Bottle or Breast Feeding Dependence and Transitioning to a Cup

                                                                                                              

Cup Transition

For most children, the recommendation to transition from the bottle to cup is typically around 1 year. Prolonged bottle use can cause:

1. tooth decay or bite malformation

2. may encourage your child to drink much more milk than he needs

3. may find it hard to break the habit of comfort sucking on a bottle.

• (See more at: http://www.aap.org/en-us/about-the-aap/aap-press-room/aap-press-room-media-center/Pages/Weaning-from-the-Bottle.aspx#sthash.7zPc4RaX.dpuf)

• (http://www.nhs.uk/Conditions/pregnancy-and-baby/pages/drinks-and-cups-children.aspx#close)

 

But where do children with feeding problems fit into this?

Children with feeding problems may follow a slightly different path. There are many different presentations of bottle and breast dependency.

1. For some children, they may be living off of breast feeding or formula in the bottle past the age of one and eating very little food.

2. Or the child may eat food, take liquids in a bottle, but totally refuse a cup.

3. Or the child may accept a sippy cup which is reinforcing a sucking pattern contributing to difficulty for the child to transition to open cup drinking and chewing.

   
   

In both scenarios, the bottle can’t be taken away abruptly or you will be facing a different type of feeding problem, one that most likely involves dehydration and possible weight loss. I have seen children whose therapist recommended taking away the bottle abruptly because of the child’s age when the child had no other way to take liquids. Some of these children would not drink enough from the cup, then refused to go back to the bottle, and ended up in a difficult situation resulting in the need for a feeding tube. If a child is living off of the bottle, do not take it away until they can meet their hydration needs via cup.

Which cup should you choose?

Many children will transition to cup drinking by moving from breast or bottle feeding to a soft or hard spouted sippy cup with a valve or a straw cup. There is nothing wrong with this for your typical feeder but sippy and straw cups reinforce a sucking pattern similar to a bottle.

“It continues to promote the anterior-posterior movement of the tongue,  characteristic of a suckle-like pattern that infants use for breast or bottle feeding.  Sippy cups limit the child’s ability to develop a more mature swallowing pattern, especially  with continued use after the first year.  The spout blocks the tongue tip from rising up to the alveolar ridge just above the front teeth and forces the child to continue to push his tongue forward and back as he sucks on the spout to extract the juice.” (Melanie Potuck from

http://blog.asha.org/2014/01/09/step-away-from-the-sippy-cup/)

There are several reasons to start working on cup drinking in therapy by using an open cup or lip cup (not a spout sticking in the child’s mouth). “Using an open cup or a free-flow cup without a valve will help your baby learn to sip rather than suck, which is better for their teeth.” (www.nhs.uk/Conditions/pregnancy-and-baby/pages/drinks-and-cups-children.aspx#close ) 

Also, if the child is “stuck” in a sucking pattern and having difficulty moving to the cup as well as progressing into a chewing pattern, then it may be more beneficial to work on open cup drinking to work on more mature oral skills. If the child is refusing a cup totally, the use of behavioral reinforcement can improve acceptance of the cup.

I have had families come in with a shopping bag full of cups that they have bought, tried and subsequently failed to have their child accept. Usually, when a child has total refusal to take a cup, it’s not about the type of cup. It’s more about aversive feeding behavior/refusal. It is very difficult to convince or make a child drink from a sippy cup if they are refusing.

Is it ever a good idea to do a trial where you take the bottle away abruptly? This has to be evaluated on a case by case basis working with a physician. There is the risk of dehydration as well as weight loss. I have seen children refuse to drink for over 12 hours. I do remember one child who was a twin. He was dependent on breast feeding and refused a bottle and a cup. The twin was progressing typically. His mother reached a certain point where she wanted to wean and made the decision to stop. She cut him off and he refused to drink for 12 hour stretches for 3 days straight, then he finally gave into a bottle. This was done with the pediatrician and a home therapist. In the end, he weaned to a bottle but the whole transition made me uncomfortable due to the possible nutritional consequences and he did lose weight in the process. Therapy then focused on acceptance of purees and open cup drinking.

In these cases of bottle or breast dependency or poor transition from a midline tongue pattern (suckle or suck), I typically begin working on open cup drinking. I will write about the types of open cups I like to use in my next post.