In October’s article, Callie, the neonatal therapist, along with the nursing staff, experienced frustration. Parents felt fear and a lack of trust. Most importantly, infants were confused and unsure of their safety. These feelings resulted from the lack of consistency when using disposable nipples. Feeling unsafe results from the infant’s vulnerability to inconsistency, in which the infant has no control. There is good news! The SOLUTION to the drama of the disposable nipple and the problems that result from their use is to follow the EVIDENCE! The inconsistency of the disposable nipple has expanded over several decades, with evidence supported by research and published articles. Even though studies vary among methods, a common theme persists: Disposable hospital nipples exhibit inconsistent flow rates. While disposable nipples are variable, there are noteworthy commercial brands that maintain consistency of nipple flow rates. References here.
Note a key point in a Britt Pados article:
“Single-use nipples commonly used for feeding infants with medical complexity were found to be highly variable and/or faster flow than other products; the safety of these products for feeding infants with medical complexity needs to be reconsidered.”
“Additionally, there are sometimes issues with the quality of the products; for example, several nipples were found to not have an opening.”
Let’s look at how each of Callie’s problems can be resolved with EVIDENCE-based medicine.
Problem 1: During feeding, Callie trialed several disposable nipples, all of which had varying flow rates within the same levels, along with one that did not even have a hole. During the time spent attempting to find the “right” flow, William became untrusting, tired, and disinterested.
Solution: Using an EVIDENCE-based reusable bottle system with quality-controlled, consistent nipple flow rates would have prevented frustration, fear, and lack of trust. Callie would have been more efficient with her time, and most importantly, William would have had a safe feeding experience.
Problem 2: Callie recommended a nipple flow rate, although the nursing staff chose a faster flow rate. Why? Because the recommended flow seemed ‘too slow’ for Francesca. This decision resulted in a lack of trust, partnership, and respect among staff. Francesca experienced multiple flow rate changes through several feedings.
Solution: Hospital adoption of a consistent, reliable bottle system that is supported in the research. When a consistent product is used, there is not a wide variation in nipple flow rates during feedings. Often, staff develop feelings of dishonesty, disrespect, and detachment when recommendations are ignored, when in fact, the products are the CHALLENGE, not the staff. Flow rate variation during each feeding experience reveals a different feeding experience from one feeding to another. Consistent products provide stability for the baby and improve staff relationships. Consistency of feeding practices promotes neurodevelopment. A statement from the Infant Family- Centered Developmental Care: “Competency 1.3: Consistency of feeding practices among staff who feed an infant should be promoted, monitored, and verified.”
The research is clear that disposable products are inconsistent, unreliable, and potentially unsafe. So why are they still accessible in neonatal units? All team members should have the right to use the same products to optimize safety, provide cohesive feeding practices, and support neurodevelopment.
Oral feedings must be safe, nurturing, functional, and individually/developmentally appropriate. Exchange the drama with EVIDENCE: Provide consistent EVIDENCE-based feeding tools and feeding practices.
For more information about how Dr. Brown’s Medical can help provide positive feeding experiences, contact us at medinfo@drbrownsmedical.com.
If you missed part 1, read here.
