I am delighted to see the discussion about cup feeding as we always should
be examining our biases very critically -- able to defend them at a moments
notice (as we leap tall buildings at a single bound....:)

I agree that we need to see the safety of cup feeding compared to the
aspiration risk of bottle feeding (and  finger feeding) NOT to
breastfeeding.  We know there is less risk of oxygen desaturation (which is
what Paula Meier's work looked at) with bfg, because bfg is in the baby's
control. Baby can opt to just hang out at the breast and do non-nutritive
sucking while it does catch-up breathing if the effort of the last sucking
burst has resulted in an oxygen deficit. Humans must put breathing first in
importance because you run out of air before you run out of food stores.

 Endurance is a huge feeding issue.  If a baby at breast has such poor
endurance that it terminates nutritive sucking too soon, before it consumes
enough calories, then it will have a presenting problem of poor weight gain.
This lack of endurance can result from respiratory problems or from
prematurity or illness from congenital issues or from poor management.  So
if  the baby can't be breastfed or fully breastfed, the question becomes:
what is the NEXT safest way to feed AND comfort this baby? The comfort part
is critical to me because sucking has been demonstrated to help baby's
stabilize state/behavior.

If an infant has a low tone set of problems (flat tongue which can't
organize milk into a swallow-able bolus, a soft palate which doesn't lift to
create a seal which prevents aspiration into the airways, lips which don't
demonstrate grasping ability, etc)  then maybe a bottle with a long, round,
rather firm teat would more safely deliver fluid to the back of the mouth,
helping the baby grove the tongue and organize the swallow better.
Cupfeeding of such an infant might lead to fluids pooling in the mouth and
spilling into the airways.  Remember, the cough (which is the reflex which
clears the airways of fluid) is sometimes not a mature reflex in newborns
--esp preterms.

High tonality (thick, bunched tongue in rear of mouth) hyperextended head
position with arching, also makes organzing milk for safe swallowing a
challenge.  Bringing baby into flexion, using feeding positions which bring
the tongue forward, etc, are all useful.  I worry about the cupfed baby who
is posturing oddly, trying to stabilize its airways.

  Alternatively feeding the infant who CAN'T breastfeed is different than
alternately feeding the baby who probably CAN breastfeed.  That baby is
probably not having too many real serious problems.  A competant baby who is
preterm, or whose mom has some breast anatomy issue which is making latch-on
difficult, or a baby who has just gotten jaundiced and sleepy and needs a
jump-start -- sure cup-feed away!  I think these are the babies we've all
seen who have made us aware that yes, they can get milk this way.  But
remember:  the LC -- esp. in private practice -- is MUCH more likely to see
the baby who has serious problems, and for whom feeding is major stress.
It's these babies I am concerned about.  We should not have a casual
attitude about these infants.  Each should be carefully observed for
oral-motor function and a feeding plan should be devised which prioritizes
their safety, their caloric intake, and facilitates long-term benefits
(which is where protecting breastfeeding comes in.) Our zeal for
breastfeeding and our teat-phobias should not make us myopic about the need
for individualized planning for each dyad.

Sorry this is so long.
Barbara

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