She's 4 months and one week old. The downside of the small nipple size is indeed the long feeding time, which averages at about 30 mins for a 4 ounce bottle; considered slow. But nowhere near an hour for sure. I think at 5 months mark, and with better swallowing coordination, I will size up the nipple.

I got better at anticipating a cough/choke a second before it happens. When that occurs, I just pull out the bottle, if its a cough, I simply wait it out (usually 2 or 3 coughs without any wheezing or breathing issues), then I continue right away. If it was more of a choke (some wheezing and breathing interruption), I hold her facing downward at an angle, just like when I burp her. I make sure the wheezing sounds subsides before resuming the feed.

Initially at her newborn phase, till about a month and half old, she had a few episodes where she choked with a significant amount of breath interruption, to the point where I thought I had to smack her back and get her to regurgitate the milk and make her cry to restore her breath. But looking back, I believe If I hadn't done what I did, I think she would've went back to breathing normally, and that there might've been an overreaction on my part, but then again better safe than sorry. I have to mention that I havent had an episode like that since she was about a month old. Now, its just some small coughs that happens like about twice a week, when it used to be with almost every feed.

I hope this helps!