Skip to main content

Feeding Neonates by Cup: A Systematic Review of the Literature

Maternal and Child Health Journal volume 20, pages 1620–1633 (2016)Cite this article

Abstract

Objective WHO and UNICEF recommend cup feeding for neonates unable to breastfeed in low-resource settings. In developed countries, cup feeding in lieu of bottle feeding in the neonatal period is hypothesized to improve breastfeeding outcomes for those initially unable to breastfeed. Our aim was to synthesize the entire body of evidence on cup feeding. Methods We searched domestic and international databases for original research. Our search criteria required original data on cup feeding in neonates published in English between January 1990 and December 2014. Results We identified 28 original research papers. Ten were randomized clinical trials, 7 non-randomized intervention studies, and 11 observational studies; 11 were conducted in developing country. Outcomes evaluated included physiologic stability, safety, intake, duration, spillage, weight gain, any and exclusive breastfeeding, length of hospital stay, compliance, and acceptability. Cup feeding appears to be safe though intake may be less and spillage greater relative to bottle or tube feeding. Overall, slightly higher proportions of cup fed versus bottle fed infants report any breastfeeding; a greater proportion of cup fed infants reported exclusive breastfeeding at discharge and beyond. Cup feeding increases breastfeeding in subgroups (e.g. those who intend to breastfeed or women who had a Caesarean section). Compliance and acceptability is problematic in certain settings. Conclusions Further research on long-term breastfeeding outcomes and in low-resource settings would be helpful. Research data on high risk infants (e.g. those with cleft palates) would be informative. Innovative cup feeding approaches to minimize spillage, optimize compliance, and increase breastfeeding feeding are needed.

This is a preview of subscription content, access via your institution.

Access options

Buy single article

Instant access to the full article PDF.

43,34 €

Price includes VAT (Finland)
Tax calculation will be finalised during checkout.

Fig. 1
Fig. 2

References

  1. World Health Organization (WHO). (2013). Pan America Health Organization (PAHO). Canada: Beyond Survival.

    Google Scholar 

  2. Horta, B. L., Victora, C. G., & World Health Organization (WHO). (2013). Short-term effects of breastfeeding: A systematic review on the benefits of breastfeeding on diarrhoea and pneumonia mortatlity. Geneva: World Health Organization.

    Google Scholar 

  3. Lang, S., Lawrence, C. J., & Orme, R. L. (1994). Cup feeding: An alternative method of infant feeding. Archives of Disease in Childhood, 71(4), 365–369.

    CAS  Article  PubMed  PubMed Central  Google Scholar 

  4. Thorley, V. (2005). Cup-feeding. Australian breastfeeding association. East Malvern. https://www.breastfeeding.asn.au/bfinfo/cup-feeding. Accessed April 27, 2015.

  5. Kuehl, J. (1997). Cup feeding the newborn: What you should know. The Journal of Perinatal & Neonatal Nursing, 11(2), 56–60.

    CAS  Article  Google Scholar 

  6. Fredeen, R. C. (1948). Cup feeding of newborn infants. Pediatrics, 2(5), 544–548.

    CAS  PubMed  Google Scholar 

  7. Davis, H. V., Sears, R. R., et al. (1948). Effects of cup, bottle and breast feeding on oral activities of newborn infants. Pediatrics, 2(5), 549–558.

    CAS  PubMed  Google Scholar 

  8. Lang, S. (1994). Cup-feeding: An alternative method. Midwives Chronicle & Nursing Notes, 107, 171–176.

    CAS  Google Scholar 

  9. Neifert, M., Lawrence, R., & Seacat, J. (1995). Nipple confusion: toward a formal definition. The Journal of Pediatrics, 126(6), S125–S129.

    CAS  Article  PubMed  Google Scholar 

  10. Thorley, V. (1997). Cup feeding: Problems created by incorrect use. Journal of Human Lactation, 13(1), 54–55.

    CAS  Article  PubMed  Google Scholar 

  11. Edmond, K., & Bahl, R. (2006). Optimal feeding of low-birth-weight infants: technical review. Geneva: Department of Child and Adolescent Health and Development, World Health Organization.

    Google Scholar 

  12. World Health Organization (WHO). (2009). Baby-friendly hospital initiative: Revised, updated and expanded for integrated care. Section 3: Breastfeeding promotion and support in a baby-friendly hospital. A 20-hour course for maternity staff. Geneva: World Health Organization. http://www.unicef.org/nutrition/files/BFHI_2009_s3.1and2.pdf. Accessed 21 Mar 2016.

