>>>From my clinical experience, there is no contraindication to giving liquids
>>> (using the generic term) infants under 4 months of age with a cup or spoon.
>>What about aspiration?  What about necrotic lung tissue that never is
>>fully discovered until autopsy?

It was my impression - I do not know where I learned this but I've
functioned under this impression and taught this information as needed
since the early 80s at least - that it is the *type* of fluid aspirated
that causes problems - some worse than others.

Formula of any kind is especially traumatic to lung tissue and causes
nasty pneumonias that rapidly become bacterial, often requiring IV
antibiotics in the infant.

Human breastmilk does not; in fact, I learned (possibly from Dr.
Jelliffe?? I'm sorry I cannot remember nor can I put my hands on any
data) that human breastmilk is a "physiological normal" fluid. This is
"normal" in the chemistry definition/sense, which I understood to mean
that breastmilk has similar properties to blood serum - similar pH, etc.
Obviously, breastmilk aspiration should be avoided if possible, but if
breastmilk is aspirated, it is gentle on lung tissue and will actually
be absorbed by the lungs at the cellular level (as if it were serum).
Also, (especially if it were fresh breastmilk) it will have lysozymes,
white blood cells and macrophages all "applied" locally in the lungs
which should actually decrease the risk of a secondary bacterial
pneumonia!

It should go without saying, but cupfed breastmilk *cannot* have any
additives such as Fortifier or vitamins or MCT oil, etc.

Thus, maybe the caveat we need to add to cupfeeding protocols for
infants under 4 months (adjusted age) should be that cup feeding is
*only* done with *plain human breastmilk, preferably fresh*.

Mostly lurking these days while I slug through grad school, but still
reading (whew! but Lactnet is prolific!),
Katharine West, BSN, MPH
Sherman Oaks, CA