Anne;

(I tried to e-mail Anne x3, but received "unsent" response each time.
So I took it to the "forum".)

You may want to hard copy this - it's a long one.  I know reading from
the CRT drives me buggy.

First, forgive my math ignorance.  Second I hope I address all your
questions because I couldn't directly overlay my response to your post.
 Here is what I know. <4 mo. (got it right this time) infants are born
with neuromotor flexion physiology.  The infant (until 3 to 4 mo.) acts
as an elementary flexor unit (Morris, et. al.).  This period of
development is termed as the stage of stability.  The infant body is
programmed to react in one motor fashion - flexion.  Oral motor flexion
(in brief) creates the suckle phenomena.  The tongue is literally a
piston that is pumped by jaw flexion and strips the nipple and creates
negative pressure and the breast is literally "milked".  Fluoroscopic
studies also show that the nipple (since it is vey flexible/supple) is
drawn to the oropharynx, breast milk rarely enters the oral cavity.  It
is expressed into the oropharynx where the (as yet to bew fully
understood) swallow occurs.  the infant averages two "pulls" at the
breast, gets a "bolus" and now learns to coordinate breathing with
swallowing.  This is a pharyngeal/laryngeal phenomena.  Airway
protection is the infants first priority - survival instinct if you
will.  After a few trials the infant organizes suckling with swallowing
and breathing.  Now the infant is an oral pump, pharyngeal swallow
mechanism.

Cup feeding goes against this paradigm as it assumes the infant can
control the bolus orally which goes against what is known about flexor
skills (again Morris and more if you wish).  And physiologic flexion
develops into the new stage (stability + mobility) with extensor
patterns seen with the only sound benchmark in the lit. - Asymmetric
Tonic Neck Reflex or ATNR.  That is the tongue works independent of the
jaw.  The jaw "stabilize"s the cup and then tongue "mobilizes" the
liquid.  Thus, drinking.

Therefore, an infant does not lap.  (Studies of infant -v- dog feeding
have been done, no references off hand).  An infant is not truely ready
for the cup, as a benchmark, until ATNR is present, ave. 4 mo.  An
infant's first response to oral stim is protect the airway.  No studies
to my knowledge have proven the real benchmark in infant feeding using
the cup - airway protection.  Bottom line, just because it dissapears,
doesn't mean it went to the stomach.  And silent aspiration is always a
risk and usually not evident until adolescence.  Scary, huh?

I am open to cup feeding but I want definitive proof of it's safety -
long term safety as well.  Just because an infant is free of pneumonia
doesn't mean it isn't aspirating.  Try an easy study.  Compare O2 sats
of cup fed and bottle fed infants in a double blind.  Lower O2 means
greater risk of airway threat.  And that is my arguement.  What is more
important infant health or cupfeeding to avoid "nipple confusion"  (I
hate that term).  And I have seen PhD's names attached to studies that
"prove" infants can cup feed as young as 30 wks AGA.  Nonsense!!!  Do
you know what infant lung maturation is at 30 wks?  Medically assisted
for short.  You orally feed a 30 weeker via any method and your risking
it's longevity if not it's life.  Again the research is out there.

 Well that is my story.  By now you may have guessed that I am
traditionally educated and pretty skeptical of cup feeding <4 mo. -
whadda ya' know, I got it right again :)  In all seriousness, I am open
to new ideas because infants are more resilient and adaptable than given
credit for.  I just won't risk their present or future health unless new
ideas i.e. cup feeding <4 mo. is clinically proven.  There are ways toi
do it (videofluroscopic swallow study, ultrasonic swallow study, O2 sat
levels) but to date the data is not there.  Yea, well - let's hope.  But
with the advent of managed care and capitation, the only way cup feeding
will be fully accepted is if it is proven to get the infant out of the
hospital faster, safe or no.  Cynical, but a hint of truth.

Sorry for the long reply.  Reply when you can.

Geoff

Please let me know if you received this, my e-mail is not always what it
seems to be.