Choosing a Bottle for Your Baby

What should I look for in a bottle and a nipple?

When looking for a bottle and nipple for your baby, it’s important to look for 2 things:

• Nipple flow rate (how slow or fast liquid flows out of the bottle when your baby eats or drinks)
• Nipple shape

You may also hear bottles and nipples together referred to as a bottle system. Your baby’s care team can help you figure out what to look for in terms of flow rates and nipple shapes.

Do bottles have different nipple flow rates?

Yes. Flow rates vary based on manufacturer. The actual flow rate may be different from what is listed on the package. The recommendations below are based on a journal review and testing of commercially-available (available in store or online) bottles.

What are the different nipple flow rates?

Flow rate	Slow rate	Standard rate	Fast rate
Important things to know	Slowing the flow of the milk may help your baby if is very eager and tends to choke, cough or dribble with standard flow	Most bottles come with standard flow that works well for babies born at term and up until age 3-4 months	Some bottle systems come with nipples that are a faster flow and are for older babies and/or babies who feed vigorously and can handle a faster flow. Some are also designed for babies who are on thickened feedings. Although some of the nipples listed below are labeled as slow flow, they are actually quite fast.
Bottle options.	Avent® Natural Flow “First Flow” and Level 0 Comotomo® Slow Flow Dr. Brown® Preemie flow Infant Labs® Slow and Standard Playtex® Baby Naturalatch 0-3m Playtex® Ventaire Breastlike Playtex® Ventaire Full-Sized	Avent® Natural Flow Level 1 Dr. Brown® Level 1 Gerber® First Essentials Evenflo® Classic Slow Flow 0m+ MAM® Anti-colic 0m+ Tommee Tippee® Anti-colic 0m+ Tommee Tipee® Closer to Nature 0m+	Avent® Anti-colic 0m+ Dr. Brown® Level 2-4 Evenflo® Slow Flow Medela® Wide-Base Slow Flow

When should I consider changing the flow rate?

Consider changing the flow rate if you notice signs that the nipple is too fast or too slow.

Signs that a nipple is too slow

• Collapsing the nipple
• If your baby becomes disorganized or fussy after vigorous sucking
• The flow appears to slow the baby down.

Make sure your baby is consistently breathing and swallowing safely before trying a faster flow.

Signs that a nipple is too fast

• Increased spillage
• Gulping
• Coughing or choking
• If your baby has more difficulty pacing their breathing
• If your baby’s skin changes color while they feed

What are the different nipple shapes?

• Standard shape – Narrow base, but still allows your baby to go from bottle feeding to breastfeeding. This nipple shape usually works best for pre-term infants who are just learning how to feed.
• Wide-based – These nipples are designed to be shaped like the breast and help with transitioning from bottle feeding to breastfeeding.
• Orthodontic shape – This type of nipple helps babies who tend to bite down on the nipple. It is not ideal for babies who are also working on breastfeeding. Please talk with your care team to see if this is the type of nipple your baby needs.

Rev. 3/2022. Mass General for Children and Massachusetts General Hospital do not endorse any of the brands listed on this handout. This handout is intended to provide health information so that you can be better informed. It is not a substitute for medical advice and should not be used to treat any medical conditions. Adapted from Jackman, K. Go with the Flow: Choosing a Feeding System for Infants in the Neonatal Intensive Care Unit and Beyond Based on Flow Performance. Newborn & Infant Nursing Reviews 13 (2013) 31–34.