Note: The Department of Health recommends exclusive breastfeeding for the first six months. If you or a friend would like help in coping with any breastfeeding difficulties, please see your midwife or health visitor, or refer to our Support Links.

Introduction

As the founder of TIPs Ltd (www.tipslimited.com) my Mission statement is:

"To educate and inform parents and professionals about best practice in breastfeeding, neonatal skin care and cord care, and other related midwifery subjects.

Cup feeding would appear to be an innocuous subject and you may wonder why I am devoting so much time to it. When researching for this piece, I did not imagine there could be so many potential hazards associated with this practice.

Cup feeding has been around for centuries. It's only in the past 50 years that bottles, teats and cups with spouts and lids have dominated Western cultures. At this point it is important to distinguise between the two types of cup feeding. One is used in the early weeks of life, when an alternative form of feeding is required, until breastfeeding is established. In this instance, cup feeding with a small 'medicine' style beaker works well (see picture).

Secondly, from six months of age, once solid foods have been introduced, cup feeding, using an open cup, can complement breastfeeding or give an alternative to the bottle. This will help to maintain breastfeeding and fulfil the UK Committee on Medical Aspects (COMA 1994) recommendation that bottles should be discontinued by the age of one year.

One of the many benefits of breastfeeding is its action in stimulating the muscles of the tongue and oral cavity while babies suck. This complex mechanism helps to shape the jaw and teeth, and develop optimum muscle and tongue strength (Palmer 1998). When babies suck on a bottle or spout, their mouth is partially closed. Their jaw, mouth and tongue muscles are not encouraged to work as hard. Consequently, the transition to breastfeeding, after a time of bottle use, can be problematic. For this reason the World Health Organization (WHO 1998) recommends cup feeding (open design) as the most suitable alternative, when direct breastfeeding is not possible.

As a passionate advocate of breastfeeding (Trotter 2004), I am keen to dissuade parents from using bottles, teats, spouts and lidded cups for at least the first six months of life (unless for specific indications, as described below). However, once weaning begins parents are drawn to all manner of designer cups with spouts and one way valves etc as a way of feeding their babies drinks. When my children were small, even 1 admit to having the ubiquitous collection of plastic receptacles in various shapes, sizes and colours of the rainbow. This is now big business with industry-wide sales running into millions for lidded cups. Modern family life is busy and much time is spent on the move. Parents feel the need to buy cups that have non-drip lids or one-way valves to stop leaks in cars or on fumiture.

Maybe the time has come to reflect on the potential consequences of this seemingly innocuous trend on our children's health. Are lidded cups even necessary? Are there implications for oral health, speech and emotional development? Are these cups safe to use or could they harbour harmful bacteria? If we are to encourage bottle-fed babies to drink from open cups, what are the implications for those breastfeeding beyond six months? This article will address these issues and propose evidence-based advice for parents and professionals to follow.

© Sharon Trotter

© Tips Limited

To view cups and other products visit www.medela.co.uk

This article can also been seen at MIDIRS Midwifery Digest 16:3 2006