Re: cup feeding
Just as a disclaimer right at the start here: I live on a ship in Africa, so the resources we deal with are WAY more primitive than what you've got.
That being said, we cup feed a ton over here. Part of the reason is because we often don't have any bottles (they get stolen when patients leave) and so our only option is medicine cups. However, we do run a small feeding program for our cleft lip / palate kiddos who need to gain weight before surgery. These babies are almost always cup fed, since somehting like a Haberman feeder is almost unheard of over here. (I think we had one, but, surprise, it got stolen!) For these little ones, we get the mamas to express what they can and then mix with fortified formula to whatever caloric density we're looking for. This often means a pretty thick final product, and especially the kids with palates just can't get a good enough suck to get that out of a nipple. As long as the kids are held pretty much upright and the milk is trickled in super-slowly, we're not seeing much, if any aspiration.
As far as nipple confusion, the babes here don't seem to get it. If a mama goes into surgery and we have to feed the baby a few bottles, they never seem to be fussed by it or by the switching back. (Although, more often than not, one of the other lactating mamas on the ward will just end up breastfeeding the kid, so we don't do that much either!)
(I'm reading back over this post and realizing all over again what a strange life I lead...)
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