Geoff, I find your comments and the responses to them both to be extremely
thought provoking.  Please continue this debate/discussion.   Also, welcome
to lactnet. NDT,OT/PT and Speech Pathology have much to contribute to the LC
field.  One common problem in these fields however is the tendency to view
bottle behaviors as the normal model instead of breast behaviors as the
normal model.

It has been suggested Geoff read LC literature.  Well, we LCs should read
NDT,OT/PT/Speech Pathology literature as well.   There is much to be
learned.  We also must struggle with learning each other's jargon.   Our
goal should be to move toward a more universal understanding and language as
related to infant feeding.

Dangers of silent aspiration have been pointed out.  We must not limit
ourselves to worrying only about infant mortality, but also consider
morbidity.   I would further suggest we keep in mind that not all infants we
work with will receive breastmilk alone from the cup.  In cases of
undersupply we may be cup feeding AIM (artificial infant milk) while working
to increase mother's supply and improve latch.  We need to know how to
safely feed AIM in our non ideal world.  Silent aspiration of AIM must
continue to be our concern.

I'd also love to see more discussing on the sippers as opposed to the
lappers.  In my practice (which is now with full term cup feeders rather
than with preemie cup feeders) I place the cup over the tongue, at the
corners of the mouth, the infant's tongue extends under the cup and s/he
sips.  It seems to me this would place the bolus further back in the mouth
and be superior to lapping.  It also may facilitate the tongue groove if the
cup is small enough in diameter.  The infant's tongue stabilizes the cup, it
seems to me much as it does the breast.  When cup feeding is going well the
infant's tongue is well extended UNDER the cup.

Susan expressed concerns about needing to be able to teach alternate feeding
methods by phone.  Let us not forget that bottle feeding is suggested BY
PHONE frequently when mothers are in distress and call their doctor's
office.  I'm confident that many of these mother's have never been taught IN
PERSON and UNDER SUPERVISION how to bottle feed.  We do have the research to
prove bottle feeding is dangerous, at least in preemies.   Let's not condemn
folks who are making the best the out of a rotten situation and remove a
tool from the phone helper without a bit more thought.  Couldn't cup feeding
be at least as well described over the phone as bottle feeding?  If not are
we not then saying that cup feeding IS more dangerous than bottle feeding?
This is not to encourage phone only consultations but really, if we condemn
teaching cup feeding by phone and no in person help is available what is the
alternative except to continue as is or to bottle feed?   Very good points
were made about differentiating what the primary reason any feeds other than
the breast are needed.  In the case where the infant's feeding skills are
the primary problem phone help is more problematic than in the cases where
the supply is compromised by management or maternal anatomical challenges
exist.  Of course determining this by phone is difficult.  I'm not
advocating "phone cures" in these cases but simply pointing out that we need
to consider that reality is sometimes ugly and ideals may not be possible in
all cases.  Also we need to remember bottle feeding is the other alternative
and it is not safe either.

This discussion is one of the best threads to appear on lactnet in a long
time.  Geoff, thank you for being here, stimulating such thought, perhaps
shaking up some complacency on our parts.  Hopefully you also are gaining
similar benefits from us.  Always remember the breast model is the norm and
the bottle is just something our culture has gotten used to.

Carla (just north of Washington, DC)