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Calma?

Posted by on Jan. 17, 2013 at 1:16 PM
  • 10 Replies

On one of my previous posts I mentioned that we are using the calma nipple and a lot of moms came back saying they are bad.  So here is my question.  He has used the nipple now....about 3 days (only while I am at school from 9:00am-3:00pm) and it has not hindered his ability to breastfeed.  So here is my question, should I stop using them?  I understand that there are no nipples that are good for breastfed babies so does it really make a difference?  I just want to do what is best for him, but I have no choice but to give him bottles Tuesday through Thursday from 9:00am-3:00pm.

by on Jan. 17, 2013 at 1:16 PM
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jesuschild06
by on Jan. 17, 2013 at 2:08 PM

medela has nipples made for the breastfeeding moms. and i think there is another brand as well. i dontknow anything about the calma nipples. im also not sure 3 days is long enough to determine whether the nipples are going to cause confusion (so not an expert yet). but i would say if you are really worried, get some medela nipples.

ChWuGu
by on Jan. 17, 2013 at 2:20 PM

The calma is made by medela

Quoting jesuschild06:

medela has nipples made for the breastfeeding moms. and i think there is another brand as well. i dontknow anything about the calma nipples. im also not sure 3 days is long enough to determine whether the nipples are going to cause confusion (so not an expert yet). but i would say if you are really worried, get some medela nipples.


audmom1218
by Silver Member on Jan. 17, 2013 at 2:24 PM
If baby's latch doesn't change you're fine. If latch changes/baby starts biting down, or refusing breast ditch the bottles and try a new one.
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jesuschild06
by on Jan. 17, 2013 at 2:25 PM

hmm maybe they have several differnt kinds of nipples? i havent done a lot o research on them. but medela is what my friends use and they havent had any problems. (i have about 8 friends currently breast feeding and working, and they all use medela).


Quoting ChWuGu:

The calma is made by medela

Quoting jesuschild06:

medela has nipples made for the breastfeeding moms. and i think there is another brand as well. i dontknow anything about the calma nipples. im also not sure 3 days is long enough to determine whether the nipples are going to cause confusion (so not an expert yet). but i would say if you are really worried, get some medela nipples.




turttlemom
by Nayelli on Jan. 17, 2013 at 2:49 PM

I have been using Avent, and they work good for DS, now I have ordere the Avent natural ones, they say the new ones are better for breastfeeding babies. I hope this could help you

K8wizzo
by Kate on Jan. 17, 2013 at 2:55 PM

This

Quoting audmom1218:

If baby's latch doesn't change you're fine. If latch changes/baby starts biting down, or refusing breast ditch the bottles and try a new one.


K8wizzo
by Kate on Jan. 17, 2013 at 2:56 PM

When breastfeeding moms either want or need for their baby to have expressed milk from a bottle, the question they usually ask is, “What bottle/nipple is most like the breast? Which bottle/nipple is best for breastfeeding babies?”

The simple truth is that the correct answer is, “None.” There is no nipple that is like the human breast. Some may be better or worse for a baby who is going back and forth between breast and bottle, but there is no “best”. What matters much more in avoiding baby developing a bottle preference is how the baby’s caregiver feeds baby with the bottle.


The problem with marketing nipples as "most like breastfeeding", or with similar claims is that it undermines breastfeeding. This is why part of the purpose of the WHO CODE (World Health Organization's International Code of the Marketing of Breastmilk Substitutes) is to prevent the aggressing marketing of bottle nipples.

One of the first bottle nipples to be marketed as “most like mother’s nipple” is the Nuk. Their claim, “Orthodontic design shaped like a mother's nipple during breastfeeding”. The marketing claims are pretty convincing:






The NUK® Orthodontic bottle makes baby's transition from breast to bottle and back a seamless one. Every nipple has unique features to make it easier to move back and forth from breast to bottle. These bottles have been scientifically designed to make feeding easier.




