Date Presented 3/31/2017
This study was designed to examine the variations of flow rates between Enfamil Cross-Cut and Dr. Brown’s Y-Cut nipples using formula thickened to a honey consistency. Understanding these flow rates helps occupational therapists promote safe feeding and ensure a more pleasurable feeding experience for infants.
Primary Author and Speaker: Kimberly Kubistek
Additional Authors and Speakers: Sarah Ickes, Kristi Cianfichi, Amanda Casem, Joanna Szeliga, Kara Yozwiak
PURPOSE: The purpose of this study was to determine the flow rate of formula thickened to a honeylike consistency through unstretched and stretched Enfamil Cross-Cut nipples and Dr. Brown’s Y-Cut nipples using a Medela breast pump. Premature and medically complex infants are at a higher risk for feeding and swallowing difficulties. Adaptations such as thickening the infant’s formula are used to decrease aspiration; however, this makes it more difficult to extract the formula from the traditional nipple. Feeding consequently becomes stressful, which can have a lasting impact on the infant and parent.
DESIGN: A comparative effectiveness design was used to evaluate the variations in flow rates between Enfamil and Dr. Brown’s nipples using formula thickened to a honey consistency.
METHOD: Enfamil Cross-Cut (stretched), Enfamil Cross-Cut (unstretched), and Dr. Brown’s Y-Cut nipples were used during this study. The Medela breast pump was used to extract formula from a bottle with the testing nipples for 30 s to determine the flow rate of honeylike thickened formula. The volume of formula extracted was measured in milliliters. In order to compare the flow rates from one nipple type to another, the mean flow rates and standard deviations were computed for each nipple and trial. This study was exempt from review by the institutional review board.
RESULTS: From the limited data collected, the means of the Enfamil Cross-Cut, both stretched and unstretched, were determined and compared with the mean of the Dr. Brown’s Y-Cut nipple. Based on these results, it was concluded that the Dr. Brown’s Y-Cut nipple (M = 271.48 ml) had a faster flow rate than the Enfamil nipples stretched (M = 81.00 ml) and unstretched (M = 59.33 ml).
CONCLUSION: This study concluded that Enfamil Cross-Cut nipples that have been stretched display a faster flow rate than Enfamil Cross-Cut unstretched nipples. These rates are important to take into consideration as both a fast or slow flow rate can be detrimental to the infant’s feeding process and lead to aspiration or apnea. Extracting thickened formula from a clogged bottle or a bottle with too slow of a flow rate increases the exertion required to suck the formula from the nipple. Conversely, extracting formula from a nipple with too fast of a flow rate allows the infant less time to organize the suck, swallow, breathe pattern, thus making the formula more difficult to control during the swallowing and breathing process. Inconsistent flow rates due to clogging or altering the nipple could lead to aspiration.
IMPACT STATEMENT: Feeding difficulties in preterm and medically complex infants can have a significant impact on the child’s safety, health, and development and on the mother–infant relationship. The results of this study are consistent with current observations seen within clinical practice. With an understanding of the dynamics of an infant’s sucking pressure on a nipple in relationship to flow rate, occupational therapists can make clinical decisions in patient care and educate parents on necessary feeding techniques. Occupational therapists can aid in the process of selecting a nipple by educating the caregiver on various types of nipples and the characteristics associated with each nipple, such as flow rate. By identifying and understanding these characteristics, parents, caregivers, and practitioners can significantly decrease the negative consequences that occur as a result of feeding difficulties.
References
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