My last posting on this was somewhat accidental, in that I was sending
it to someone privately, and hit a wrong button.  For this reason, it
may not have been too clear and to the point.  To tell you the truth, I
am personally getting a little tired of the whole subject.  There have
been a lot of side issues which have deflected us from the point, I
think.  So here goes.

There seems to be something called "silent aspiration", never documented
in premature babies, but coming from the observation of older children
with severe neurologic problems.  This hardly seems a solid foundation
on which to develop an entity in healthy premature babies.

There is a concern, based on theory, that premature babies (or even
infants 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 be
documented safe before using it in premature babies.

Though several people brought up the question of what fluid was actually
being 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, the
theory 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 also believe, based on my
experience, 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 lot
of 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.  Why aren't we?  Or are we and I am not
aware of it?  In the situation in adolescents that Geoff quotes, obvious
aspiration occurs not infrequently.

Cup feeding has been around for much longer than bottle feeding.  If we
are 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.  Some of you
are 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.

Finally, I would like to point out that, with a few exceptions, some of
whom 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).

We *could* help support breastfeeding mothers, LC's, physicians and
OT'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.

Jack Newman, MD, FRCPC