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.