Dani asked for refs. to document the advantage of cup feeding over bottle
feeding for non-nursing infants.  I appreciate Sandra Lang's work and the
experience and feed-back from all of those who are successfully using this
method to feed babies, but I think it is important to remember that sucking
is very impt. for babies.  It helps them organize state behavior, and in the
work of Bernbaum, Anderson and others from the early 80's, we see that
preemies allowed to suck on pacifiers progressed more quickly to oral feeds,
had better weight gain, and were discharged earlier. Those are important
benefits. I think cup feeding has some benefits when a feed or two must be
missed, or a baby needs a jump-start of energy to help a feed go better, but
I have some reservations about weeks of cup-feeding and the deprivation of
all that sucking.  If the intent is to prevent nipple confusion, is the risk
worth the benefit?  Especially seeing as how babies can get fixated on any
alternative form of feeding. This is a question that has not been adequately
answered in my mind, and I hate to see these therories be made into the
dogma de jour.  No one technique or feeding alternative is right for every
baby, and we need to select all clinical options on a case by case basis. To
want all babies in a unit to be cupfed is as inappropriate as insisting that
all be bottlefed.

The issue of whether cup feeding better approximates correct tongue activity
is something else to consider.  In breastfeeding as I understand it, the
anterior tongue extends to the lower lip line, the tongue grooves around the
nipple, and there is no lapping motion.  The tip of the tongue stays curled
around the nipple.  The posterior tongue rises in a peristaltic wave to
compress the teat against the hard palate, moving the bolus of milk to the
back of the throat. If I was working with a baby with a short frenulum, and
I wanted to promote wider range of motion and more stretching of the
anterior tongue, I might choose cup feeding for that very reason.  But I
don't understand how lapping approximates nursing better than sucking a
bottle teat does.

Additionally, the immature response (infants 0-4 days of life esp.) to fluid
on the larynx is apnea followed by swallowing to clear material out of the
air way.  By the end of the 1st mo pp most babies will have developed the
more mature response of coughing first.  Just because some say infants
handle cup feeding well becaues they don't cough during cup feeds doesn't
mean silent aspiration isn't going on. This might prove very stressful to
prematures, where apnea is more common anyway.  I think that very careful
feeding technique and close observation would maybe prevent this, but when I
think about wholesale switching from bottles to cup feeds in preemie
nurseries, I wonder about whether these issues will be adequately addressed.
Pneumonia rates need to be carefully observed in these units, and
appropriate in-servicing of feeding staff would be critical.

Don't get me wrong.  I think bottles have problems too, witness Meier's work
on apnea and oxygen desaturation.  We need to carefully chose type of
bottles according to shape, flow rates, etc. so that if a bottle seems the
appropriate choice for a non-nursing infant it is chosen with deliberate and
clinically based intent.

You know, I keep harping on the same themes, but this is supposed to be a
science.  We are supposed to play devil's advocate and assume a real "prove
it to me" attitude about new techniques so that we do no harm.  We also are
supposed to remember the important old articles and read the new ones, and
apply the kind of selection process with equipment that other specialties
would.  I certainly don't want my mother's cardiac doctor trying some new
proceedure just because it sounds good and fits some philosophical bias he
has. I want him to prove to me that it is both safe and efficacious.

Barbara