Parent/Caregiver Nipple Flow Guidelines

Dr. Brown’s® Medical Nipple Selection Guide for all Dr. Brown’s® Zero-Resistance™ Options+™ Bottle Systems

The Original Natural Flow, Options+™, and Specialty Feeding System

Every feeding experience matters.

We understand all infants’ feeding experiences are individualized and should always be safe and positive. Each infant has their own unique feeding skills, which may not be a reflection of their age or size. For this reason, Dr. Brown’s designed eight (8) reliable and consistent nipple levels and flow rates to custom-fit an infant’s feeding needs. All levels of Dr. Brown’s® Narrow silicone nipples may be used with the original Dr. Brown’s Original Natural Flow, Dr. Brown’s® Zero-Resistance™ Options+™ as well as the Dr. Brown’s® Zero-Resistance™ Specialty Feeding System. When using the Wide-Neck bottle systems, please note that all eight nipple flow levels are not available.

One nipple level does not fit all babies.

Bonding during feedings is important to learn how to read a baby’s signals (“cues”) 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 an infant at different stages of their feeding skill development. Changing to a different nipple level should be based on the behaviors an 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 an infant from the earliest bottle feedings and as they grow. If a 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 the infant can tolerate. Some of the signs the nipple is too fast for an infant may include but are not limited to:

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

When appropriate, a slower flow nipple has been shown to help infants feed more comfortably and may allow an infant to accept the correct amount of fluid and nutrition needed to grow, develop and thrive.

This guide “Dr. Brown’s® Medical Nipple Selection for all Dr. Brown’s® Zero-Resistance™ Bottles Systems” is useful for determining which Dr. Brown’s® Nipple Level and flow rate best aligns with the individual infant’s feeding skill. This guide was established to compliment an infant-driven feeding practice and provide an appropriate solution for choosing the best nipple for the infant. Caregivers will need to determine which Dr. Brown’s® Nipple Level and flow rate best aligns with an individual infant’s feeding skill. Please refer to the information listed below.

Dr. Brown’s® Ultra-Preemie Nipple

  • The slowest of slow flow nipple rates available in the Dr. Brown’s Medical line.
  • The Ultra-Preemie™ nipple is often the first choice of medical professionals with very premature or medically fragile infants.
  • This nipple is often used when the flow rate of a faster flow nipple (Preemie Flow™ Nipple Level) is attempted and a baby continues to show signs that the flow rate is too fast.

Dr. Brown’s® Preemie Flow Nipple

  • Best nipple choice for newborns and/or infants who are breastfed and receiving supplemental bottle feedings.
  • The Preemie Flow™ nipple should be considered for a premature infant’s first oral feedings or if an infant displays feeding stress signals that the flow is too fast when using a faster flow nipple.

Dr. Brown’s® Level T Nipple

  • Best choice for an infant IF feeding well with no signs of feeding challenges and does not require the use of a slower flow nipple.
  • For use with infants requiring a nipple flow slower than Level 1 or needing to transition from the Preemie Flow™ level nipple to a higher flow nipple.
  • Often useful for full-term infants who are breastfeeding but are receiving supplemental bottle feedings.

Consider consulting a healthcare provider before changing nipple levels or bottle systems when an infant is having signs of difficulty accepting bottle feeding.

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 an infant’s feeding needs.

Dr. Brown’s® Level 1 Nipple

  • Use if an infant is beginning to show consistent feeding skill and starting to take larger amounts of feedings at breast and bottle.
  • When using the Zero-Resistance™ Specialty Feeding System, this is typically the nipple flow first attempted with full term infants born with a cleft palate.

Dr. Brown’s® Level 2 Nipple

  • Select this nipple level if:
    • An infant has established consistent feeding skills without difficulties.
    • An infant is taking larger amounts of feedings at breast and bottle.
    • An infant seems to be taking a long time when feeding from a Dr. Brown’s® Level 1 nipple.
  • This nipple may be best if your infant is sitting-up with assistance or without support.
  • May consider this nipple if your infant is accepting early solids such as small amounts of cereal via spoon.

Dr. Brown’s® Level 3 Nipple

  • Select this nipple level if:
    • An infant has established feeding skills.
    • An infant no longer exhibits signs of needing a slower flow nipple.
  • This nipple may be best if an infant is sitting-up with assistance or without support.
  • May consider if an infant is taking solid foods such as rice cereal and stage 1-2 fruits and vegetables from a spoon.

Dr. Brown’s® Level 4 Nipple

  • Select this nipple level 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.
  • May consider for your infant if transitioning to finger foods and cup drinking.

Dr. Brown’s® Y-Cut Nipple

  • The Y-Cut Nipple flow rate should only be used when dispensing the highest level of viscosity. Not for use with preterm infants.

Dr. Brown’s® Levels 2, 3 and 4 have been reported to be efficient when dispensing thicker liquid consistencies.1

Dr. Brown’s Medical does not endorse the clinical practice of thickening PO feedings. Nipple level flow rates described above are based on testing with thin liquid viscosity.

For more information, please contact Dr. Brown’s Medical at or 844-967-6767.

1Pados B, Mellon M. Effect of thickening on flow rates through bottle nipples. JOGNN. 2021;50:78-87.