Cup feeding: when baby can’t breastfeed

In a society where we are used to bottles, it seems strange to suggest cup feeding that you feed a small baby with a cup. When I first started studying breastfeeding as a student, I was amazed to hear that the World Health Organization recommends avoiding all bottles and using only cup feeding for breast-fed babies. I wouldn’t even have thought it’s possible to feed a newborn baby from a cup!

Now, being older and more experienced, I can confidently say that it is absolutely possible. In fact, it’s not even difficult once you get the technique right. When I worked in a neonatal unit, we taught the mothers to cup feed their premature babies. The babies started cup feeding when they were still very tiny – as small as 1,5 kg! – and they did very well. And you don’t need to be especially clever to cup feed either; most of our moms were minimally schooled, unemployed women from the townships and farms, and they managed to cup feed perfectly. The best part is, nearly all of those babies transitioned to feeding exclusively at the breast with no problems at all. When I compare this to the breastfeeding difficulties of the babies I see in the private sector, who had bottles of breast milk in the hospital, cup feeding really seems like a no-brainer.

Why cup feeding?

Cup feeding has many benefits over bottle feeding, especially for a breast-fed baby:

• When using a bottle, there is a significant risk that baby will learn to prefer the bottle over the breast. Not so with cup feeding.
• Cup feeding allows baby to set the pace of the feed, which is similar to breastfeeding on demand. Baby decides how quickly and how much he wants to drink; unlike a bottle, you cannot force him to drink more.
• Cup feeding ensures interaction between mom and baby. This helps mom to be more aware of baby’s cues and behaviour, which strengthens the mother-baby bond. I’m not saying you can’t interact during bottle feeding, but it is possible to bottle feed without paying any attention to the baby – not so with a cup.
• Cups are easy to keep clean.
• Because baby sits upright during cup feeding, milk will not pool in the mouth and throat. This (in theory) reduces the risk of tooth decay and ear infections.

Which babies are candidates for cup feeding?

Cup feeding is ideal for any baby that needs to get expressed breast milk or formula before breastfeeding is well established. Some of the common scenarios include:

• A baby that does not suckle well from the breast for whatever reason. Things I see often include a baby that is sleepy from a difficult birth, tongue ties and inverted nipples. Cup feeding provides a way to continue feeding the baby while you work on the breastfeeding problem.
• Premature, sick and small babies that are not yet strong enough to take all their feeds at the breast. As I said above, I’ve used cup feeding with these babies for many years, with excellent results.
• If mom wants to give expressed milk for whatever reason in the first 6 weeks or so, before breastfeeding is well established (for example, if mom needs to go somewhere or if she is expressing because of a very sore cracked nipple).
• If mom is in poor hygienic circumstances, where she cannot wash and sterilize bottles (in this case, even formula should be fed with a cup)

Once baby is a bit older and breastfeeding is well established, it is possible to give a bottle in a way that doesn’t interfere with breastfeeding. If that’s you, check out this post on paced bottle feeding. Otherwise, keep reading for instructions on how to cup feed.

How to cup feed a baby

Preparing the cup

You can use almost any kind of cup to feed a baby – even a teacup! The only requirement is that it must be clean, free from cracks and not have a lip. I find a small plastic cup is the easiest to use, but you can use whatever you have available. Even the cap that you place over the teat of a baby bottle works well.

Place your milk in the cup. It is easiest to feed the baby if the cup is one third to two thirds full; if the cup is too full it spills a lot, and if it is too empty you have to tilt the cup at an awkward angle. Rather refill your small cup from a larger container regularly to keep it comfortable.

If the milk is cold from the fridge, you can warm it by standing the cup in a container of hot water (never in the microwave!). Room temperature milk should be fine, though.