I was working with a mom who was wanting to transition her baby off of bottles of expressed milk on to the breast. I asked her what nipples she was using and she told me Nuk. I mentioned that she may want to switch to a different bottle and nipple that would encourage baby to use his mouth more like he would on the breast. I explained to her that the Nuk nipples tended to encourage sucking that could interfere with breastfeeding. She was shocked. “But is says right on the package that it is most like mother’s nipple and good for breastfeeding babies!”. She fell for the marketing hook, line and sinker.

Independent research, summarized on lowmilksupply.org,  has shown the problems with these “orthodontic” nipples:

  • Ultrasound studies by Smith revealed that round nipples with a broad base, as opposed to the "orthodontic nipples" with flattened tips, best facilitate tongue and jaw motions similar to sucking at the breast(1)


  • Although orthodontic nipples such as the Gerber Nuk are frequently recommended for use by nursing mothers, they seem to teach the baby to retract his tongue and hump it up in the back of his mouth during feeding.
  • This creates problems with breastfeeding, since babies must flatten their tongues and extend them forward to get milk from the breast. In addition to reducing milk transfer, this type of tongue movement can cause severely abraded nipples.(2), (3)



Newer nipples are getting much more sophisticated and have even bigger claims. The Breastflow bottle, by The First Years claims:

Works like mom
The only bottle with a 2-in-1 nipple that lets your baby use the same natural motions as breastfeeding.

Soft outer nipple
mimics the feel of the breast and allows baby's tongue to stay in the same position as breastfeeding.

Inner nipple
allows your baby to control the flow naturally like breastfeeding whether you use breast milk or formula.

While I can’t find any independent research on how much these are or are not “just like” the breast, the fact is it is impossible. Moms report trying these to avoid “nipple confusion” but the fact remains that anything other than moms breast has the potential to cause nipple confusion or bottle preference, particularly if baby is being overfed with them. There are no shortage of complaints about this somewhat complicated system with multiple parts being difficult to clean, or the nipple frequently leaking, or collapsing while baby is feeding. This is a lot of extra effort and work for moms who believe the marketing that this nipple is somehow best for their breastfed baby.

The mimijumi bottle is designed to look like the breast:

With natural colors, textures and forms, the mimijumi baby bottle provides the perfect complement to breastfeeding and the best possible transition to bottle feeding.

The innovative nipple design replicates a mother’s breast, creating a natural feeding and latching experience for a happier and healthier bottle fed baby. Bold colors and soft textures are combined to give the Not So Hungry bottle a distinctive, eye-catching appearance.
 




I want moms to understand that “the best possible transition to bottlefeeding” is a marketing ploy! They want you to buy their bottle. Even if they tried to make it most like the breast with the best of intentions, that does not make it so.

Looks don't make a difference when you are wanting to avoid a flow preference with your baby and make an easy transition from breast to bottle and back. Users of the mimijumi have reported a fast flow rate and a stiff nipple:

"I ordered this bottle thinking that it would be closest to a breast, but I was very mistaken. My husband filled the bottle with breast milk and turned the bottle upside-down over the sink to show me that the milk just comes streaming out of the nipple. The baby was practically choking when he fed her using this bottle."
"Not only is the nipple extremely hard and inflexible, it also lacks control over the flow rate. My baby was permanently choking with this bottle, even with the "slow flow" nipple." 

The new kid on the block comes with great marketing claims. Produced by the heavily marketed Medela brand comes the Calma:


Introducing Calma: Designed exclusively for breastmilk feeding.
 

Switching from bottle back to breast has never been easier. Calma was developed using evidence-based research on babies' natural feeding behavior so you can enjoy your breastfeeding bond longer.
With Calma, the milk will only flow if your baby works and creates vacuum to remove the milk. This enables the feeding behavior learned at the breast to be used with Calma.



I decided to do some more research after the comment from a breastfeeding mom on an on-line forum. Other moms on the breastfeeding forum were suggesting that her baby was being overfed with the bottle, and this was the underlying cause of the problems she was having. The amounts her baby was getting from the bottle exceeded what research suggests a breastfed baby should get. She responded that it was not possible that her baby was being overfed with the bottle because she was using the Calma, which is just like the breast. She would not even begin to listen to the possibility that baby was getting too much milk because she did not think it was possible with this specially designed nipple.

