Question: Do you know the flow rate of Avent level 1 and 2 compared to Dr. Browns flows???

Catherine’s Answer: The data you are asking about is available through the researcher’s paid access portal. Remember that your skills as a diagnostician and observer of infant feeding is the foundation for your differential and for assessing optimal flow rate, which may include objective data in radiology if indicated by your hypothesis. While the flow rate data can potentially add to that differential, your clinical impression via skilled diagnostic observation must guide you every step of the way. The flow rate data is only one piece of information – you could superimpose that on your impression and go from there. But you can still make sound clinical judgements if you do not have the flowrate data from a breast pump. There won’t always be data for every nipple in the unique setting of that infant’s co-morbidities, oral-motor control, unique swallowing physiology and nuances of RR, WOB and overall sensory-motor foundation—-which are essential considerations. Our data set from our clinical experience, and from many swallow studies with a wide variety of infants both with normal physiology (who happen to land in radiology), and with our infants with pathophysiology, together offer us data about nipple flow rate and its interaction with physiology/pathophysiology, based on our training in oral-sensory-motor, swallowing and swallowing disorders and evidence-based interventions. There won’t always be flowrate data but that should not preclude the critical thinking and reflection that underpins our differential and plan of care every time, with every infant. Step back and sort out what you understand about the infant and ask what else may be part of what is happening and stay in that “grey zone” where your clinical impressions become the pathway to interventions.