Position the baby

Many people recommend swaddling the baby while you cup feed, so that his hands don’t knock the feeding cup. In practice, however, swaddling has one big problem: baby tends to fall asleep! A sleeping baby cannot drink. I also like to be able to see baby’s hands during feeding, so that I can spot if he’s getting stressed. So here’s what I do:

• Sit baby upright, or nearly upright, on your lap. This is very important to prevent choking! Hold baby nice and close to your body to help support his back and neck.
• Use your arm to support baby’s back. Baby should be sitting against your non-dominant arm – i.e., if you’re right-handed, let baby sit on your left leg and support him with your left arm.
• Tuck baby’s arm that is closest to you between baby and your body, and tuck the other arm in between baby and your arm.
• Alternatively, use the hand of the arm that is holding baby to hold both of baby’s arms in front of his body.
• You other arm needs to be free to hold the cup, obviously. You will use your dominant (strongest) arm to hold the cup.

If you are still learning to cup feed, I recommend you take baby’s shirt off (make sure you’re in a warm room!) so that you can catch any spills with the cup. Otherwise, if baby’s already feeding well, just put a bib on baby or place a paper towel on baby’s chest to catch any small drips.

How to feed

With baby positioned as above, pick up the cup and hold it to baby’s lips. Wait for baby to open his mouth and put the cup in his mouth. The cup should reach all the way to the corners of the mouth so that the whole lower lip is against the cup. This prevents milk from spilling out at the corners of the mouth.

To let baby drink, just tip the cup until the milk is touching baby’s lip or tongue. Do not pour the milk into baby’s mouth. I repeat: do not pour the milk into baby’s mouth! If you pour, baby has no control over how fast the milk flows, and there is a real risk that the milk can go into baby’s lungs if he cannot swallow fast enough. When the milk touches baby’s lips or tongue, he will sip or suck the milk in.

Watch baby closely: when he stops sipping, or if he shows any stress signals, tilt the cup back to upright and let him take a few breaths first. Stress signals to look out for include: gulping, wide eyes, frowning, arching his back or splaying his fingers (as if he’s gesturing “stop!”). These things all show that the milk is flowing to fast for baby to handle. Stop and give baby a breather. When you continue feeding, make sure baby is in an upright position and don’t tilt the cup so far, so that baby has more control over the milk flow.

If any milk spills out of the mouth, use the cup to catch those drips. Every drop of milk is precious!

When baby closes his mouth to show that he’s had enough, it’s time to end the feed. If baby needs to take a certain amount at each feed, just wait 30 minutes to an hour and try again. Never force a baby to drink; it can create a hatred of feeding that lasts a lifetime.

Transitioning from cup to breast

How you transition from cup to breast will depend on the reason why you were using the cup in the first place. If you were just giving an occasional cup feed in-between successful breastfeeds, you can ignore this section.

Many times, however, we use a cup because the baby isn’t taking the breast. In this case, you need to keep trying to offer the breast – you don’t want to be expressing forever! Offer the breast before every cup feed, and in-between cup feeds at any time when baby seems interested. Once baby starts taking the breast, you can offer the cup after breastfeeds just in case baby wants a bit more milk. Pretty soon, baby will not need the cup anymore, and you will hopefully go on to have a long and happy breastfeeding relationship.

Alternatives to cup feeding

Just to round out the picture, here are a few other ways that you can feed expressed breast milk to your baby:

• Using a syringe. This is even easier for baby to handle than the cup, and it’s usually how we start to feed our premature babies. A syringe works well when you’re feeding relatively small volumes of milk. In most cases, a 5-10 ml syringe is a comfortable size. When feeding with a syringe, be very careful not to squirt the milk faster than baby can swallow it!
• Using a teaspoon. This is only really useful in the first few days, when you may only be producing drops of colostrum. Express them directly onto the spoon and feed to baby.
• Using a bottle. I only recommend using a bottle once breastfeeding is well established, otherwise you may end up with a baby who refuses the breast. Always do paced bottle feeding – read more about that in this post.

Have you ever used cup feeding or any of the alternative methods I discussed here? If so, leave a comment and tell me about your experiences!