The truth is it is easy to overfeed with any bottle and just like the other contenders, the Calma does not replicate the human breast and deliver milk in the same way. It was not too hard to find the following information, right on the Medela website:

INTERVIEW: Conquering Breastfeeding Challenges with Calma (As if a bottle can solve breastfeeding problems, sigh.)

On the comments of this article on the Medela website several IBCLCs reported a consistent problem with fast flow, and babies choking on the surge of milk flowing into their mouths. A Medela representative responds to these complaints by explaining that a baby cannot suck on the Calma nipple the same way they do at the breast because it will cause too fast of a flow.

Wait a minute. Let’s all stop here right now. Didn’t Medela claim that this new wonder nipple, “enables the feeding behavior learned at the breast to be used with Calma.” Now they are saying baby needs to suck differently on the Calma than they do at the breast? The Medela rep further explains:


"We’ve found sometimes that Calma takes a little getting used to. Typically, babies suck vigorously at the beginning of a feeding to stimulate let down. With Calma, relaxed sucking, similar to the middle of a feeding, works best. Many moms found that after a few tries, babies adjust their sucking at the beginning of the feed with Calma and that Calma helped immensely with the transition from bottle to breast."

An IBCLC, who was complaining about the fast flow she had seen with the bottle poiints out:

"If babies have to adjust their suck to be LESS vigorous to adapt to a bottle, then they will not be sucking in an appropriate manner for the breast. Effectively you are admitting to what I have found with 100% of the clients I have seen who have tried this bottle — babies suck worse on the breast. So while you may have found some resilient babies who are highly adaptable (because most babies WILL eventually take the breast when mothers maintain their supply through pumping) the babies who are having significant problems that comprise my clientele will not. Furthermore, aspiration from choking is a health risk. The degree of choking I observed among my clients was severe — not mild — and much worse than with other bottles."

What really matters when choosing and using a bottle with a breastfed baby

One of the main reasons a baby may prefer the bottle to the breast is due to flow preference. Baby likes the fast and immediate flow from the bottle. They come back to the breast and don’t want to “work” for the let down. Medela has basically just said that babies need to learn to not suck to trigger let down when using this bottle.

What do breastfeeding moms need to know about bottle feeding expressed milk?





(1) Smith, W., Erenbert, A., Nowak, A. Imaging evaluation of the human nipple during breast-feeding. Am J Dis Child 1988; 142:76-78.
(2) Smith, W., Erenbert, A., Nowak, A. Imaging evaluation of the human nipple during breast-feeding. Am J Dis Child 1988; 142:76-78.
(3) Nowak, A., Smith, W., Erenberg, A. Imaging evaluation of artificial nipples during bottle feeding. Arch Pediatr Adolesc Med 1994 Jan; 148:40-2.

© Teglene Ryan
Quoting jesuschild06:

hmm maybe they have several differnt kinds of nipples? i havent done a lot o research on them. but medela is what my friends use and they havent had any problems. (i have about 8 friends currently breast feeding and working, and they all use medela).


Quoting ChWuGu:

The calma is made by medela

Quoting jesuschild06:

medela has nipples made for the breastfeeding moms. and i think there is another brand as well. i dontknow anything about the calma nipples. im also not sure 3 days is long enough to determine whether the nipples are going to cause confusion (so not an expert yet). but i would say if you are really worried, get some medela nipples.





melindabelcher
by mel on Jan. 17, 2013 at 3:44 PM
Agreed

If you eventually have problems the playtex natural latch seems to be a highly recommended nipple. I used it and had no issues.


Quoting K8wizzo:

This

Quoting audmom1218:

If baby's latch doesn't change you're fine. If latch changes/baby starts biting down, or refusing breast ditch the bottles and try a new one.



