This post concerns infant development and cup feeding >4 mo. of age.
Exerpts from Susan Evans Morris, PhD, "Prefeeding Skills in the Infant" and "Feeding Skills in
Infant Development".  Both can be obtained if you e-mail your request.  What follows may be
review - but review never hurt.

INFANT DEVELOPMENT

Fetal development of rudimentary feeding is developed inutero.  As the fetus grows it is
constricted by the uterus into it's primitive development of flexor tone.  Flexion is muscle
tendency to contract to the (fetus) body's center.  The newborn's first neuromotor instinct and
function is flexion or contraction.  Studies re: fetal development (third trimester) inutero show
this flexion pattern in suck\swallow of amniotic fluid.  The "breathe part of this paradigm is
obviously missing at this time.  The flexor pattern is (hopefully) carried over at birth.

Neonatal feeding is a flexor phenomena.  The entire body is involved as the infant must flex to
feed.  Mothers assist this pattern by swaddling and cradling.  Neonatal feeding is also a flexor
response.  Mother provides torso\head\neck support as the neonate uses the flexor pattern and
energy allotment to nipple\feed.  Without proper flexion the infant expends too much energy
putting the body into alignment and subsequently terminates a fully successful feed and goes into
slumber.  This has been termed as "organization".  The infant's awake state was termed as "state
control".

Infant feeding is based on (by my education) flexion, state control and also airway maintenance -
protection from aspiration or "food" getting into the lungs.

CUP FEEDING >4 MO.

Cup feeding of neonates has to be addressed in context of all three measures (flexion, state,
airway maintenance).  Because (and I can back this up with a lit. review) cup feeding is not a
developed skill until at least 4 mo. of age.

BUT - Evidence exists that it can (and has) been done.  Problem is no conclusive evidence has
been supported to say it is SAFE.  And folks, let's be realistic.  Safety is the real issue.  Cup
feeders >4 mo. SAY it's safe.  But no studies have conclusively proved it.  Why?

Let's address why.  An MD's first concern is survival. (and with the advent of managed care -
even more so).  But it still is a good point, wouldn't you say?  In infant survival today the
primary concern (especially in the NICU) is cardiorespiratory - not breast feeding.  Heart don't
pump, lungs don't absorb, baby dies.  (I'll never forget my first.)  Cup feeding >4 mo. threatens
the airway.  See JAMA and NEJM.  That is what MD's read.  (But not SP's)

Point - Prove your worth.  How - Definitve evidence cup feedind >4 mo. works.  What -
Videofluoroscopic Swallow Studies on infants for cup feeding.  Unacceptable!  Invasive barium and
irradiating infants won't "pass muster" in either professional or lay circles.  It is done but
too limited to provide the hard evidence.  Alternative - I'm looking into ultrasound as it is
noninvasive and underexplored.  Can it be done? Comments?

Geoff

Passion - The primary element to success.  Compassion (or empathy if you will) what naturally
follows.  Enlightenment - The ability to develop passion into an achievable goal.  The three
together equals success.