Nipple Level Selection Guidelines for Parents & Caregivers

Every feeding experience matters.

We understand every infants’ feeding experiences are special and should always be safe and positive. Each infant has their own individual feeding skills, which may not be a reflection of their age or size. For this reason, Dr. Brown’s® designed seven (7) reliable and consistent nipple levels and flow rates to custom-fit an infant’s feeding needs. All levels of Dr. Brown’s® Standard Silicone nipples may be used with the original Dr. Brown’s Natural Flow® and Dr. Brown’s® Specialty Feeding Systems®. “One nipple level does not fit all babies.’’ As you and your infant bond during feedings, you learn how to read your baby’s signals and know if a nipple change is needed to make their feeding experience positive and happy.

Dr. Brown’s® has developed these guidelines to help you identify the ideal nipple level and flow rate to support your infant at different stages of their feeding skill development. Changing to a different nipple level should be based on the behaviors your infant shows during bottle feeding combined with their current level of feeding skill.

Infants may feed more comfortably and successfully on a nipple level for a long period of time or may move to different nipple levels, at their own pace. Using all of the Dr. Brown’s® Nipple Levels available during their bottling experience may not be required.

Changing nipple levels may be helpful to support your infant from the earliest bottle feedings and as they grow. If your newborn infant shows some of the challenging signs – as indicated below – during feeding with a certain nipple level, it could mean the nipple flow may be faster than your infant can tolerate. Some of the signs the nipple is too fast for your infant may include but are not limited to –

  • Falling asleep at the start of feedings
  • Gulping
  • Hard sounding swallowing
  • Coughing
  • Choking
  • Bottle refusal
  • Taking a very long time to eat small amounts
  • Hard swallowing and fluid loss from mouth

Slower flowing nipple levels have been shown to help infants feed more comfortably and may allow your infant to accept the correct amount of fluid and nutrition needed to grow, develop and thrive.

Dr. Brown’s® Preemie Nipple

  • Best nipple choice for newborns and/or infants who are receiving supplemental breast feeding
  • Consider this Preemie nipple level for your baby if they are displaying behavioral discomfort such as one or more of the signs as provided above, during bottle feedings when using a faster flow nipple – for instance the Level 1 nipple.

Dr. Brown’s® Ultra-Preemie Nipple

  • The slowest of slow flow nipple rates available.
  • The Ultra-Preemie Nipple is often the first choice of medical professionals with premature or medically fragile infants.
  • This nipple is often used when the flow rate of a slower flow nipple – Preemie Nipple Level – is attempted and your baby continues to show signs that the flow rate is too fast.

Consider consulting your infant’s healthcare provider before changing nipple levels or bottle systems when your infant is having signs of difficulty accepting bottle feedings.

When considering a transition from the current nipple level, be sure to read the following information about nipple levels, flow rates, and feeding skill developmental stages that may suit your infants feeding needs:

Dr. Brown’s® Level 1 Nipple

  • Best choice for your infant if feeding well with no signs of feeding challenges and do not require the use of a slower flow nipple.
  • Use if your infant is beginning to show consistent feeding skill and starting to take larger amounts of feedings at breast and bottle.
  • This nipple level has 60% more flow rate than the Preemie level nipple.

Dr. Brown’s® Level 2 Nipple

  • Select this nipple level if your infant has established consistent feeding skills with no difficulties and taking larger amounts of feedings at breast and bottle.
  • If your infant is taking a long time when feeding from a Dr. Brown’s® Level 1 nipple consider using Level 2.
  • May consider this nipple if your infant is accepting early solids such as small amounts of cereal via spoon.
  • This nipple level has 60% more flow rate than Dr. Brown’s® Level 1 nipple.

Dr. Brown’s® Level 3 Nipple

  • Select this nipple level if your infant has established feeding skills and no longer exhibits signs of needing a slower flow nipple.
  • This nipple may be best if your infant is sitting-up with assistance or without support.
  • Use if infant is taking solid foods such as rice cereal and stage 1 – 2 fruits and vegetables from a spoon.
  • This nipple level has 50% more flow rate than Dr. Brown’s® Level 2 nipple.

Dr. Brown’s® Level 4 Nipple

  • Select this nipple level and flow for your infant with advanced feeding skills.
  • Appropriate if your infant has shown consistent feeding skills with no feeding difficulties and taking larger amounts at breast and bottle.
  • Consider for your infant if transitioning to finger foods and cup drinking.
  • This nipple flow rate has a 50% more flow rate than Dr. Brown’s® Level 3 Nipple.

Dr. Brown’s® Medical does not endorse the clinical practice of thickening feedings. All nipple levels have been tested with thin liquids only.

For more information, please contact the Dr. Brown’s® customer service department at or 1-800-778-9001.

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