Posted on the NEW CafeMom Mobile
aehanrahan
by Group Mod - Amy on Jan. 17, 2013 at 5:46 PM
Kate posted the information that explains why the calma nipples can be harmful to a breastfeeding relationship.
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maggiemom2000
by Ruby Member on Jan. 17, 2013 at 5:54 PM

Some babies are really prone to developing flow preference and/or nipple confusion and will start to refuse the breast. Some babies will never refuse the breast even if you do everything "wrong" and use a fast flowing nipple, over feed with the bottle etc. Some babies will still have trouble even when you do everything "right". 

If it is working with your baby right now, no need to invest in a whole new set of bottles/nipples. Keep an eye out for problems, and know that changing nipples may help if problems start to come up. 

Most important is that his care giver "paces" his feeds, like this article describes:

http://blog.nurturedchild.ca/index.php/2010/12/10/baby-led-bottle-feeding/

Baby-led Bottle Feeding

Unlike breastfeeding, we’ve all seen bottle feeding, and we all know how to do it. We’ve been surrounded by it growing up. If someone handed you a baby and a bottle you would know what to do right? Of course you would, but would you know how to do it without causing a stressful feeding? Despite the large number of parents who use bottles in today’s society (whether those bottles contain breastmilk or formula), there are very few who have actually been taught how to bottle feed their baby in a manner that is respectful of the baby’s airway and natural feeding rhythm.

Bottle feeding may seem like a strange topic for a lactation consultant to be blogging about, but I feel it’s an important one. Conventional bottle feeding methods can cause problems for both breastfed and bottle fed babies, and all babies deserve to be fed in a respectful manner. By “conventional” bottle feeding, I mean the method of bottle feeding that most of us are used to, which is baby more or less on his back, and the bottle being tipped up to ensure there are no air bubbles.

This baby is being overwhelmed with milk and is showing clear stress signs.

Although I work with breastfeeding moms and babies, I do a lot of teaching about bottle feeding. The moms  that come to me, are usually having difficulty with breastfeeding, and are sometimes supplementing breastfeeding with bottles of expressed milk or formula. There are of course alternate methods of supplementing (supplemental nursing system, finger, syringe or cup feeding) but many moms are either already using bottles when I see them, or find that bottles are simply easier to deal with because they are familiar.

I often hear from moms who are afraid that they aren’t producing enough milk because their baby will gulp down a bottle after breastfeeding. It’s important for parents to understand that with conventional bottle feeding methods, babies have no choice but to gulp down everything in their bottle in order to protect their airway. If you hold a bottle upside down (even one with a slow flow nipple), it drips. When a baby being given a bottle swallows, the negative pressure created draws more milk into the baby’s mouth, meaning the baby has to swallow again to avoid choking. This is stressful for the baby, and babies will often display stress cues such as splayed fingers or toes, milk running out of the corner of the baby’s mouth, trying to turn their head away, or trying to push the bottle away. The picture above is a good example of this.

It’s not normal for babies to gulp down their entire feeding in a few minutes. When you watch a baby breastfeeding, you see that they drink for a while then take a little break before drinking again (with the exception perhaps of oversupply/forceful let down, which is a different situation). Breastfeeding is the biological norm for infant feeding. This means that with any other feeding method used, care should be taken to mimic breastfeeding as much as possible.  I have seen conventional bottle feeding methods lead to overfeeding, spitting up, reflux, wheezing and  difficulty breathing while feeding, and even feeding refusal (due to feeding being so stressful). Bottles being given to a breastfed baby can also cause problems with breastfeeding. Babies suck differently from a bottle than they do at the breast, and babies can become accustomed to the faster flow of milk from a bottle, causing them to become impatient at the breast. The tips below can help to minimize some of the problems associated with bottle feeding.

Good positioning for bottle feeding, and a baby who is relaxed and enjoying feeding.

 

Tips for bottle feeding any baby (not just a breastfed one!)

1. Hold your baby sitting upright, and start by placing the nipple of the bottle against your baby’s top lip. Wait for your baby to open up before putting the bottle in his mouth. Never force a bottle into a baby’s mouth.

