QUESTION:
Is Alimentum formula considered a thicker formula? We have a baby that is adjusted to 37 weeks and two days and was put on the one time use Similac standard flow nipple (clear ring) that per Pados’ research is “very fast”. Our med team had nursing get nipple from our term baby floor and are using it because the Similac slow flow (yellow collar) nipple was getting plugged. However, there was a feeding when baby coughed and dropped saturation rates to the mid-80s with this faster flow nipple. I was not aware Alimentum was thicker so wanted to hear what your experiences are. I’d rather use a quality commercial nipple so at least it’s the same exact flow rate every time for starters.
CATHERINE’S ANSWER:
Alimentum is a hypoallergenic formula that is typically thinner and not typically perceived as “thicker” or likely to cause a clogged nipple. The reason for the reported observed lack of flow through the Sim Slow flow may have been the nipple ring being overly tightened, which creates a vacuum. We don’t know anything about the infant’s GA, which research tells us is more predictive of feeding problems than PMA. This infant’s history and co-morbidities may indeed profile greater risk for airway invasion with the medium flow clear ring nipple. The coughing and deep desaturations are indeed worrisome , and both are correlated with silent aspiration in the research by Ferguson. Agree a slower flowing nipple is indicated based on what we know, and perhaps other protective interventions ( swaddled sidelying, co-regulated). The Dr. Brown’s preemie flow may provide protection and avert over tightened ring. Have you had the opportunity to do a clinical assessment, and can you tell us more about history and co-morbidities? Understanding the bigger picture always helps me understand the “why” and consider both next steps and interventions more thoughtfully.
Alimentum is so super thin at baseline, that even when it is fortified 24 cal it still is quite thin and watery, in my experience. I do hear some caregivers comment that it is “thicker” when 24 cal but I suspect that is conjecture – based on the idea that typically adding something might increase viscosity. But it’s all about the baseline integrity of the fluid. Alimentum at baseline is 80% water by composition and extensively hydrolyzed, so very watery. Often, those infants who require 24-cal Alimentum have multiple possible reasons why drive to feed and volume transferred may be suboptimal. The assumed culprit is often “its thick” but, as you know, our fragile feeders often have complex underlying issues that can adversely affect feeding success.