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Cup Feeding a Newborn - Breastfeeding Support

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By Philippa Pearson-Glaze IBCLC

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22 Jan, 2021

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 useful short-term 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 preference/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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Baby must be awake and alert to cup feed

Pros and cons of cup feeding

Advantages of cup feeding

Better oxygen saturation and heart rate. A premature baby can feed at his own pace which may improve his oxygen saturation and heart rate making him more physiologically stable¹²³
Cup feeding may help preserve breastfeeding by avoiding bottles. Studies show cup feeding premature babies instead of using bottles can increase the number of babies who breastfeed and increase the length of time they breastfeed⁴⁵
Cup feeding can prepare a baby for breastfeeding. Feeding technique (use of muscles) while cup feeding is thought to be closer to breastfeeding than using a bottle⁶ and may help prepare a baby for breastfeeding by encouraging the tongue to come forward for lapping/sipping
Open cups are easily available, inexpensive and very easy to clean in resource poor areas or emergencies compared with teats, bottles or feeding tubes
Suitable for very young babies. Cup feeding can begin from as early as 29 weeks gestational age.⁷

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 ⁸
Long term cup feeding can dampen the sucking reflex or create a preference for the cup
Not suitable for sleepy babies as there is a risk of choking.

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. ⁹ 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 for term¹⁰, late preterm¹¹ and premature babies (Penny et al. 2018). The Academy of Breastfeeding Medicine¹² states cup feeding may help preserve breastfeeding and the World Health Organisation¹³ 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. They will advise you whether the technique is suitable for your baby. To cup feed a 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 as these all increase the risk of your baby choking.

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:

Cup feeding description

The following description is summarised from the video above. 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. You may need a cloth under baby’s chin in case any milk spills.

Half fill or two thirds fill a small cup with slightly warmed breast milk or infant formula
Ensure your baby is fully awake, alert and interested in feeding. Never cup feed a sleepy baby
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. Never cup feed a baby who is lying flat on their back
Rest the rim of the cup lightly 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 always 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 resting lightly on baby’s lower lip
Burp baby if needed during the feed.

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:

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 ¹⁴. 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 ¹⁵.

Traditional paladai (left) as part of a baby set

Alternatives to cup feeding

Alternatives to cup feeding for the breastfed baby who needs supplementing include:

Supplementing at the breast. A breastfed baby who is latching well to the breast but who needs additional milk can be supplemented while they are breastfeeding by way of a small feeding tube alongside the nipple. The free end of the feeding tube is placed in a container of milk and provides milk when baby suckles with a good seal around breast and tube. For much more information about the pros and cons of this system see Supplementing at the Breast.
Finger feeding. Finger feeding is another method of providing supplemental milk to a breastfed baby by way of a feeding tube (above). In this case the feeding tube provides additional milk while the baby suckles on a clean finger. For more information on the pros and cons of finger feeding see What is Finger Feeding?
Bottle feeding. A traditional way to provide supplemental milk is by bottle and teat. Feeding from an artificial teat has a number of differences to breastfeeding which could cause nipple preference or confusion in some babies. However there are several ways to reduce the differences to help preserve breastfeeding, see Tips to Bottle Feed a Breastfed Baby and Best Bottle for a Breastfed Baby?

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 breastfeeding specialist or health professional can help you decide which option is best for you and your baby.

Footnotes & References

Penny et al. Cup Feeding as a Supplemental, Alternative Feeding Method for Preterm Breastfed Infants: An Integrative Review. Matern Child Health J. 2018
Rocha et al, Cup or bottle for preterm infants: effects on oxygen saturation, weight gain, and breastfeeding, 2002
Marinelli et al, A comparison of the safety of cupfeedings and bottlefeedings in premature infants whose mothers intend to breastfeed, 2001
Collins et al. Avoidance of bottles during the establishment of breast feeds in preterm infants. Cochrane database of systematic reviews. 2016
Penny et al. Cup Feeding as a Supplemental, Alternative Feeding Method for Preterm Breastfed Infants: An Integrative Review. Matern Child Health J. 2018
Franca et al. Electromyographic analysis of masseter muscle in newborns during suction in breast, bottle or cup feeding. BMC Pregnancy and Childbirth volume 14, 2014
Gupta et al, Cup feeding: an alternative to bottle feeding in a neonatal intensive care unit, 1999
McKinney et al, Feeding Neonates by Cup: A Systematic Review of the Literature, 2016
Han AM, Cup-feeding versus other forms of supplemental enteral feeding for newborn infants unable to fully breastfeed, 2010
McKinney et al, Feeding Neonates by Cup: A Systematic Review of the Literature, 2016
Yilmaz et al, Effect of cup feeding and bottle feeding on breastfeeding in late preterm infants: a randomized controlled study, 2014
ABM Clinical Protocol #3: Supplementary Feedings in the Healthy Term Breastfed Neonate, Academy of Breastfeeding Medicine, Revised 2017
Protecting, Promoting and Supporting Breastfeeding in Facilities Providing Maternity and Newborn Services, WHO, 2017
Malhotra et al, A controlled trial of alternative methods of oral feeding in neonates, 1999
Aloysius & Hickson, Evaluation of paladai cup feeding in breast-fed preterm infants compared with bottle feeding, 2007

Important

This article should not be construed as medical advice. Information found online should always be discussed with your own IBCLC lactation consultant and doctor to ensure it is appropriate for you and your baby’s situation. Contact your doctor, paediatrician or health care provider with any concerns about your baby’s health and welfare.