  13. Surjono, D., Ismadi, S. D., Suwardji, et al. (1980). Bacterial contamination and dilution of milk in infant feeding bottles. Journal of Tropical Pediatrics, 26(2), 58–61.

    CAS  Article  PubMed  Google Scholar 

  14. Armstrong, H. (1998). Research in action; techniques of feeding infants-the case for cup feeding. Cajanus, 31(4), 178–185.

    Google Scholar 

  15. Ritchie, J. F. (1998). Immature sucking response in premature babies: Cup feeding as a tool in increasing maintenance of breast. Journal of Neonatal Nursing, 4(2), 13–17.

    Google Scholar 

  16. Dowling, D. A., Meier, P. P., DiFiore, J. M., et al. (2002). Cup-feeding for preterm infants: mechanics and safety. Journal of Human Lactation, 18(1), 13–20.

    Article  PubMed  Google Scholar 

  17. Lanese, M. G. (2011). Cup feeding-a valuable tool. Journal of Human Lactation, 27(1), 12–13. doi:10.1177/0890334410396668.

    Article  PubMed  Google Scholar 

  18. Jones, E. (1994). Breastfeeding in the preterm infant. Modern Midwife, 1, 22–26.

    Google Scholar 

  19. Samuel, P. (1988). Cup feeding: How and when to use it with term babies. Practising Midwife, 1(12), 33–35

  20. Huang, Y. Y., Gau, M. L., Huang, C. M., et al. (2009). Supplementation with cup-feeding as a substitute for bottle-feeding to promote breastfeeding. Chang Gung Medical Journal, 32(4), 423–431.

    PubMed  Google Scholar 

  21. Malhotra, N., Vishwambaran, L., Sundaram, K. R., et al. (1999). A controlled trial of alternative methods of oral feeding in neonates. Early Human Development, 54(1), 29–38.

    CAS  Article  PubMed  Google Scholar 

  22. Flint, A., New, K., & Davies, M. W. (2007). Cup feeding versus other forms of supplemental enteral feeding for newborn infants unable to fully breastfeed. Cochrane Database of Systematic Reviews. doi:10.1002/14651858.CD005092.pub2.

    PubMed  Google Scholar 

  23. Collins, C. T., Makrides, M., Gillis, J., et al. (2008). Avoidance of bottles during the establishment of breast feeds in preterm infants. Cochrane Database of Systematic Reviews. doi:10.1002/14651858.CD005252.pub2.

    Google Scholar 

  24. Yilmaz, G., Caylan, N., Karacan, C. D., et al. (2014). Effect of cup feeding and bottle feeding on breastfeeding in late preterm infants: A randomized controlled study. Journal of Human Lactation, 30(2), 174–179. doi:10.1177/0890334413517940.

    Article  PubMed  Google Scholar 

  25. Marinelli, K. A., Burke, G. S., & Dodd, V. L. (2001). A comparison of the safety of cupfeedings and bottlefeedings in premature infants whose mothers intend to breastfeed. Journal of Perinatology, 21(6), 350–355. doi:10.1038/sj.jp.7210539.

    CAS  Article  PubMed  Google Scholar 

  26. Aloysius, A., & Hickson, M. (2007). Evaluation of paladai cup feeding in breast-fed preterm infants compared with bottle feeding. Early Human Development, 83(9), 619–621. doi:10.1016/j.earlhumdev.2006.12.004.

    CAS  Article  PubMed  Google Scholar 

  27. Freer, Y. (1999). A comparison of breast and cup feeding in pre-term infants: Effect on physiological parameters. Journal of Neonatal Nursing, 5(1), 16–21.

    Google Scholar 

  28. Lopez, C. P., Chiari, B. M., Goulart, A. L., et al. (2014). Assessment of swallowing in preterm newborns fed by bottle and cup. CoDAS, 26(1), 81–86.

    PubMed  Google Scholar 

  29. Cloherty, M., Alexander, J., Holloway, I., et al. (2005). The cup-versus-bottle debate: a theme from an ethnographic study of the supplementation of breastfed infants in hospital in the United kingdom. Journal of Human Lactation, 21(2), 151–162. doi:10.1177/0890334405275447.

    Article  PubMed  Google Scholar 

  30. Brown, S. J., Alexander, J., & Thomas, P. (1999). Feeding outcome in breast-fed term babies supplemented by cup or bottle. Midwifery, 15(2), 92–96.

    CAS  Article  PubMed  Google Scholar 

  31. Nyqvist, H. K., & Strandell, E. (1999). A cup feeding protocol for neonates: Evaluation of nurses and parents’ use of two cups. Journal of Neonatal Nursing, 5(2), 31–36.

