Principles of infant nutrition
Cup feeding
Learning outcomes
Having read this chapter, the reader should be able to:
Cup feeding is considered to be a viable alternative to using a teat for a breastfed baby but it is important that the technique is correct. This chapter considers the indications for cup feeding, the potential dangers and the correct technique. It should be read in conjunction with Chapter 43, sterilization of equipment, and Chapter 41, breastfeeding.
Advantages
The undisputed ideal way for a newborn baby to feed is to be effectively breastfed. However, when this is not possible, for whatever reason, cup feeding provides a method of feeding that:
• promotes tongue action consistent with breastfeeding
• removes the possibility of nipple/teat confusion
• allows the baby to pace the feed and therefore avoid overexertion
Samuel (1998) notes that less is taken from a cup than a bottle; the newborn baby’s stomach is therefore not overdistended and the feeding pattern is likely to be similar to a baby-led breastfeeding pattern. Yilmaz et al’s (2014) randomized controlled study (522 participants) added to the literature that advocates cup feeding for preterm infants (32–35 weeks’ gestation in this study). Those cup fed were more likely to be exclusively breastfeeding on discharge and at 3 and 6 months of age than those who were fed with a bottle. This conflicted with earlier work by Flint et al (2007), who concluded that at 3 and 6 months of age it made no difference to breastfeeding status whether the baby had been fed with a cup or a teat. UNICEF (UNICEF UK 2007) consider that this latter study was flawed and continue to uphold the principle that teats should be avoided (WHO/UNICEF 1989).
Disadvantages
It is recognized that term babies can become addicted to cup feeding if not put regularly to the breast and that they can also lose the skills needed to breastfeed if the cup feeding technique is incorrect. Aspiration may also occur with an incorrect technique (Thorley 1997) and while milk wastage may be higher, the length of feed can also be longer.
Indications
Cup feeding is recognized to have three valuable uses:
1. As an interim measure for full-term babies when breastfeeding is not yet established (e.g. birth trauma, use of opiates in labour, maternal infant separation, mild palate deformities), or if supplementation is medically indicated. Samuel (1998) describes the way in which babies mature their sucking action and cites examples of the ways in which cup feeding aided term babies that initially lacked the skill. Equally, the breastfeeding mother may prefer her baby to use a cup during periods of absence, e.g. on return to work, rather than a bottle and teat.
2. For the preterm infant without sufficient suck/swallow coordination, who can easily tire if breastfed or bottle fed. Lang et al (1994) suggest that cup feeding is appropriate for babies from 30 weeks’ gestation. However, Freer (1999) demonstrated that preterm infants underwent greater physiological instability when cup feeding than breastfeeding and so encourages caution. Yilmaz et al (2014) recognized the value of cup feeding for preterm infants as a transition method prior to breastfeeding.
3. Cups are easier to sterilize than bottles and teats and can provide a safe feeding method in an emergency (ABA 2012).
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