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Babies are tiny humans. Their main job in early life is to eat, sleep, and poop. While the latter two of these activities may come pretty naturally, the feeding part may be interrupted for a variety of reasons.

Cup feeding — providing milk to your baby with a small medicine cup or similar device — is a temporary alternative to breast or bottle feeding.

Cup feeding is a method that may be used as a temporary feeding option when:

Babies are born prematurely and are not yet able to nurse.
Babies are temporarily unable to breastfeed due to separation from mother.
Babies are ill or have certain medical conditions.
Babies are refusing the breast.
Mothers must take a break from breastfeeding for some reason.
Mothers must supplement feeding and want to avoid using bottles or causing “nipple confusion.”

While the idea of feeding your baby using a cup may sound tedious or daunting, it’s actually a simple option that is used, according to the World Health Organization, in developing countries where items for feeding are less readily available. Cup feeding requires very few pieces of equipment — items that can be more easily cleaned and sterilized than bottles.

Here’s more about how cup feeding might benefit your baby, challenges you might encounter, and some practical instructions to get you started.

Related: I never understood the pressure to breastfeed

Babies need breast milk or formula for their bodies and brains to grow. If your baby won’t or cannot take the breast or bottle for some reason, cup feeding is a solid alternative.

Other benefits of cup feeding:

It’s appropriate for the youngest babies. In lower-resource countries cup feeding is often used with babies born prematurely, as early as 29 weeks gestation. This method may also helpful for babies who have low birth weight or have certain medical issues, like a cleft palate.
It may work for babies who are temporarily unable or unwilling to take the breast or bottles for some other reason (e.g. issues with sucking, nursing strike, mastitis).
It allows for paced feeding. In fact, you should let your baby feed at their own speed throughout the process and not pour the milk down their throat.
It’s relatively inexpensive compared to other methods. All you need is a plastic medicine cup, or something similar, and your milk or formula. The rest is about learning technique and patience.
It’s easy to learn. The process itself is relatively intuitive and both baby and caregiver can get into a good rhythm with enough practice.

Related: The best and worst natural supplements for your milk supply

As you can imagine, the first few times you attempt to cup feed your baby, you may lose some milk. While this is a disadvantage to this style of feeding, you’ll likely develop better technique with time. That said, losing milk in the process can also make it hard to track how much your baby is getting.

Another concern with this method is that cup feeding takes sucking out of the equation. Instead, babies sip or lap up the milk. If your baby has issues with sucking, ask your doctor or lactation consultant for suggestions on other ways to support and develop this important skill.

Last, there is a chance your baby may aspirate the milk while cup feeding. Symptoms of aspiration include things like choking or coughing, rapid breathing during feeds, wheezing or issues with breathing, and slight fever. Contact your baby’s pediatrician if you have any concerns. Untreated, aspiration may lead to dehydration, weight loss, or nutritional deficiencies, among other complications.

Making sure that you’re using the correct method during all cup feedings can help to avoid aspiration.

Related: 13 best baby formulas

The first few times you cup feed your baby, consider asking an expert for help. Again, this may be your child’s pediatrician or a lactation consultant. You might also watch this video for tips.

Once you learn the basics you should get the hang of this method with a little practice.

Step 1: Gather your supplies

To feed your baby using a cup, you can use a basic medicine cup or even a shot glass — both may have the measurements printed on them. Other options include a Foley cup (a cup developed specifically for feeding infants that has a channel that works similarly to a straw) or a paladai (a feeding vessel traditionally used in India that has a reservoir for the milk and a cone-like tip that reaches baby’s mouth).

Other supplies:

Warm breast milk or formula. Don’t use a microwave to warm the milk. Instead, place a bottle or ziplock baggie of it in a bowl of warm water.
Burp cloths, washcloths, or bibs to catch any spills, drips, and spit-up.
Swaddle blankets to help secure baby’s arms so they don’t interfere with feeding.

Step 2: Hold your baby

Before feeding, make sure your baby is awake and alert, but also calm. You’ll want to hold your little one in an upright position so they don’t choke on the milk as they drink. If they’re fidgeting or moving their hands in the way, consider swaddling or wrapping their arms in a blanket, but not too tightly.

You may also place the burp cloth or washcloth under your baby’s chin before beginning.

Step 3: Feed your baby

Now that you’re set up for success, the best way to describe how your baby will drink from a cup is that they’ll “slurp” or sip the milk. Resist pouring the milk into their mouth, which may cause them to choke.

