Many feedi
ng therapists will find themselves in a position to help their clients move from bottle, breastfeeding, or even tube feeding to cup drinking.
Which cup do you choose? Do you start with straw, sippy, or open cup? I don’t think that there is a right or wrong answer nor is the answer always clear cut. But there are many factors to consider.
The choice should be made based on the following:
- child’s ability
- medical history
- skill level
- desire
- oral and gross motor function.
Here are some ideas on how to guide your practice.
Choose a straw or sippy cup for:
- A tube fed child who actively sucks on a sippy or straw cup. If weight and growth are optimal, and if the child can drink the formula going into tube feeding, it can be subtracted from the tube feedings and should be encouraged to assist with moving off the tube.
- An infant or toddler with delayed oral and gross motor skills (poor head/neck and trunk stability) who actively sucks, may have more success sucking on a soft spout or straw.
Note: prolonged use of the spouted sip cups can negatively effect a child’s oral development. Pretty much everyone agrees, sippy cups are a temporary drinking solution only. Caregivers like the no-spill option of a sippy cup, however, there are several good “spill proof” non spout toddler cups on the market now.
Choose a straw cup for:
- The child with whom you want to encourage a chin tuck while drinking.
- The child who you want to encourage tongue retraction and lip seal. You can assist by using a straw cup that allows for squeezing small volumes in the mouth.
“The easiest drinking utensil is a flexible straw in a closed container, a straw bottle.” (from this post by Debra Beckman
http://www.agesandstages.net/qadetail.php?id=33)
Choose an open cup (or non spout toddler cup) for:
- The toddler who is stuck in a sucking pattern. We will use open cups to teach children to use a more mature oral pattern. The child must learn to control the flow, form a bolus and transfer.
- The older infant who needs to avoid spouts such as post cleft palate repair. A bottle or spout may rub against the repair and cause problems.
- The toddler who refuses the cup. I find the open cups are easier to teach a child to accept by bringing the cup to the child’s lips and delivering a sip into the child’s mouth (while the sippy and straw cups demand some active sucking unless you are squeezing liquid into the child’s mouth).
(This is where I put most of my energy with my feeding clients- working on open cup drinking! Check out my post on open cup drinking to see some cup options. http://pediatricfeedingnews.com/working-on-cup-drinking-the-benefits-of-using-an-open-cup/)
If you want to read more on this subject, check out these posts:
http://www.arktherapeutic.com/blog/post/299
http://www.talktools.com/honey-bear-with-flexible-straw/
http://www.agesandstages.net/qadetail.php?id=33
http://www.arktherapeutic.com/blog/post/tag/cup-drinking
http://blog.asha.org/2014/01/09/step-away-from-the-sippy-cup/
http://www.drgreene.com/perspectives/the-surprising-reason-sippy-cups-can-hurt-your-toddler/
http://www.communicationstationspeech.com/tongue-thrust-part-2-prevention/
I think that if a child has the gross motor skills to potentially manage an open cup, this is by far the best option. I appreciate that caregivers often prefer non-spill options but I think that the the emphasis has to be on what best fits the child’s needs, even if this is less convenient. I recommend Babycup to my clients (I am a Feeding Consultant) as the optimum method of giving liquids when transitioning from bottle or breast. It’s especially helpful in situations where a child is struggling with sucking, for example, cases of tongue tie / cleft.
Thank you for this breakdown…great info!
Any thoughts on skipping the bottle for a 10 month old on a g-tube who was just cleared for thin liquids? Can she just move to a straw/sipper cup? She can currently now suck about an ounce of formula through a straw but cannot express anything from a bottle.
I can only give general advice because I have not see the child but definitely okay to skip the bottle, especially, if you are having more success with a straw. Some children who are starting to orally feed later never suck on a bottle. This may be due to the fact that the infant oral reflexes fade around 4-5 months and they have lost some of the biological drive to suck on a nipple. Would also let the child’s gross motor control guide my decision making as to what type of straw/cup will work best. If you feel the straw is what the child is having the most success with- you could look at the bear cups with the flexible straws, the sip tip cup (straw valve to maintain fluid in the straw), or even shorter straws. You can see some of these in the store on this site. Good luck!