle the flow and needs slower as he gets sleepy? Or needs a slow start and once he’s eating steadily up the flow? Every kiddo is so different it’s hard to know what they’ll like best, but choking on the milk is definitely too fast. Are you doing side lying paced feeds?

 

[mzglass]

@brethrenfund1 Yup we’re doing side laying and pacing. With one he falls asleep about 15-20 minutes in, sleeps for 10, and then wakes up and finishes so the whole process of feeding him ends up being around an hour. One size bigger and he’s overwhelmed!

 

[brethrenfund1]

@mzglass I would just give it a little more time before 100% swapping to the faster flow. As long as he’s taking appropriate volumes and gaining weight it’s probably better to go a little slower instead of choking. You could just keep trying the transitional nipple when he looks really awake and excited to eat but be prepared to swap back if it’s overwhelming. He’ll get there

 

[mzglass]

@brethrenfund1 I think that’s probably the best solution right now - he is usually fine at the start of his feed but then chokes closer to the end when he’s tired. I’ll give it a try!

 

[brethrenfund1]

@mzglass Oooh then definitely could start with the fast flow and swap once he slows down. Choking like that at the end of the feed is just him getting tired. So I would just keep both next to you when you feed. Eventually you won’t need to swap and he’ll be fine with the faster flow

 

[makesense114]

@mzglass We have been dealing with a comparable issue with the change from T to 1 for our son (our son was full term in the NICU, HIE diagnosis. Started out with nipple N in the NICU and then went to T - not sure if this same issue happened with that transition because he was not at home then but in the NICU still). I wonder if there is some kind of transition time where they get used to it? I’m curious to see what others say!

 

[katrina2017]

@mzglass We started with p for the first 2ish months then switched to 1. He still falls asleep during most feedings- we just change his diaper half way through. He’s 3 months now.

 

[mzglass]

@katrina2017 As long as he’s fed and happy I’ll quit worrying about his feeds taking a little longer. The next size up can probably wait. Thanks!

 

[akadascribe]

@mzglass My son was born in August at 31.0 weeks. He’s now 3.5 months old but 1.5 months actual. The NICU’s standard nipples were too much for him so they had him on Dr. Brown’s preemie nipple the entire time. His feeds at home would take forever, 30 mins+ for 2-3 ounces. I had no idea that there was even a T nipple before transitioning to 1 so we just went straight to 1, burping him often. We did that for about 3 weeks & he’s now on 2’s at 4 ounces each feed; we plan to stay here for about another month but we felt like him having to work so hard to feed through a slow nipple was probably contributing to him falling asleep during the feed.

 

[jewels0414]

@mzglass My son was the same but he was like even folding the P nipple so they told us to just stick with the T but give him less oz until he got the hang of it. After a few days he adjusted. We would still pace and burp him halfway and that helped him a lot.