Cup feeding associated with longer hospital stays

Elvish, BSN, DNP, RN, NP · Aug 11, 2008

So... does the baby like, lap it out of the cup like a cat? How does this even work?

Supposedly so. That is supposed to help baby keep his tongue down (or train him to do so if he's not) in order to maintain his breastfeeding latch. It's been my experience that by the time we get around to cup feeding (frantic, starving baby) that he's slurping it. That really does no one any good, IMO.

WildcatFanRN, BSN, RN · Aug 11, 2008

For those of us wanting to work with babies what exactly is cup feeding? Like with a sippie cup? I didn't think that was possible in infants let alone premie infants. Or am I really off? :confused:

prmenrs, RN · Aug 11, 2008

http://www.breastfeeding.org/articles/cup.html

(exerpt): cup feeding policy and proceedure

nancy e. wight md, faap, ibclc

why cup feed?

...to provide a positive oral experience for the baby.

to provide an alternative when mother is not available to breastfeed.

to reduce the need for nasal and oral gastric tubes.

to avoid the use of bottles which may introduce the baby to an inappropriate pattern of feeding (prevent "nipple confusion/preference").

possible advantages of cup feeding

it stimulates appropriate tongue and jaw movements.

it stimulates olfactory and oral sensory receptors.

it stimulates the production of saliva and lingual lipases resulting in more efficient digestion.

antibacterial factors in breastmilk may have a protective effect, even in the infant's mouth (e.g. otitis media).

it provides good eye contact, social stimulation and is comforting to the infant. 8

less fat is lost with a cup than via gastric tubes.

there is nothing besides milk inside the infant's mouth for him to cope with.

disadvantages of cup feeding

term babies, and to some extent pre-term infants, tend to dribble.

term healthy babies may become "addicted" to the cup if they do not have the opportunity to breastfeed regularly.

the nurses must watch what they are doing. there appears to be no aspiration unless milk is poured into the mouth, which is not the technique for cup feeding. 19,40,42

it does not fulfill the infant's need to suck.

indications for cup feeding

a baby who is near discharge who is breastfeeding but whose mother cannot be present for all feedings.

a baby whose mother is ill after delivery and who could not breastfeed.

a cleft lip/cleft palate infant whose mother wishes to breastfeed.

a baby who has a uncoordinated suck and swallow.

a term baby, when complimentary feedings are needed due to hypoglycemia, jaundice or dehydration, or to give drugs orally.

babies with neurologic problems are often able to sip or lap milk from a cup. cup feeding encourages the movement of the tongue and muscles of the mouth, allows the baby to enjoy its feedings, and strengthens the relationship between parent and child.

contraindications to cup feeding

any newborn who is likely to aspirate (poor gag reflex, generally lethargic, marked neurologic deficits)

when to introduce cup feedings

introduce cup feedings after the infant is tolerating q 2-3 hour bolus feedings by gavage. remove the indwelling ng tube after the infant is tolerating 3 cup feedings in a row.

teach all family members to cup feed. this is not difficult.

cup feeding infants take varying amounts. look at the totals, not single feeding amounts.

it can be confusing to use a cup plus a bottle plus finger feeding plus breast. use cup feeding and breast and gavage tube only to minimize the skills an infant needs to learn.

developmentally, infants tend to lap milk from the cup initially and then sip milk as their suck, swallow, breathing coordination is more mature.

procedure for cup feeding

wrap the baby so the cup will not be knocked.

support the baby in an upright sitting position.

fill the 30 cc medicine cup at least half full with breastmilk or formula.

place the brim of the cup at the outer corners of the upper lip, resting gently on the lower lip with the tongue inside the cup. (some term infants may prefer their tongue under the lip of the cup.)

tip the cup so the milk is just touching the baby's lips. do not pour the milk into the baby's mouth.

the infant usually laps the milk, or may sip it.

allow time for the infant to swallow.

let the infant pace the feedings, but limit the length of the feeding to approximately 30 minutes to minimize fatigue.

stop to burp from time to time.

leave the cup in position during the feed; that is, while the baby rests, do not move the cup from this position.

do not attempt to cup feed an infant who is not alert or who is excessively sleepy.

i have done it for term babies, never for premies. (as some of you know, i don't trust those kiddos ) sometimes, you just need to get some food into the kid, then s/he can calm down and nurse! mom and baby relax a little. 15-30 mls, no more.

it does require some patience and a lot of concentration!

crissrn27, RN · Aug 11, 2008

I have noticed that your poor breastfeeder is usually a poor cup feeder. I tend to think those kids have a belly full of junk, or they are just weirded out by the whole eating seen, lol.

WildcatFanRN, BSN, RN · Aug 12, 2008

http://www.breastfeeding.org/articles/cup.html
(exerpt): cup feeding policy and proceedure
nancy e. wight md, faap, ibclc
why cup feed?

...to provide a positive oral experience for the baby.
to provide an alternative when mother is not available to breastfeed.
to reduce the need for nasal and oral gastric tubes.
to avoid the use of bottles which may introduce the baby to an inappropriate pattern of feeding (prevent "nipple confusion/preference").

possible advantages of cup feeding

it stimulates appropriate tongue and jaw movements.
it stimulates olfactory and oral sensory receptors.
it stimulates the production of saliva and lingual lipases resulting in more efficient digestion.
antibacterial factors in breastmilk may have a protective effect, even in the infant's mouth (e.g. otitis media).
it provides good eye contact, social stimulation and is comforting to the infant. 8
less fat is lost with a cup than via gastric tubes.
there is nothing besides milk inside the infant's mouth for him to cope with.

