Baby Cup Feeding

The cup can be used by parents who primarily wish their baby to be breastfed, but who on occasion need an alternative method of feeding. It will be most successful when the baby is wide awake and interested. Expressed breast milk is the ideal milk to use but formula milk may also be given.

How to cup feed

The method of cup feeding is the same for any baby.

1. Wrap the baby securely, to prevent its hand knocking the cup. Place a napkin under its chin.
2. Support the baby in an upright sitting position on your lap, so that you are both comfortable.
3. Have the cup at least half full (if possible).
4. The cup should be tipped so the milk is just touching the baby’s lips. It should NOT be poured into the baby’s mouth.
5. Direct the rim of the cup towards the corners of the upper lip and gums, with it gently touching/resting on the lower lip. Do not apply pressure to the lower lip.
6. Leave the cup in the correct position during the feed. Do not keep removing it when the baby stops drinking. It is important to let the baby take as much as it needs in its own time.

How to clean the cup

1. Wash in warm soapy water
2. Rinse in clean water before sterilising

The baby with special needs

Reasons for its use:

1. To provide a positive oral experience for a baby.
2. To provide an alternative method of feeding when a mother is not available to breastfeed her baby.
3. To avoid nipple/teat confusion, which can arise from the early and inappropriate introduction of bottles.
4. To reduce the need for nasal and oral gastric tubes.

Advantages:

1. The baby paces its own intake in time and quantity.
2. It requires little energy expenditure.
3. It stimulates the suck and swallow responses.
4. Stimulation of saliva, lingual lipases and more efficient digestion of the milk.
5. It stimulates tongue and jaw movement.
6. Less fat is lost with a cup than via gastric tubes.
7. Very easy to maintain good eye contact, the baby is held very close for the feed.

Disadvantages:

1. Term babies tend to dribble!
2. Term healthy babies can become addicted to the cup if they cannot breastfeed regularly

The cup must not replace breastfeeding without very good reason and must not be used without professional guidance.

The Preterm Baby

A cup can safely be used to feed a baby from 32 weeks gestation!

A cup may be appropriate when:

1. A preterm baby is wide awake and restless at feed times.
2. Shows signs of wanting to suck.
3. Is not satisfied by gastric tube feeds.
4. A baby is not yet able to feed directly from the breast, or has only enough energy to satisfy part of its total nutritional needs at the breast.

The majority of preterm babies receive their milk via nasal or oral gastric tubes. Cup feeding may be commenced when 2-3 hourly bolus tube feeds are introduced or established. It is not appropriate whilst continuous or 1 hourly bolus feeds are required.

When the baby is initially being introduced to the breast an occasional cup feed may be given if supplementation is required. It may be a useful compromise to give the baby gastric tube feeds overnight and alternate the breast with cup during the day. Otherwise the cup should be used intermittently when the baby is able to go to the breast successfully on 3 or more occasions a day, this can be continued overnight as appropriate. The gastric tube should be removed at this time, but should be replaced if there is any concern over the baby’s weight gain.

The term baby

Cup feeding is ideal when a gastric tube is unacceptable or inappropriate, particularly at times when the mother is not available for all breast feeds. It can be used as a method of supplementation in a number of situations, such as jaundice, and giving oral drugs to a breastfed baby.

The cleft lip and/or palate baby

Cup feeding may be used if there is a possibility that the baby will be able to breastfeed. It can be used in the period during which establishment of breastfeeding is taking place. It is helpful to give an initial small amount by cup so that the baby is less frustrated initially at the breast, or it can be used to supplement a baby’s feed.

The baby who cannot suck

Cup feeding has a particularly important role with babies unable to feed from either the breast or bottle. Once this difficulty is established, cup feeding should be considered as an alternative to the long term use of gastric tubes. Rather than suck, a baby sips or laps milk from a cup, and those with neurological problems are also capable of this.

Not only does cup feeding encourage the movement of the tongue and muscles of the mouth, but also allows the baby to enjoy its feeds and strengthens the relationship between parent and child. Early positive oral experiences are likely to lead to more successful weaning.

How much should the baby take?

This will depend upon a number of factors:

1. Initially a preterm baby may take only a small amount from the cup, maybe 5-10 mls.
2. A baby, at any gestation, may want very little milk at one feed and a lot at the next. Whether the baby requires topping up or not depends on
3. In the case of a baby who is capable of breastfeeding but not yet able to satisfy all its needs allow it to have a cup after the breast. The
4. If a preterm (or term) baby initially 'fights' at the breast, to settle the infant, give a small amount of milk by cup before the breastfeed.

References

Cup feeding in the developed world:

1.    Giroux JD, Sizun J, Alix D. L’alimentation a la tasse chez le nouveau-ne. Arch. Fr. Pediatr. 48: 737-40 1991

Additional reading

Cup feeding in Developing Countries:

1.    Musoke RN. Breastfeeding Promotion: Feeding the Low Birth Weight Infant. Int J Gynecol. Obstet 31: Supple. 1 57-59 1990
2.    Armstrong HC. Breastfeeding Low Birthweight Babies: Advances in Kenya. Journal of Human Lactation. 3 (2) 1987
3.    Mulhudhia SO et al, Postnatal Weight Gain of Exclusively Breast Fed Preterm African Infants. Journal of Tropical Paediatrics. 35:241-244 1989

Other references to cup feeding:

1.    Newman J. Breastfeeding Problems Associated with the Early Introduction of Bottles and Pacifiers. Journal of Human Lactation. 6 (2): 59-63  1990
2.    Minchin M. Premature Babies: Why Breast is Best. New Generation, 36-37 September 1987
3.    Auerbach KG. Assisting the Employed Breastfeeding Mother. Journal of Nurse-Midwifery. 35(1):26-34 1990

This information has been compiled by Cornwall Midwives as part of the UNICEF training pack for health professionals. Thank you to them for allowing Real Baby Milk to use them on www.realbabymilk.org

Date: Sep 2006