Cup feeding

How does cup feeding work?

Feeding by cup (cup feeding) is an option for younger babies who need milk supplements. When cup feeding, babies lap the milk with their tongue. The advantages are that it prevents the baby from getting used to the bottle and may allow for an easier transition to the breast than bottle-feeding. It’s easy and works for most babies. On the other hand, it can produce spills and there is a small increase in the choking risk. To feed a baby with a cup, place the edge of the cup inside the lower lip and tip the cup down to bring a small amount of milk forward to the edge of the cup. The baby will lap the milk like a kitten. Babies older than six months can drink from a sippy cup or other safe drinking container. This is not cup feeding.

A) Describing cup feeding

Baby feeding from a cup.

After six months of age, many babies can drink milk from sippy cups (a cup with a lid that has a spout or hard nipple) or other safe drinking containers.

Younger babies can use cups by lapping the milk with the tongue. This is called cup feeding. This is one way of giving milk to babies who need supplementing with milk.

Cup feeding has a long history as a feeding option for newborns (McKinney 2016).

B) Pros of cup feeding

Cup feeding (Collins 2016):

  • Prevents the baby getting too used to the bottle.
  • May allow for easier transition to the breast compared with bottle-feeding (Gomes 2009).
  • Uses jaw and mouth muscles in a way that is closer to breastfeeding than bottle-feeding (França 2014; Gomes 2009).
  • Is cheap.
  • Results in easier cleaning than other feeding tools.
  • Works for most babies.
  • May increase long-term breastfeeding rates of premature babies (Howard 2003; Yilmaz 2014).
  • When used by hospitalized babies (Penny 2018):
    • Appears to increase breastfeeding rates (Collins 2016).
    • Allows for better oxygen levels and a more stable heart rate than bottle-feeding (Flint 2016).
    • Does not result in slower weight gain (Flint 2016; Nunes 2019).

C) Cons of cup feeding

Considerations when cup feeding:

  • Babies can spill milk when they knock the cup with their hands.
  • There is a small increase in the risk of choking (Collins 2016).
  • Technique is important.

Cup feeding:

  • May not be acceptable to parents or other care givers (Collins 2016).
  • Is best for smaller amounts of supplement.
  • Can result in babies taking in less milk compared with bottle-fed babies.
  • May delay discharge from hospital for very premature babies (Flint 2016).

D) Equipment

You will need a container with an open edge, which could be a:

  • Small cup
  • Egg cup
  • Medicine cup
  • Commercially-made feeding cup
  • Paladai (a feeding tool which is shaped a little like a gravy-boat and commonly used in India)

The cup should be clean and not have a sharp rim.

A feeding cup is different from a sippy cup, which has a spout.

E) Method of cup feeding

Have the baby at about a 45-degree angle with the head above the bum:

  1. You may have to wrap the arms up a little in a blanket to keep them out of the way.
  2. Hold the baby sideways against you: 
    • With your hand behind the baby's neck and shoulders and the bum resting on your lap or on a pillow on your lap, or
    • With the baby’s neck and back supported by the bend in your arm, your arm wrapped around the baby, and your hand holding the baby’s thigh.
  3. Place the edge of the cup inside the lower lip with your other hand.
  4. Tip the cup down to bring a very small amount of milk forward onto the tongue.
  5. The baby will not drink from the cup but rather will lap like a kitten.
  6. Watch the baby carefully for signs of worry, unhappiness, or choking as these can be signs that the milk is flowing too quickly into the baby’s mouth.
  7. Cup feeds should not take more than 30 minutes.

References

Collins CT, Gillis J, McPhee AJ, et al. Avoidance of bottles during the establishment of breast feeds in preterm infants. Cochrane Database Syst Rev. 2016 Oct 19;10:CD005252
 
Flint A, New K, Davies MW. Cup feeding versus other forms of supplemental enteral feeding for newborn infants unable to fully breastfeed. Cochrane Database Syst Rev. 2016 Aug 31;(8):CD005092
 
França EC, Sousa CB, Aragão LC, et al. Electromyographic analysis of masseter muscle in newborns during suction in breast, bottle or cup feeding. BMC Pregnancy and Childbirth. 2014;14:154. doi:10.1186/1471-2393-14-154
 
Gomes CF, Thomson Z, Cardoso JR. Utilization of surface electromyography during the feeding of term and preterm infants: a literature review. Dev Med Child Neurol. 2009 Dec;51(12):936-42

Howard  CR, Howard  FM, Lanphear  B, et al. Randomized clinical trial of pacifier use and bottle-feeding or cup feeding and their effect on breastfeeding. Pediatrics. 2003;111(3):511–518 

McKinney CM, Glass RP, Coffey P, et al. Feeding Neonates by Cup: A Systematic Review of the Literature. Matern Child Health J. 2016 Aug;20(8):1620-33
 
Nunes JA, Bianchini EMG, Cunha MC. Oxygen saturation and heart rate in premature: comparison between cup and finger feeding techniques. Saturação de oxigênio e frequência cardíaca em prematuros: comparação entre as técnicas de copo e sonda-dedo. Codas. 2019 Dec 2;31(6):e20180221
 
Penny F, Judge M, Brownell E, et al. Cup Feeding as a Supplemental, Alternative Feeding Method for Preterm Breastfed Infants: An Integrative Review. Matern Child Health J. 2018 Oct 16

Yilmaz G, Caylan N, Karacan CD, et al. Effect of cup feeding and bottle feeding on breastfeeding in late preterm infants: a randomized controlled study. J Hum Lact. 2014;30(2):174–179