    Google Scholar 

  32. Al-Sahab, B., Feldman, M., Macpherson, A., et al. (2010). Which method of breastfeeding supplementation is best? The beliefs and practices of paediatricians and nurses. Paediatrics & Child Health, 15(7), 427–431.

    Google Scholar 

  33. Rocha, N. M., Martinez, F. E., & Jorge, S. M. (2002). Cup or bottle for preterm infants: Effects on oxygen saturation, weight gain, and breastfeeding. Journal of Human Lactation, 18(2), 132–138.

    Article  PubMed  Google Scholar 

  34. World Bank. (2015). World econonmic situation and prospects: Country classification. http://www.un.org/en/development/desa/policy/wesp/wesp_archive/2015wesp_full_en.pdf. Accessed April 27, 2015.

  35. Abouelfettoh, A. M., Dowling, D. A., Dabash, S. A., et al. (2008). Cup versus bottle feeding for hospitalized late preterm infants in Egypt: A quasi-experimental study. International Breastfeeding Journal, 3, 27. doi:10.1186/1746-4358-3-27.

    Article  PubMed  PubMed Central  Google Scholar 

  36. Gilks, J. (2004). Improving breast feeding rates in preterm babies: Cup feeding versus bottle feeding. Journal of Neonatal Nursing, 10(4), 118–120.

    Google Scholar 

  37. Gomes, C. F., Trezza, E. M., Murade, E. C., et al. (2006). Surface electromyography of facial muscles during natural and artificial feeding of infants. Journal of Pediatrics, 82(2), 103–109. doi:10.2223/JPED.1456.

    Article  Google Scholar 

  38. Mosley, C., Whittle, C., & Hicks, C. (2001). A pilot study to assess the viability of a randomised controlled trial of methods of supplementary feeding of breast-fed pre-term babies. Midwifery, 17(2), 150–157. doi:10.1054/midw.2000.0244.

    CAS  Article  PubMed  Google Scholar 

  39. Schubiger, G., Schwarz, U., & Tonz, O. (1997). UNICEF/WHO baby-friendly hospital initiative: does the use of bottles and pacifiers in the neonatal nursery prevent successful breastfeeding? Neonatal Study Group. European Journal of Pediatrics, 156(11), 874–877.

    CAS  Article  PubMed  Google Scholar 

  40. Rekha, S., Rao, S. D., & Fernandez, M. (1996). Two different methods for feeding low birth weight babies. Indian Pediatrics, 33(6), 501–503.

    CAS  PubMed  Google Scholar 

  41. Collins, C. T., Ryan, P., Crowther, C. A., et al. (2004). Effect of bottles, cups, and dummies on breast feeding in preterm infants: A randomised controlled trial. BMJ, 329(7459), 193–198. doi:10.1136/bmj.38131.675914.55.

    Article  PubMed  PubMed Central  Google Scholar 

  42. Dalal, S. S., Mishra, S., Agarwal, R., et al. (2013). Feeding behaviour and performance of preterm neonates on Paladai feeding. Acta Paediatrica, 102(4), e147–e152. doi:10.1111/apa.12148.

    Article  PubMed  Google Scholar 

  43. Howard, C. R., de Blieck, E. A., ten Hoopen, C. B., et al. (1999). Physiologic stability of newborns during cup- and bottle-feeding. Pediatrics, 104(5 Pt 2), 1204–1207.

    CAS  PubMed  Google Scholar 

  44. Howard, C. R., Howard, F. M., Lanphear, B., et al. (2003). Randomized clinical trial of pacifier use and bottle-feeding or cupfeeding and their effect on breastfeeding. Pediatrics, 111(3), 511–518.

    Article  PubMed  Google Scholar 

  45. Gupta, A., Khanna, K., & Chattree, S. (1999). Cup feeding: An alternative to bottle feeding in a neonatal intensive care unit. Journal of Tropical Pediatrics, 45(2), 108–110.

    CAS  Article  PubMed  Google Scholar 

  46. Cavallaro, F. L., Cresswell, J. A., Franca, C. G., et al. (2013). Trends in ceasarean delivery by country and wealth quintile: cross-sectional survys in southern Asia and sub-Saharan Africa. Bulletin of the World Health Organization (WHO), 91(12), 914D–922D.

