In Maloney Hall earlier this year, a breast pump sat on a table, chugging like a metronome as it propelled formula through a baby bottle and into a glass beaker. After a minute, Britt Pados 鈥03, an assistant professor at the Connell School of Nursing, recorded the amount of formula in the beaker, poured it back into the bottle, screwed a new silicone nipple into place, and restarted the machine.

Britt Pados

Assistant Professor Britt Pados (photo by Lee Pellegrini)

For hours, as the timer beeped at sixty-second intervals, Pados recorded the rate at which formula flowed through various brands of bottle nipples. In jeans and a blazer, with an Apple watch on her wrist, Pados screwed and unscrewed plastic ring after plastic ring. It鈥檚 far from glamorous, but Pados鈥檚 work is helping to improve the artificial nipples used by millions of babies every day in hospitals and homes across the world.

It turns out that there are no objective standards for bottle nipples. Their flow rates vary wildly, and their marketing claims can be confusing to the point of being meaningless. That matters because specialists and researchers like Pados believe that nipple-flow rates鈥攍iterally, the rate at which nourishing fluid enters a baby鈥檚 mouth鈥攃an contribute to infant feeding problems. That鈥檚 especially concerning at a time when increasing numbers of parents are reporting such problems. The National Institutes of Health estimates that as many as one in four infants and toddlers are affected by feeding struggles.

Problems with feeding can pose health risks for babies and be a major source of anxiety for parents. Of the many things that expectant parents lose sleep over, their newborn鈥檚 ability to feed is rarely on the list. Drinking formula or breast milk seems like something that will just happen organically. When it doesn鈥檛, it can feel like failing Parenting 101. 鈥淔eeding is a big part of establishing a bond with a baby,鈥 Pados said. 鈥淲hen that鈥檚 not going well, that鈥檚 really stressful, because they need to eat to live.鈥 One study likened parental reactions to their preemies鈥 feeding issues to post-traumatic stress disorder.

1 in 4

infants and toddlers are affected by feeding struggles

鈥 National Institutes of Health

Pados鈥檚 work is changing the way that hospitals, parents, and specialists across the country select bottle nipples. But nipple-flow rates are just one of the factors that can contribute to infant feeding problems. Pados has also created assessment tools that are helping parents and pediatricians better identify and treat babies suffering from problems that range from long term refusal of certain foods to inadequate nutrition during critical periods of brain development.

And sometimes, at night, Pados will find herself responding to emails from desperate parents looking for help with feeding problems. She knows firsthand just what they are going through.

Britt Pados

Growing up in Texas and Connecticut, Pados loved to hear her grandmother, a pediatric nurse, tell stories about the children she cared for. 鈥淚 knew pretty early on that I wanted to pursue a career related to the health care of children,鈥 Pados said. That led her to 涩里番下载鈥檚 undergraduate nursing program, during which she spent time in a neonatal intensive care unit, or NICU. She fell in love with the intensity and focus of the NICU environment and, after eventually earning a master鈥檚 degree in nursing from the University of Pennsylvania, Pados became a neonatal nurse at Beth Israel Deaconess Medical Center in Boston and then a nurse practitioner at Morgan Stanley Children鈥檚 Hospital of New York-Presbyterian.

She worked with infants being treated for heart problems. It amazed her whenever parents would tell her that the most difficult part of the ordeal was not the cardiac surgery itself, but the weeks their infant would spend in the NICU afterward while learning to feed properly. 鈥淚 think parents can say,听It鈥檚 not my job to do heart surgery. It鈥檚 not my job to manage medications,鈥 she said. 鈥淏ut being unable to feed your baby can feel like a personal failure.鈥

Feeding is a big part of establishing a bond with a baby. When that鈥檚 not going well, that鈥檚 really stressful.
Britt Pados , Assistant Professor, Connell School of Nursing

In 2007, Pados began working on her Ph.D. in nursing at the University of North Carolina Chapel Hill. Three years into the program, she gave birth to twins, a boy and girl鈥攁nd learned all about the stresses of infant feeding problems. Pados first experienced contractions at twenty-three weeks, when the babies could have barely survived on their own. They ended up being born only a few weeks premature, but still needed to be fed through feeding tubes in the NICU. Pados knew the tubes snaking into their noses and throats would be in place until the babies could eat on their own. It wasn鈥檛 until day ten that her son went home. When she returned to the hospital the next day, she was devastated to find her daughter, who had been taking breast milk and formula through a bottle, back on a feeding tube. It was another week before her daughter had mastered feeding well enough to go home. 鈥淭hose were the longest eighteen days of my life,鈥 Pados said.

After completing her Ph.D. in 2012, she worked at UNC as a clinical assistant professor and adjunct professor focused on the feeding issues faced by very preterm infants. She has continued and developed that work since joining 涩里番下载 as an assistant professor in 2017.

In the Maloney Hall testing room, boxes of bottle nipples were stacked on the floor and dozens of nipples in purple, blue, and orange rings awaited testing. This batch had come from Australia, the result of a research collaboration between Pados and a speech pathologist in that country. Over two days of testing in January, Pados and Rebecca Hill, a Ph.D. student in the Connell School of Nursing, measured their flow rates. Differences among the nipples were glaring enough to be apparent to the naked eye: Some emitted tiny drips into the beaker; others, significant drops.

Assistant Professor Britt Pados

A nipple鈥檚 flow rate can be crucial, because the mechanics of swallowing formula or breast milk are anything but simple. In many ways, feeding is the CrossFit of infancy. 鈥淚t鈥檚 the most physically strenuous and complex thing we ask them to do,鈥 Pados said. Every swallow requires a baby to hold his or her breath for around a second. 鈥淔or babies who are premature or have respiratory or cardiac issues, we鈥檙e asking them to suck, swallow, suck, swallow, so that they鈥檙e interrupting their breathing a lot,鈥 Pados said.

A couple of decades ago, she said, medical personnel interpreted preemies鈥 discomfort during feeding as fatigue. If milk came out of the bottle faster, they reasoned, the feeding would go faster and be easier on the baby. 鈥淲hat we didn鈥檛 know at the time was that the reason they were getting tired was because they were having to hold their breath so much,鈥 Pados said. 鈥淎 lot of these babies can鈥檛 hold their breath that much without becoming distressed. If we slow down the flow rate, it allows them to breathe more. It slows down the pace of the feeding.鈥

When liquid exits a nipple too rapidly, she said, it can cause coughing or choking. Imagine running on a treadmill while trying to drink water being squirted into your mouth from a bottle. You鈥檇 hold your breath long enough to swallow but would end up gagging if the timing or volume of liquid wasn鈥檛 what you expected. Many newborns cope with a similar situation every time they eat, said Kayla Hernandez, a speech-language pathologist at Boston Children鈥檚 Hospital who works each week with up to forty children鈥攆rom birth through age six鈥攚ith eating disorders. It can be overwhelming and stressful and cause babies to not want to eat, and that can lead to feeding disorders. In extreme cases, she said, some child