Some tips:

Try to stimulate your baby’s rooting reflex before feeding. This is the same reflex they have when feeding at the breast or bottle. Simply tap their lower lip with the edge of the cup. This should help signal to them that it’s feeding time.
You may further stimulate this reflex by touching the edges of the cup to their upper lip, grazing the bottom lip as well. You’ll want to make sure your baby’s tongue can move easily at the cup’s lower edge.
Gently tip the cup to allow the milk to flow closer to the cup’s edge. You’ll want to stay in this position even if your baby isn’t actively drinking. This way, they’ll more easily return to their sipping after short breaks.
Allow your baby to use their tongue to lap the milk from the cup.
Stop feeding occasionally to burp your baby (after about every half ounce consumed). Then continue this process as needed.

Note: How much milk you’ll feed your baby depends on their age, weight, and other factors. In other words: It is up to you and your doctor to discuss specifics.

Step 4: Pay close attention

Watch your baby closely for cues that they’re done eating. In general, cup feeding shouldn’t last longer than 30 minutes total. (Fun fact: This is around the same length of time babies spend at the breast, 10-15 minutes on each side.)

How often you cup feed throughout the day will depend on your reason for doing it in the first place. If it’s to supplement, you may only need to do it a few times a day. If it’s your baby’s sole source of nutrition, you’ll need to work closely with their doctor to determine an appropriate schedule.

Related: “Breast is best”: Here’s why it mantra can be harmful

Cup feeding may feel slow and unnatural at first, but your baby should get more efficient with time. While this method may be new to you and perhaps feel unusual, rest assured that cultures across the world appear to have been cup feeding infants for hundreds to thousands of years. It’s just another way to get your baby the nutrients they need to grow and develop.

It’s always a good idea to consult with your child’s pediatrician or even a certified lactation consultant if you have questions or concerns about feeding practices. A specialist can help diagnose issues with feeding or illnesses, provide tips on technique, and give you the support you need in real time.

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How to teach your baby to drink from a cup

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When learning a new skill, break it down into several steps to make the process much easier. That's exactly what we did when we developed a solution that will help your baby move from a bottle to a non-spill cup. Use this guide to learn about the four stages of learning to drink from a cup and which cup is best for a child at a given developmental stage.

At what age should you start teaching your child to drink from a cup?

On average, it takes about 15 months for babies from the age of 4 months to go from a bottle to a cup. We have labeled our non-spill cups by age, but remember that every child is different and develops at their own pace.

Take it step by step

To learn to drink like adults, your baby needs to learn more complex oral motor skills and be able to coordinate movements.

We've broken down the process into steps to help you learn.

Step 1: Learn to drink by holding handles

First, teach your baby to hold a non-spill cup. You can make the process easier by starting training while your baby is bottle-feeding with our training set: your baby will hold the bottle by the soft, comfortable handles and drink through the familiar nipple.

Matching non-spill cup: Bottle to Cup Training Set

Perfect solution for babies from 4 months who have learned to sit upright with support

Step 2: Learn to drink through the spout

As your baby transitions to solid foods, you can teach him a new skill - drinking through the spout. Here the baby will need a little more skill than when feeding from a pacifier. This skill will also help your baby develop the suction needed to drink from a cup, which a baby usually starts learning around 6 months of age. To help you at this stage, we have created a soft and flexible spout that does not damage the gums. When the child begins to chew food with his teeth, you can switch to a denser, bite-resistant nose.

Matching non-spill cup: cup with spout

Ideal solution for babies from 6 months old who have learned to sit on a high chair

Step 3. Learning to drink through a straw

When the next baby learns to drink through a natural spout step is to learn to drink through a straw. This is a more complex oral motility, which will help develop a full-fledged skill, like an adult.

Suitable non-spill cup: cup with straw

The perfect solution for babies from 9 months old who have learned to crawl

Step 4. Learn to drink from a cup

Finally you can move on to the main thing - drinking from a cup over the edge, like real adults do. Don't worry, this step won't cause you much inconvenience: our "adult" cup is equipped with a leak-proof valve that only opens when it comes into contact with a child's lips.

Suitable non-spill cup: "Adult" cup

Ideal solution for babies aged 9 months to crawl

Choosing the best non-spill cup to help your baby develop properly

First look at age markings to find the right cup for your baby at this stage of development. However, remember that there are no clear and hard rules here: perhaps the baby has not yet learned how to sit on his own or he needs a little more time to figure out how to hold the cup. It is important to choose a cup that will help the child develop correctly and move on to the next stage of learning.

Convenient solution

But don't rush to think: "How many cups do you need to have with you!". Most Philips Avent non-spill cups, spouts and lids are interchangeable. This means that you can use the same spout with different cups or put it on a bottle. Convenient, right?

We recommend changing the spouts and caps of baby bottles and non-spill cups every three months.

Would you like to know more about our children's non-spill cups? Click here to view the range.

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