Bottle/Nipple Systems

August | September 2010 Nursing for Women’s Health 271

the lower gum line when it should be positioned forward and covering the gum line.

• Slowerflowingnipplestopreventepisodes of desaturation, as venti-lation can be compromised from swallowing repeatedly without breaks for breathing.

• Softsiliconethatiseasilydeflectedis especially helpful for late preterm infants or those with weak sucking.

I recommend the Web site http://www.lowmilksupply.org/nipples.shtml as a resource.

Marsha Walker, RN, IBCLC Weston, MA

ReferencesDowling, D. A., & Tycon, L. (2010). Bot-

tle/nipple systems: Helping parents make informed choices. Nursing for Women’s Health, 14(1), 61–66.

Geddes, D. T., Kent, J. C., Mitoulas, L. R., & Hartmann, P. E. (2008). Tongue movement and intra-oral vacuum in breastfeeding infants. Early Human Development, 84, 471–477.

Gomes, C. F., Trezza, E. M. C., Murade, E. C. M., & Padovani, C. R. (2006). Sur-face electromyography of facial muscles during natural and artificial feeding of infants. Jornal de Pediatria (Rio J), 82, 103–109.

Jacobs, L. A., Dickinson, J. E., Hart, P. D., Doherty, D. A., & Faulkner, S. J. (2007). Normal nipple position in term infants measured on breastfeeding ultrasound. Journal of Human Lactation, 23, 52–59.

into the mouth, usually several milli-meters anterior to the junction of the hard and soft palate (Jacobs, Dickin-son, Hart, Doherty, & Faulkner, 2007), forms a teat and holds it in place with a baseline vacuum of –60 mmHg over the entire breastfeeding. The motion of the tongue during a suck cycle does not show a peristaltic action (as in bottle-feeding), but rather the tongue is up and in apposition with the hard palate with the anterior tongue not indent-ing the nipple. Vacuum is generated as the tongue and jaw move down, which allows milk flow from the nipple. Peak vacuum coincides with the tongue at its lowermost position. As the tongue moves back up, vacuum decreases and milk flow ceases. The tongue captures the milk that has flowed into the nipple, holding it in place until the tongue and jaw lower again with the sequestered milk subsequently flowing into the oral cavity. Electromyography has shown differences in facial muscle activity be-tween breastfeeding and bottle-feeding (Gomes, Trezza, Murade, & Padovani, 2006). Use of artificial nipples reduces masseter muscle activity and weakens an infant’s suck. Infants can remove milk from artificial nipples by sim-ply biting down on the nipple, gener-ating little vacuum. The same motion on the breast would result in nipple trauma and little milk removal from the breast—one of the prime reasons for avoiding artificial nipples until the in-fant is well-established at the breast.

Based on what is known about sucking parameters at the breast, a rea-sonable choice of artificial nipples for use with a breastfeeding infant would include the following:

•Thosewithawidebasethatgradu-ally slope toward the nipple to as-sure a more wide open mouth.

•Anipplethatisrelativelyshortandrounded as the human nipple gen-erally does not elongate as far as the junction of the hard and soft palate. Orthodontic nipples tend to cause the infant’s tongue to retract behind

ReferencesSmith, S. A., Hulsey, T., & Goodnight, W.

(2008). Effects of obesity on pregnan-cy. Journal of Obstetric, Gynecologic, & Neonatal Nursing, 37(2), 176–184.

Walters, M. R., & Taylor, J. S. (2009). Ma-ternal obesity: Consequences and pre-vention strategies. Nursing for Women’s Health, 13(6), 486–495.

Safe Infant Sleeping

Having just received the latest issue of Nursing for Women’s

Health, I eagerly read Lindsey Hoog-steen’s (2010) article about safe infant sleeping. I found it very informative. We have been very involved with this subject, having seen some of our pre-cious newborns return to our emer-gency department as victims of unsafe sleeping practices.

We also spend much time teaching our parents about safe sleep practice, but I must ask the question—Are we, as nurses “guilty by example”? In how many instances do we medicate our moms for pain, put them back to bed and then bring them the baby? How many of us have walked past a room and seen a mother sound asleep with a newborn in her arms? I think this is a call to action. Patients don’t always re-member everything we tell them in the hospital, but they certainly do remem-ber what we do.

Arlene Costello, RN, MS, NE-BC West Islip, NY

ReferenceHoogsteen, L. (2010). Safe infant sleep-

ing: What is the ideal sleeping envi-ronment? Nursing for Women’s Health, 14(2), 120–129.

Bottle/Nipple Systems

I would like to comment on “Bottle/nipple systems: Helping parents make

informed choices” (Dowling & Tycon, 2010). Vacuum (negative pressure) has been shown to be the driving force during breastfeeding (Geddes, Kent, Mitoulas, & Hartmann, 2008). Nega-tive pressure draws the nipple-areola

Erratum DOI:10.1111/j.1751-486X.2010.01568.x

In a recent article on warfarin me-tabolism (De Sevo, 2010), Box 3 on page 135 mistakenly listed the drug Coreg as an antidepressant. It is actually a beta-blocker.

ReferenceDe Sevo, M. R. (2010). Genetic vari-

ations in warfarin metabolism: Why one size doesn’t fit all with some drugs. Nursing for Women’s Health, 14(2), 131–136.