    Article  Google Scholar 

  47. World Health Organization. (2010). The global numbers and costs of additionally needed and unnecessary caesarean sections performed per year: Overuse as a barrier to universal coverage. In World Health Report (pp. 1–31). Geneva: World Health Organization. http://www.who.int/healthsystems/topics/financing/healthreport/30C-sectioncosts.pdf. Accessed 21 Mar 2016.

  48. Musoke, R. N. (1990). Breastfeeding promotion: Feeding the low birth weight infant. International Journal of Gynaecology and Obstetrics, 31(Suppl1), 57–59.

    Article  PubMed  Google Scholar 

  49. World Health Organization. (2010). Essential newborn care course: Trainer’s guide: Module 4, session 11 (pp. 138–144). Geneva: World Health Organization. http://apps.who.int/iris/bitstream/10665/70540/3/WHO_MPS_10.1_Training_file_eng.pdf. Accessed 21 Mar 2016.

  50. World Health Organization. (2003). Managing newborn problems: A guide for doctors, nurses, and midwives. Geneva: World Health Organization.

    Google Scholar 

  51. World Health Organization. (2004). Guiding principles for feeding infants and young children during emergencies. http://www.who.int/nutrition/publications/guiding_principles_feedchildren_emergencies.pdf. Accessed 21 Mar 2016.

  52. World Health Organization, The Aga Khan University, The Partnership for Maternal NCH. (2011). Essential interventions, commodities and guidelines for reproductive, maternal, newborn and child health: A global review of the key interventions related to reproductive, maternal, newborn and child health (RMNCH). Geneva: World Health Organization. http://apps.who.int/medicinedocs/documents/s21666en/s21666en.pdf. Accessed 21 Mar 2016.

  53. World Health Organization. (2011). Guidelines on optimal feeding of low-birthweight infants in low-and middle-income countries. Geneva: World Health Organization. http://www.who.int/maternal_child_adolescent/documents/9789241548366.pdf?ua=1. Accessed 21 Mar 2016.

  54. World Health Organization. (2008). The international code of marketing of breast-milk substitutes: Frequently asked questions. Geneva: World Health Organization. http://www.who.int/nutrition/publications/Frequently_ask_question_Internationalcode.pdf. Accessed 21 Mar 2016.

  55. Franca, E. C., Sousa, C. B., Aragao, L. C., & Costa, L. R. (2014). Electromyographic analysis of masseter muscle in newborns during suction in breast, bottle or cup feeding. BMC Pregnancy Childbirth, 14, 154.

    Article  PubMed  PubMed Central  Google Scholar 

  56. Gomes, C. F., Gois, M. L., Oliveira, B. C., Thomson, Z., & Cardoso, J. R. (2014). Surface electromyography in premature infants: A series of case reports and their methodological aspects. The Indian Journal of Pediatrics, 81(8), 755–759.

    PubMed  Google Scholar 

Download references

Acknowledgments

Dr. McKinney and Ms. Rue were supported by NIH NCATS Grant #2KL2TR000421-06. This work was also supported by the Jean Renny Endowment for Craniofacial Research, Seattle Children’s Hospital Craniofacial Center.

Author information

Affiliations

  1. Oral Health Sciences, School of Dentistry, University of Washington, Box 357475, Seattle, WA, 98195, USA

    Christy M. McKinney & Matthew G. Vaughn

  2. Department of Rehabilitation Medicine, University of Washington, Seattle, WA, USA

    Robin P. Glass

  3. PATH, Seattle, WA, USA

    Patricia Coffey

  4. Institute of Translation Health Sciences, University of Washington, Seattle, WA, USA

    Tessa Rue

  5. Pediatrics, School of Medicine, University of Washington, Seattle, WA, USA

    Christy M. McKinney & Michael Cunningham

Authors
  1. Christy M. McKinney
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Robin P. Glass
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Patricia Coffey
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Tessa Rue
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Matthew G. Vaughn
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Michael Cunningham
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Christy M. McKinney.

Ethics declarations

Conflict of Interest

The authors declare they have no conflicts of interest.

Electronic supplementary material

Below is the link to the electronic supplementary material.

Supplementary material 1 (DOCX 49 kb)

Rights and permissions

Reprints and Permissions

About this article

Verify currency and authenticity via CrossMark

Cite this article

McKinney, C.M., Glass, R.P., Coffey, P. et al. Feeding Neonates by Cup: A Systematic Review of the Literature. Matern Child Health J 20, 1620–1633 (2016). https://doi.org/10.1007/s10995-016-1961-9

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s10995-016-1961-9

Keywords

  • Cup
  • Cup feeding
  • Paladai
  • Neonates
  • Preterm
  • Feeding
  • Systematic review