In response to Jan's question, 

Jan wondered if the infants were being cup fed because they had problems with breastfeeding. "I would posit that these babies were having problems with breastfeeding to begin with which is why they were being cup fed. Until it is known what the problem was in the first place, how do you know
that cup feeding is causing it?"

No this was not the case! The majority of infants that I had observed had received cup feeding prior to and in between nursing. As I had stated in my first post on this subject, I had worked on a very resistant and backward unit where the staff did not believe in the normalcy or adequacy of breastfeeding. Hence, nursing infants were frequently supplemented for no good reason. This was particularly true when I first arrived on the unit and was one of the many battles that I had to fight. 

The "routine" on the unit was to cup feed infants several times during their stay on the floor, starting at birth. Yet, as time went on there were a growing number of exceptions. For example, infants who were born to parents who had attended my breastfeeding classes prior to birth and felt strong enough to speak up, claimed their infants after birth and nursed them. Other mothers were lucky to be attended to by nurses who had also began to work with me and to internalize that infants should nurse at birth and continue to exclusively nurse thereafter. These nurses advocated for and supported their clients right to exclusively nurse.


However, initially, the majority of mothers and babies were not that lucky. Most of these infants became acquainted with the cup before they had ever smelled, licked or suckled at their mother's breasts. In fact, even many of the infants who had nursed at the breast right after birth were also subsequently cup fed when they were brought to the nursery after birth (another battle that we had to fight). Others babies were cup fed in between nursing and especially at night simply because some of the staff convinced mothers that it was easier or better for the maternal/infants that way. 

On a positive note, I should add that an increasing amount of members of the health team gradually joined forces to optimize breastfeeding conditions and we began to work together to make change. More importantly, as parents became more educated, they demanded that their infants not receive supplemental feeding. By the way this was in 1995-1997, not twenty years ago as one might think! 

Now, the reasons that led me to propose that there might be an association between the cup feeding and dysfunction nursing were, the similarity between the dysfunctional behaviors exhibited at the breast and the behaviors that infants displayed while being cup fed. Furthermore, as I wrote in my last post, "I came to the conclusion that cup feeding had played a role in their dysfunctional behavior, after I noted that many infants who had a history of cup feeding, displayed similar behaviors. The infants and their families did not have any other significant shared features. It is also important to note that several of my colleagues, some of whom engaged in cup feeding, noted the same behavioral patterns. The similarity in dysfunctional patterns and the similar history of oral interventions most certainly suggests that there is a possible association between the two variables! Naturally, there are intervening factors that determine if and to what degree infants, as individuals, are affected by any intervention, including alternative feeding methods." 

I would also like to comment on Pat's letter in which she suggested that infants might have problems nursing after receiving any form of alternative feeding, not just cup feeding. I fully agree. Some infants may become "breast" confused or display signs of "breast" preference" when they are brought to the breast after or while, receiving comfort (feeding, drinking pacifying) from any alternative source. Psychological reasons were discussed in earlier posts.

Pat also gave the wonderful example; "A gavage fed baby, who gets K care seems to make the transition from no feeds to breastfeeds more easily than the baby who has to jump through multiple hoops until s/he gets to mom's breast!" 

I might suggest that we compare the multiple hoops to foster care, and think of how this affects older children's ability to attach to human objects.

Keren Epstein-Gilboa MEd BScN RN LCCE FACCE IBCLC PhD(Candidate)  Human Development/Family Relations 

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