I have difficulty with the idea that a parent could be taught cup feeding
over the phone.  There is an article in a recent JHL about a baby whose
feeding problems worsened significantly because parents were cup feeding
with poor technique.  Due to the risk of silent aspiration in immature
neonates, I believe that cup feeding should be demonstrated in person and
that parents using it should be observed while doing it to make sure the
infant is doing well.

I continue to have reservations about broad sweeping recommendations about
cup feeding.  I don't think it is appropriate for infants with low tonality
problems.  These infants often have difficulty organizing a bolus of milk
for a swallow.  If they are breastfeeding poorly and can't be nursed, a
bottle teat sometimes is safer than a cup as a feeding alternative because
the stiffer, longer teat helps the tongue form a central groove and helps
deliver milk to the back of the mouth for a more organized swallow. The
greater pressure -- esp. front to back-- on tongue increases
propioreceptivity and "wakes up" the mouth, "turning on" the proper feeding
reflexes.  A finger can do the same.  Both bottle teats, and fingers, and
cups for that matter can result in continued breast refusal in infants with
significant feeding problems.

 I direct interested parties to the article by Neifert, Seacat and Lawrence
calling for a standard definition of nipple confusion.  The baby who CAN'T
nurse is not nipple confused.  It is a baby with a serious feeding problem.
A lot of mothers who have babies who can't nurse get blamed, or blame others
for creating a problem called "nipple confusion."  I think the teat use may
be just a red herring in these cases because (just like all of us) the baby
must eat to survive and begins to prefer the first method that works. Once
the baby matures beyond the problem, or clever positioning or management
helps baby cope with the problem, these infants generally can nurse fine.
Of course if baby has not ever been put to breast  during the time it takes
to fix the problem, then they lose the awareness that they should be
nursing. The three authors above do discuss what nipple confusion IS (as
many of us understand it), but I think it is very important to know what it
probably ISN'T.

 Management consists of feeding baby by means of the safest way FOR THE
BABY, maintaining the milk supply, and continuing to move toward feeding at
the breast.  I do cup feed some infants, but I continue to have reservations
about jumping on the bandwagon without a good deal of critical examination
of the issues, clinical trials (yes, we should  be looking at ultrasounds of
swallowing during cup feeding). As a profession we need to be careful about
blanket statements about cup feeding.

Barbara

Barbara Wilson-Clay, BS, IBCLC
Private Practice, Austin, Texas
Owner, Lactnews On-Line Conference Page
http://moontower.com/bwc/lactnews.html