Look for information about aspiration risk during feeding in the physical
therapy, occupational therapy, and speech pathology literature and you will
find plenty of reasons to be concerned about cup feeding the baby who has a
swallowing problem.  Cup feeding is just one more way to alternatively feed
a baby who is not feeding normally (ie not able to breastfeed -- which is a
symptom of dysfunctionality, either transient or enduring).  Cup feeding is
nothing like like breastfeeding.  That doesn't make it good or bad.  It is a
tool which is an appropriate intervention if:  1.  the baby can safely
swallow,  2. is something mother can keep cleaner than a bottle, and 3.  is
something the feeders can be taught in person with return demonstration.
Read Virginia Thorley's article about improper cup feeding technique and
aspiration risk in JHL, 13(1) 1997.

Can a normal baby cup feed?  Sure.  Can a cup be a good remedy for a
short-term jump-start for the baby who just needs a bit of help?  Yup.  Can
the cup be a good method for feeding the preemie if there is a feeder who is
willing to go slow and let the baby control the pace?  You bet.  But babies
who are unable to breastfeed BECAUSE they are dysfuntional swallowers may do
far worse on a cup -- esp. if the feeder is pouring the milk into them
trying to hurry up the feed and get to the next baby or next task. I cringe
when I watch the body language of some of the babies in the cup feeding
videos shown at conferences or when I try to pace my breathing to duplicate
theirs.

Aspiration can occur before, during and after a swallow.  Before:  milk
pools in the vallecular and pyriform sinuses due to inability to organize
the bolus, or because there is a delay in triggering the swallowing reflex.
The next time the baby breathes, aspiration occurs.

During:  reduced or insufficient laryngeal elevation and closure permits
milk to seep under the epiglottis and into the airway waiting for the next
breath to get sucked into the airway.  This type of aspiration can occur in
infants with stamina problems.  They feed well for a while, but as they
fatigue toward the end of the feed they aspirate.  This is termed "fatigue
aspiration".

After the swallow, some infants who have inhaled milk into their
nasopharynx will have milk then drip down into their airways and aspirate.

Babies with swallowing probs. usually have 'wet' or noisy breathing, and
often sound congested.  I would be very hesitant to cup feed a baby who has
a swallowing dysfunction.  I would chose a very slow flowing bottle and
teach paced bottle feeding, or a finger-feeding method where I could control
the bolus and match it to baby's facial responses and body language and
breathing rhythm.  I'd show the mom how to help baby pace the
suck-swallow-breathe no matter which method I chose.  No one method should
be written into a protocol on a one-size fits all just for its "political
correctness."  All alternate feeding tools should be matched to the
individual baby and be evaluated for safety by direct observation for a
whole feed.

Barbara Wilson-Clay, BSEd, IBCLC
Austin Lactation Associates, Austin, Texas
http://www.jump.net/~bwc/lactnews.html

             ***********************************************
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