Cup feeding is unquestionably a way to get milk into a baby.  It is,
however, nothing like sucking.  It doesn't encourage good bolus formation
because the milk is delivered so far forward on the tongue.  There is
consequently a lot of pooling up of milk in the mouth, which does increase
the potential for aspiration.  When performed with poor technique, cup
feeding has risks.

For instance, I can recall standing in the back of a conf. room with Alison
Hazelbaker watching a cup feeding video.  We had a real 'moment' as we both
realized we were pacing our breathing with the very stressed baby on the
screen.  Most of the people in the room were going "Cool!  That baby is cup
feeding!", and the two of us were out of breath and rather miserable, having
empathsized  with the baby, who had wet breathing sounds, and was averting
and finger splaying and shutting down during the whole process.

Kay Hoover has video she filmed of some nurses who were demonstrating
paladai feeding in a NICU in Philadelphia.  I could barely watch it.  The
speed with which the fluid was delivered, the lack of attention to the clear
stress cues of the babies upset me.  One baby's apnea monitor was going off
the whole time, and I could hear Kay's voice in the background suggesting
the baby needed a break.  Baby, monitor, and Kay were all ignored, and the
nurse just kept pouring.

I suspect that if oxygen monitoring was done of  babies cup fed with this
kind of disregard for their cues, the results might be similar to what Paula
Meier discovered about bottle feedings and oxygen sats.  In fact, I wonder
if those results were obtained monitoring babies being bottle fed the way
they typically are.  The bottle is screwed into their mouths, and if the
baby stops swallowing for a min. they are jiggled and prodded -- all in the
name of finishing the feed as quickly as possible.  This results in babies
being deprived of oxygen and does not allow for normal respiration during
feeding (between swallowing).  It prob. also feels like force feeding, which
is defined as a form of torture in the Geneva Convention.

Many capable and sensitive people have good cup feeding technique which
paces the swallowing and breathing.  I'm not talking about them. And more
people these days (thanks to the OTs) have learned how to make bottle
feeding safer using the technique of feeder-controlled pacing.  I'm not
talking about them either.

 I AM talking about how important it is to learn assessment skills that
allow, indeed, that INSIST, upon observing the infant's feeding respiratory
rate.   ANY alternative feeding method should be individually tailored to
that baby's responses.  Perhaps prudent restraint is called for before
embracing a whole new feeding protocol, seeing as how few people have ever
trained in person with someone skilled in the technique.  Additionally, we
need emphasis on training nurses and LCs in assessment of infant stress
cues, and on improved bottle feeding technique.


Barbara Wilson-Clay BSEd, IBCLC
Austin Lactation Associates
http://www.lactnews.com

             ***********************************************
The LACTNET mailing list is powered by L-Soft's renowned
LISTSERV(R) list management software together with L-Soft's LSMTP(TM)
mailer for lightning fast mail delivery. For more information, go to:
http://www.lsoft.com/LISTSERV-powered.html