2. Your baby should be sitting up enough that the bottle is horizontal (parallel to the floor). Tip the bottle just enough to keep the tip of the nipple filled with milk (as the bottle empties, you will have to tip the bottle up more). It’s fine if there is an air bubble at the base of the nipple as long as the tip is filled with milk. This works much better with a straight bottle rather than an angled one.

3. If you are supplementing a breastfed baby, or pumping and bottle feeding in the hopes of getting baby back to nursing, it is beneficial to let your baby suck on the nipple for a minute or two without getting anything, and then tip the bottle so your baby is getting milk. When breastfeeding, babies have to wait a minute or so for mom’s milk to let down, and they have to suck to trigger that let down. Babies who have been bottle fed sometimes get used to the immediate reward from the bottle and then are impatient at the breast and don’t want to wait for let down. By letting baby suck for a short while without getting anything from the bottle, you are mimicking the process at the breast, and it can help with the transition. There is no need to worry about your baby taking in air, one end or the other it will come back out!

4. Watch your baby’s cues All babies, whether breast or bottle fed should be fed whenever they show signs of being hungry, and not according to any kind of schedule. During feeding, if your baby starts to show any signs of stress (splayed fingers and toes, milk spilling out of mouth, turning head away, pushing bottle away – see picture above) then your baby needs a break. Keep the bottle in your baby’s mouth, but tip the bottle so that the nipple is pointing towards the roof of the baby’s mouth. By doing this, your baby knows that the bottle is still there and will start sucking again when ready. At that point you can tip the bottle back up so that baby is again getting milk. It is frustrating for your baby if you take the bottle out of his mouth to give him a break because he doesn’t know where it has gone or if it’s coming back. If your baby is showing signs that he is done (turning head, trying to push bottle away etc), then respect those cues and end the feeding.

5. Alternate sides part way through the feeding to mimic breastfeeding and allow stimulation to both eyes and both sides of the body. This also helps to prevent the development of a side preference when feeding.

6. Find a nipple that works well for your baby. There are no black and white answers as to which bottle nipple is “best” for a breastfed baby, because all babies are different. For young babies, make sure you are using a slow flow nipple. Even with older babies a slow flow nipple may be best if your baby is struggling with the flow of milk. Don’t worry about the recommended ages on the bottle nipple packaging, watch your baby to determine what works best for them. Unfortunately, “slow flow” is not something that is standardized, and some “slow flow” nipples actually flow quite quickly, so again, watch your baby. I do not recommend the “Nuk” or orthodontic type nipples because mom’s nipples don’t look like that! (If mom’s nipples are pinched or flattened after baby feeds, it’s a sign that baby isn’t latched on properly, or some other issue is causing baby to compress the nipple). Your baby should be able to “latch” onto the base of  whichever nipple you use. Some bottle nipples that are advertised as having a wide base and being “more like mom’s breast”, are so wide that baby ends up being just on the nipple, which is something to be avoided. There are some good pictures of how your baby should look when latched onto a bottle nipple on this post from Best for Babes titled How to Bottle-feed as You’d Breastfeed, and more information at the websitewww.breastandbottlefeeding.com.

Things to avoid:

1. Never prop a bottle. It’s a dangerous practice that is stressful for your baby.

2. Don’t bottle feed your baby while he’s swaddled. You need to be able to see your baby’s hands to watch for stress signs, and your baby needs to have his hands free to participate in feeding.

3. Don’t feed your baby with him facing away from you. Feeding is an important time for the development of social interaction in babies. Make eye contact with your baby, talk to him and enjoy the feeding as a fun interaction with your baby rather than another task to get through as quickly as possible.

4. Don’t force your baby to finish a bottle by twisting it or moving it around in baby’s mouth. Let your baby decide when he’s done. Overfeeding can lead to an uncomfortable and unhappy baby!

 

More information about the baby-led method of bottle feeding can be found in Dee Kassing’s article Bottle-Feeding as a Tool to Reinforce Breastfeeding

 

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