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A useful method for feeding your baby if they will not feed at the breast.

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Cup feeding is an alternative to bottle feeding if a baby can't latch to the breast and needs to be given some milk. It can also be used for supplementing a baby who is not getting enough milk or for a baby who is separated from his mother for a while. It is thought to be a good alternative to using a bottle teat as it avoids a baby getting confused by the different sucking action required on an artificial bottle nipple (nipple confusion). However, there are disadvantages as well as advantages to cup feeding. This article looks at the pros and cons of cup feeding and how to cup feed a newborn baby.

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Pros and cons of cup feeding

Advantages of cup feeding

Cup feeding can begin from as early as 29 weeks gestational age

A baby can feed at his own pace which may improve his oxygen saturation and he may be more physiologically stable

Cup feeding is thought to be a positive oral experience for baby and avoids nipple confusion so helps preserve breastfeeding (see below)

Open cups are very easy to clean in resource poor areas or emergencies compared with teats, bottles or tubes

Cup feeding can prepare a baby for breastfeeding by encouraging the tongue to come forward for feeding.

Disadvantages of cup feeding

There is a risk of aspiration or choking if cup feeding is not done correctly

Feeds can take a long time

There can be a lot of spilled and wasted milk compared with bottle feeding or tube feeding

Long term cup feeding can dampen the sucking reflex or create a preference for the cup.

Can cup feeding help preserve breastfeeding?

One review found cup feeding had no significant benefit in maintaining breastfeeding after discharge from hospital and that the length of hospital stay was likely to be a lot longer with cup feeding in some settings . However more recent studies have found the opposite - more cup fed babies were exclusively breastfeeding at discharge, and beyond, with no apparent increase in hospital stay . The Academy of Breastfeeding Medicine states cup feeding may help preserve breastfeeding and the World Health Organisation recommends cups or spoons rather than bottles and teats for premature babies.

How to cup feed a baby

Cup feeding is best taught by a demonstration from your experienced health care professional if possible. Your baby needs to be awake and alert, and in an upright position. Never cup feed a sleepy baby or a baby who is lying flat and never pour milk into a baby's mouth.

Use a small cup with a smooth edge such as a medicine cup, sherry glass or shot glass-your maternity hospital may give you one. You can also buy little plastic cups specially for the purpose which can be shaped slightly during feeding.

Half fill or two thirds fill a cup with slightly warmed breast milk or infant formula

Ensure your baby is fully awake, alert and interested in feeding

If needed wrap your baby to prevent him knocking the cup out of your hands

Sit your baby in a comfortable, upright position on your lap, you may need a cloth under baby's chin in case of spillage

Rest the rim of the cup on your baby's lower lip or their lower gum ridge

Tip the cup just enough so that milk reaches the rim of the cup, don't put the cup too far into baby's mouth

Your baby will quickly learn to sip or lap milk from the rim of the cup with his tongue

DO NOT pour the milk into his mouth, go slowly keeping the milk just at the rim of the cup

Leave the cup in position when baby pauses to rest between swallows and is not drinking, avoid putting pressure on the lower lip

Continue to tip the cup enough to keep the milk at the rim of cup

Burp baby if needed during the feed.

Cup feeding videos

Global Health Media has a lovely series of videos about breastfeeding, the first clip below (9 minutes long) discusses how to safely cup feed a small baby who isn't breastfeeding yet and includes spoon feeding, using a paladai (see below) and using a nifty cup:

Short film clips of cup feeding

In the following short clip from Global Health Media, a premature baby is cup feeding. Notice how the baby's tongue extends to lap the milk.

Jack Newman is a Canadian paediatrician and breastfeeding expert. Here is a clip of cup feeding from his International Breastfeeding Centre:

Baby feeds from a medicine cup

In this clip notice how mum is responsive to baby's feeding pace-pausing several times during the cup feed.

Using a paladai

Mothers in India have used a small spouted cup called a paladai for centuries. One study compared the use of a bottle, cup and a paladai in 100 newborn babies. Infants took the most milk in the least time and stayed calmest with the paladai . However a more recent pilot study comparing the paladai with bottle feeding in preterm infants found increased spillage, longer feed times and more stress cues .

Summary

Used correctly, cup feeding can be a useful way to give a newborn baby supplementary milk for short term feeding. Other options for supplementary feeds include using a supplemental nursing system at the breast, or a bottle using our tips to minimise nipple confusion. Your IBCLC lactation consultant or health professional can help you decide which option is best for you and your baby.

