>To tell you the truth, Iam personally getting a little tired of the whole subject.<

That doesn't resolve anything.


>There seems to be something called "silent aspiration", never documentedin premature babies,<

Uh, excuse me.  There are closets of video tapes documenting this.  There
is literature documenting this.

>but coming from the observation of older childrenwith severe neurologic problems.<

That is absolutely incorrect.  Silent aspiration is not relegated to *severe
neurologic problems as you *suggest*.

>  This hardly seems a solid foundationon which to develop an entity in healthy premature babies.<

If you are wrong it is.

> There is a concern, based on theory, that premature babies (or eveninfants younger than 4 months) may not be able to drink from a cup
without this "silent aspiration" occurring, and possibly leading to
chronic lung problems.<

>There has been a proposition put forth that cup feeding must bedocumented safe before using it in premature babies.<

>Though several people brought up the question of what fluid was actuallybeing fed, this was dismissed on some occasions.  This is of capital
importance.  It is the reason, for example, that barium studies of
reflux or other contrast for aspiration are suspect.  Contrast is not
milk, and breastmilk is not formula.<

>I would like to point out that, according to some of Geoff's posts, thetheory also seems to state that babies younger than 4 months cannot lap
up milk from a cup.  This is patently false as many of us have
witnessed in real life, not in theory. <

I suggest you check your infant development just a little closer.
Casual observation does not prove anything.  An infant does not *lap*
The response is suckle and the point is far from moot.

> I also believe, based on myexperience, that babies (some, if not all) do suck differently on a
bottle than at the breast, regardless of what the theory states.<

>I have never heard of a baby aspirating when cup fed, and we use a lotof cup feeding in Toronto (more than is necessary, for sure, but that is
another issue).  One must ask the question:  If silent aspiration is
occurring, then surely we should be seeing at least a few cases of
obvious aspiration as well.<

How do you *see* silent aspiration?  You have already discounted video
fluoroscopy.  And you have not even remotely addressed the possibility
of ultrasound.

>Why aren't we?  Or are we and I am notaware of it?  In the situation in adolescents that Geoff quotes, obvious
aspiration occurs not infrequently.<

So what are the risks? *Or are we and I am not
aware of it?*  You imply that there are risks.  I am stating those risks
need to be observed and studied.  They have not been to date.  Flaming me
*I am personally getting a little tired of the whole subject.* doen't
answer the question.

>Cup feeding has been around for much longer than bottle feeding.  If weare going to try to prove that cup feeding is safe, then we also need to
prove bottle feeding is safe, which has never been done.<

I agree.
>Some of youare in a beautiful position to actually do the studies and the studies
should be done.  Let us do the studies, with breastfeeding, bottle
feeding and cup feeding (maybe finger feeding and use of a nursing
supplementer as well).  Start with the O2 saturations first.<

O2 sats have been found to be a screening tool only when matched against
directb observation.  I'll mail the article if you like.  I use them but
they need to be compared directly with video studies.  That process is
presently under way.

>Finally, I would like to point out that, with a few exceptions, some ofwhom are on Lactnet, pediatric occupational therapists, are generally
wedded to bottle feeding.  They love bottle feeding.  They spend much of
their time trying to get babies with various problems to learn to bottle
feed.  Their entire outlook on infant feeding is from the bottle feeding
point of view.  This colours their interpretation of data.  Many, if not
most, of the studies of "normal" feeding were done on bottle feeding and
this taken as the norm.  I would point out to all you out there that
only a few years ago pediatricians said that babies did not smile before
the age of 8 weeks.  That was the theory.  So if the baby smiled before
8 weeks, the reason could not have been social development, it must have
been "gas" (medical students giggle at staff man's comment and at
mothers' obvious stupidity in thinking their 5 week old was smiling
socially).<

Without new evidence, documented proof, the present standards have to be
followed until proven different.  May I remind you that being an MD also
*colours* your interpretations as well.  What if I were to quote Homeopathy
to contradict you?  Let's be fair about this.

>We *could* help support breastfeeding mothers, LC's, physicians andOT's, but I only wish OT's spent as much time studying breastfeeding as
they do bottle feeding.  And even spent half the time helping mothers
and babies to breastfeed as they do helping them to bottle feed.<

Please provide some accepted measure to back this statement.  It is pure
anecdote and wholly incorrect where I practice. Therapy centers on the
mother's wishes, not what the therapist wants.  Need I remind you that
the medical course is in more cases than not designated by the MD.

>Jack Newman, MD, FRCPC<

Response by Geoff Blankenmeyer,MS;CCC-SLP