Cup Feeding a Newborn

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.

Alert baby in mother's arms
Baby must be awake and alert to cup feed

Pros and cons of cup feeding

Advantages of cup feeding

  • Cup feeding can begin from as early as 29 weeks gestational age 1
  • A baby can feed at his own pace which may improve his oxygen saturation 2 and he may be more physiologically stable 3
  • 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

  • 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 4
  • 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 5. 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 67.

baby drinking from an open cup

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 or  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) 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 8. 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 9.

silver plated paled as part of a baby gift set
Traditional paladai (left) as part of a baby set

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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