I enjoyed our Lactnet lunch at Kay Hoover's wonderful and inspiring workshop
last weekend.  I saw Pat Young's post about my and Allison Hazelbaker's
comments about cup feeding, and want to clarify a bit -- at least about my
own comments.  I also cup feed sometimes, and spoonfeed too.  I find it a
useful method with some babies.  I don't NEVER cupfeed, just as I don't
ALWAYS cupfeed.  No one method is appropriate for all babies.  I am
concerned that feeding of preemies and of some neurologically immature
infants is problematical vis a vis apnea.  The gag reflex (which some one
who posted said is what she checks to make sure it's safe to cup feed)
serves to protect the airways from LARGE objects.  It is the COUGH reflex
which serves to protect the airways from liquids.  It is noted in the PT
lit. that the cough reflex can be absent or delayed in preemies and even in
term infants in the first few days to weeks of life.  The response to fluids
in the pharynx in such infants is apnea (they hold their breath so they
don't aspirate more.) The apnea is followed by attempts to clear the
passages by swallowing.

It may not be apparant that the infant is in fact aspirating unless you
observe closely for other visable aspects:  color around lips, breathing
patterns, motoric stress signals, etc. Some of the scariest experiences I've
had have been with babies engaged in silent aspiration:  both were feeding
with bottles.  You can have a baby who isn't ready for oral feeds who will
aspirate on WHATEVER.  If the baby is having trouble with tongue control and
organization of milk into a swallowable bolus, cup feeding may be especially
difficult.

 What I object to is the deification of technique to the point where the
baby and the baby's capabilities are ignored.  There is a temptation, I
think, to seize upon some new piece of information and believe that it is
the magic bullet which will slay all the problems.  I got so excited the
first time I read about suck training.  I thought:  "Oh boy, a way to fix
everything!"  It made me feel powerful, and I had only the best intentions
to use that power to save all the babies I could.  But there were still
babies I couldn't "make" breastfeed.  I think that cupfeeding is the trick
du jour.  If we just banish the bottles...  The problem is, that doesn't
"fix" the babies who aren't nursing because they CAN'T nurse.  There is
something wrong with those babies.  Hopefully they will recover and be fine.
But we must remember those are the babies we must be the very most careful with.

Just some thoughts, and of course I agree with Kathleen Auerbach who wisely
points out that all sorts of alternative methods of feeding have been around
since before dirt, and all have been more or less successful with at least
some babies.  Tools are just tools -- our job is to intelligently individuate.
Barbara

Barbara Wilson-Clay, BS, IBCLC
Private Practice, Austin, Texas
Owner, Lactnews On-Line Conference Page
http://moontower.com/bwc/lactnews.html