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Is it necessary to change bottle nipples as my baby grows?
Q: I have been breastfeeding my 3-month-old exclusively since birth, and intend to do so for as long as I can. I am also expressing my milk so my husband can participate in our baby’s feedings, as well. The bottles I’m using suggest that I need to change nipples according to the baby’s age (the older the baby, the faster the flow). I understand the concept that the older a baby gets, the more milk he'll drink, which may perhaps indicate a need for a faster milk flow from a bottle. But if I’m breastfeeding, my breasts won't know when to increase the flow rate as my child ages…so is changing nipples really necessary?
A: Carolyn, it’s great that you’re giving your baby all the health advantages of breastfeeding. In fact, the formula manufacturers still haven’t been able to produce milk that is as healthy as breastmilk; and the bottle manufacturers still haven’t produced bottles and nipples that are as efficient as the breast.

Your breast tissue is very flexible and adapts itself to your baby’s needs. You’ve probably noticed that your breasts naturally make the amount of milk that your baby needs. The more your baby nurses, the more milk you make. Even though you may not think your nipples change, they do. The nipple tissue is also very elastic and can change depending on how hard your baby sucks. Your own nipple will deliver milk at the right speed when your baby is a 7-pound newborn with a small mouth and a weaker suck, and when he is a 21-pound 1-year-old with a larger mouth and stronger suck.

So do you need to buy new nipples for the bottle as your baby grows? Not necessarily. Since you’re bottle feeding so rarely, you might want to avoid the added expense. Watch your baby feeding from the bottle to see if he seems frustrated that the milk isn’t flowing fast enough. If his feedings are going fine, your current nipples are fine. If you want to speed up the flow of milk, you can try the old technique of taking a needle to the nipple to enlarge the hole or add another small hole. Then try out the “new” nipple to see how the feedings go. If this doesn’t work well, go ahead and buy the nipple size recommended for your son’s age.
Karen Sokal-Gutierrez M.D., M.P.H. Pediatrician