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Cup Feeding a Newborn - Breastfeeding Support

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Cup feeding is an alternative to bottle feeding if a baby can't latch to the breast and needs to be given some milk. It can also be used for supplementing a baby who is not getting enough milk or for a baby who is separated from his mother for a while.

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Which Formula to use and how to feed it to your baby.

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When someone else is caring for and feeding your baby

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When someone else is caring for and feeding your baby

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How to make and use
your own Supplemental Nursing System

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A supplemental nursing system (SNS) or "supply line" allows a mother to feed her baby supplemental milk at the breast. It can be used as a short-term aid on the way back to full breastfeeding and can sometimes be used longer-term. The SNS feeding tube can also be used as a way to finger-feed your baby either as a sucking exercise or when transitioning your baby back to the breast. Keeping in touch with an IBCLC lactation consultant or your health professional is advisable while you are using an SNS. For the pros and cons of this method of feeding and further information on commercial supplementers and how to use them see Breastfeeding With a Supplemental Nursing System. This article describes how to make a homemade supplemental nursing system.

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Making a homemade supplemental nursing system

You will need

An ordinary feeding or storage bottle and teat

A 5 or 6 French, 50cm or 90cm feeding tube (nasogastric tube)

A 5ml or 10ml syringe for flushing and cleaning the tube-your local pharmacy may sell these or online stores like Amazon sell individually wrapped sterile syringes.

Setting up

1. Slightly enlarge the hole of a bottle teat or vent (with clean scissors) so that you can feed the tubing upwards through the teat. The plastic attachment (an open/close valve) on the feeding tube sits in the milk at the bottom of the bottle (make sure the valve is open). A tight fit for the tube through the bottle nipple will reduce spillage.

2. Add your expressed breast milk or formula supplement to the bottle. Screw the artificial teat onto the bottle with the feeding tube threaded through it and the valve end of the tube submerged in the milk.

3. Piercing a second hole in the teat, or using a teat with a vent, allows air into the bottle so your baby doesn't need to suck harder as the bottle empties. Some mothers find it works well without the extra hole.

4. Place the bottle on a table close to where you are feeding your baby, or put it in a shirt pocket, between your breasts or between your knees depending on the length of the tube.

5. The free rounded end of the tube should lie alongside mother's nipple and be taken into the baby's mouth when he begins to suck. Alternatively you can latch your baby on the breast first, and then slide the tube into the corner of the baby's mouth when you are ready (for example after he has breastfed on both breasts first).

6. Some mothers find it useful to tape the tube to their breast with surgical tape or a plaster and others prefer not to, experiment to find what works for you. If you tape the tube to your breast before your baby latches, make sure the tape is far enough away from your nipple so that it won't interfere with your baby's latch. Also check that the tube isn't extended further than your nipple or it may make your baby gag or reach the back of his throat (taping it to the breast will help avoid this). Jack Newman, a Canadian paediatrician and breastfeeding expert says the tube only needs to be over the baby's gums to work properly .

Adjusting milk flow

If your baby can make a good seal on the the breast with the tube in place, you will soon see milk rise up the tube into his mouth and he will start swallowing. If the flow of milk seems too fast (your baby is gulping milk too quickly) or too slow (you can't hear many swallows) you can adjust the flow by;

Adjusting the height of the bottle of milk. The bottle containing the supplement should not need to be held higher than your baby's head to work. The higher the bottle the faster the flow of milk.

Using different sized tubes to alter milk flow. The wider the diameter of the tube the faster the flow of milk, 6 French (6 fr) is a wider tube than 5 fr.

Pinching the tube to narrow the diameter and slow the flow.

If your baby struggles to suck milk up the tube to get the flow started he may start to get frustrated. Filling the tube with breast milk using the 5 ml syringe will require less work and give him an instant reward. You could also experiment lifting the bottle higher to get the flow started.

Tips from Jack Newman

Jack Newman has some tips for using a lactation aid in the following article including the benefits of using one and how to wean your baby from using it when you are ready:

Excerpt From

Lactation Aid, Jack Newman MD, FRCPC, IBCLC & Edith Kernerman, IBCLC, 2009

[The lactation aid] does seem to function better if the tube is placed in the corner of the baby's mouth and enters straight into the baby's mouth over the tongue. (Point it slightly to the roof of the baby's mouth). It is occasionally helpful for the mother to hold the tube in place with her finger, as some babies tend to push the tube out of position with their tongues.

Cautions

Discuss with health care team. The homemade system is endorsed by some hospitals and medical professionals but parents are encouraged to discuss the suitability of this feeding method with their own health professionals as it may not suit every baby.