disadvantages of cup feeding

term babies, and to some extent pre-term infants, tend to dribble.
term healthy babies may become "addicted" to the cup if they do not have the opportunity to breastfeed regularly.
the nurses must watch what they are doing. there appears to be no aspiration unless milk is poured into the mouth, which is not the technique for cup feeding. 19,40,42
it does not fulfill the infant's need to suck.

indications for cup feeding

a baby who is near discharge who is breastfeeding but whose mother cannot be present for all feedings.
a baby whose mother is ill after delivery and who could not breastfeed.
a cleft lip/cleft palate infant whose mother wishes to breastfeed.
a baby who has a uncoordinated suck and swallow.
a term baby, when complimentary feedings are needed due to hypoglycemia, jaundice or dehydration, or to give drugs orally.
babies with neurologic problems are often able to sip or lap milk from a cup. cup feeding encourages the movement of the tongue and muscles of the mouth, allows the baby to enjoy its feedings, and strengthens the relationship between parent and child.

contraindications to cup feeding

any newborn who is likely to aspirate (poor gag reflex, generally lethargic, marked neurologic deficits)

when to introduce cup feedings

introduce cup feedings after the infant is tolerating q 2-3 hour bolus feedings by gavage. remove the indwelling ng tube after the infant is tolerating 3 cup feedings in a row.
teach all family members to cup feed. this is not difficult.
cup feeding infants take varying amounts. look at the totals, not single feeding amounts.
it can be confusing to use a cup plus a bottle plus finger feeding plus breast. use cup feeding and breast and gavage tube only to minimize the skills an infant needs to learn.
developmentally, infants tend to lap milk from the cup initially and then sip milk as their suck, swallow, breathing coordination is more mature.

procedure for cup feeding

wrap the baby so the cup will not be knocked.
support the baby in an upright sitting position.
fill the 30 cc medicine cup at least half full with breastmilk or formula.
place the brim of the cup at the outer corners of the upper lip, resting gently on the lower lip with the tongue inside the cup. (some term infants may prefer their tongue under the lip of the cup.)
tip the cup so the milk is just touching the baby's lips. do not pour the milk into the baby's mouth.
the infant usually laps the milk, or may sip it.
allow time for the infant to swallow.
let the infant pace the feedings, but limit the length of the feeding to approximately 30 minutes to minimize fatigue.
stop to burp from time to time.
leave the cup in position during the feed; that is, while the baby rests, do not move the cup from this position.
do not attempt to cup feed an infant who is not alert or who is excessively sleepy.

i have done it for term babies, never for premies. (as some of you know, i don't trust those kiddos ) sometimes, you just need to get some food into the kid, then s/he can calm down and nurse! mom and baby relax a little. 15-30 mls, no more.

it does require some patience and a lot of concentration!

wow, i had no idea. thanks for the info. i want to work with littles so much. i know it will be a lot of work, especially after reading this procedure. i wonder who came up with that one or who thought of putting a cup up to a babys mouth to see if they would lap up the milk?

i guess people have to come up with interesting ways to get a kiddo to eat something huh?

prmenrs, RN · Aug 12, 2008

You don't have to do it very often. Thankfully. Best kind of baby to do it on is a term kid rooming in who won't have anything to do w/mom's flat as a pancake nipples. You it once or twice to keep everyone from getting frantic. That's it! I don't like doing it all day long.

You're right, Chris, some babies have "dumb baby syndrome".

JMHO!!

elizabells, BSN, RN · Aug 12, 2008

I'll have to ask our feeding specialist about this. I think we may be gearing up to go "Baby Friendly" soon, but we also firmly reject the idea of nipple confusion.

And can I just say, and no offense to anyone who has seen it work, that this sounds like the dumbest damn idea I ever heard. Maybe if I saw it done, I'd get it, but on paper it seems kind of ridiculous.

Elvish, BSN, DNP, RN, NP · Aug 12, 2008

I'll have to ask our feeding specialist about this. I think we may be gearing up to go "Baby Friendly" soon, but we also firmly reject the idea of nipple confusion.
And can I just say, and no offense to anyone who has seen it work, that this sounds like the dumbest damn idea I ever heard. Maybe if I saw it done, I'd get it, but on paper it seems kind of ridiculous.

I have seen it work (whatever that means) and I still think it's ridiculous. I don't believe in nipple confusion and neither does any other staff nurse I work with.

RainDreamer, BSN, RN · Aug 12, 2008

this sounds like the dumbest damn idea I ever heard

You're right. It is.

prmenrs, RN · Aug 12, 2008

@ the time I decided to "give it a shot", I had seen someone do it successfully, the hosp was going baby-friendly, and I figured if a mom-baby couple went home unsuccessful @ breastfeeding, I didn't want anyone to say it was MY fault!

So, it was a defensive move. I'm just saying it can be done, and if it will help a mom be a successful breastfeeder, I'm all for it.

Whatever you do, don't lay the baby horizontally in the typical cradle hold, and try pouring the milk in their mouth--they will definitely try and choke!!

Elvish, BSN, DNP, RN, NP · Aug 12, 2008

Nah, I'm not knocking anyone for doing it, prmenrs. I've done it many a time myself for the same reasons you have. I just don't buy into all the hype surrounding nipple confusion is all. I do it for the parents' peace of mind because somewhere out there these parents are hearing that feeding their babies a bottle here and there will destroy breastfeeding forever.

I too find that it works better if you sit baby upright on your lap. Not as much slurping & more lapping.

BittyBabyGrower, MSN, RN · Aug 13, 2008

We aren't allowed to cup feed anymore since we had more than a few kids choke and give the nursery nurses a scare....then they would ship the kids to NICU because they had a "spell". Hmmm, wonder why? So, that was the end of that.

We will finger feed if the parent requests it.