Use at own risk. A single use nasogastric feeding tube is manufactured to be used as a feeding tube that carries food internally via a baby's nose and throat into their stomach-not as an external feeding mechanism to run alongside the breast or finger. Please note that when using any device in a different way to a manufacturer's intended use you do so at your own risk. Commercial purpose made versions of supplemental nursing systems are available for long term use-see Breastfeeding With a Supplemental Nursing System for further details.

Feeding tubes are very difficult to clean properly and need to be replaced frequently, see next section.

Replace feeding tubes every day

Single use nasogastric feeding tubes are not made to withstand boiling or steam sterilisation which makes them very difficult to clean properly. Chemical cleaning by cold water sterilisation could also break down the tube lining. Disposable tubes should therefore be replaced frequently with new. In their fact sheet, the Royal Women's Hospital in Australia advise replacing tubes (and the syringes used to flush them out) every 24 hours . Canadian paediatrician Jack Newman discusses that with careful washing, tubes may be reused for a few days .

Inspect tubes carefully for signs of wear and tear before use and bear in mind that although tubes may look clean, bacterial cultures may be building inside.

If your baby is premature, or particularly vulnerable to infection it will be especially important to discuss using a homemade supplementer with the health professionals caring for your baby, to observe very careful hygiene and replace the tubes very frequently.

Cleaning the homemade supplemental nursing system

Cleaning the bottle and teat

Clean and sterilise the bottle and teat as usual-See Sterilising Baby Bottles (National Health Service website, 2016).

Cleaning the feeding tube

Rinsing and cleaning tubes as soon as possible after use will remove any milk residue before milk can start to dry in the supply line. Precise cleaning instructions for feeding tubesvary slightly between practitioners. Washing instructions include:

1. Push cool boiled water through the feeding tube with a 5ml or 10ml syringe in the end-cap straight after use and repeat several times as needed . Warm water for the initial rinse could cause the milk to curdle and stick to the inside of the tubing making cleaning more difficult.

2. After thoroughly rinsing with cold water, some recommendations advocate flushing the tubes with hot soapy water and then rinsing thoroughly.

3. After washing, shaking the tubes (e.g. making a lasso action with the tube) can remove most of the water inside. They can then be left to dry (Newman, 2009) or stored in a clean sealed container in the fridge.

4. Change the tube for a new one every 24 hours (see above).

See below for cleaning information from the Royal Women's Hospital fact sheet, and Counseling the Nursing Mother:

After 24 hours the tube and syringe must be discarded. A new tube and syringe must then be used for the next 24 hours.

As soon as the feed is finished the tubing must be cleaned to avoid milk drying in the tubing and to prevent growth of bacteria:

Use a 10ml syringe to flush 10mls of cooled boiled water through the tube.

Flush the tube at least 3 times, or more if there is any milk residue visible in the tube.

Store the cleaned tube in a sealed clean container or plastic bag in the refrigerator until next use.

After every use the tubing needs to be flushed with cold water, washed with hot soapy water, and then rinsed with clear water.

The Centers for Disease Control and Prevention (CDC) recommends using a washing bowl that is separate to the family sink for cleaning a baby's feeding equipment . For cleaning information for tubes supplied with a commercial supplementer-always check the manufacturer's instructions.

Useful video

Making a Supplementary Nursing System, Canadian Childbearing Almanac

Summary

A homemade supplemental nursing system can be used as a way to give your baby supplemental milk at the breast or via finger feeding. It is an alternative to commercially available supplementers, cup feeding, or using a bottle. A supplementary nursing system is not suitable for all babies and is best used under the supervision of an IBCLC lactation consultant or other health professional. A homemade system involves adapting the use of a disposable nasogastric tube which is not intended to be repeatedly washed and reused, so tubes must be replaced often. This article should be read in conjunction with Breastfeeding With a Supplemental Nursing System which discusses all the advantages and disadvantages of using this kind of device.

Footnotes & References

1. Your IBCLC lactation consultant may stock them or try a medical supplier such as VetUK (individual Vygon tubes for infants stocked at time of writing) or IMS Euro in UK

2. Counseling the Nursing Mother, Lauwers and Swisher, 20111

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Homemade Supplemental Nursing System - Breastfeeding Support

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A supplemental nursing system (SNS) or "supply line" allows a mother to feed her baby supplemental milk at the breast. It can be used as a short-term aid on the way back to full breastfeeding and can sometimes be used longer-term.

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Includes step-by-step instructions on how to safely make up powdered infant formula.
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