Cup Feeding as a Supplemental, Alternative Feeding Method for Preterm Breastfed Infants: An Integrative Review

Abstract

Background The benefits of human milk for the preterm infant are well established. Preterm infants have lower breastfeeding rates and often face breastfeeding challenges. It is important that feeding practices for preterm infants optimize their chances of breastfeeding. Objective The purpose of this integrated review is to synthesize and critically analyze research related to the safety and efficacy of cup feeding as an alternative, supplemental feeding method for breastfed infants. Data Sources The electronic data bases of PubMed, CINAHL and were used to identify studies published in English from 1998- 2017. Design Using inclusion and exclusion criteria, 27 articles were initially assessed. After further screening 19 articles were included in the full review and of these 5 more were excluded. Lastly, an in-depth review of these 14 studies resulted in 2 more exclusions, for a total of 12 studies that met full inclusion and exclusion criteria. Review Methods Studies were examined for information on safety and efficacy of cup feeding as an alternative, supplemental feeding method for preterm breastfed infants. Studies were grouped into categories of outcomes that included (a) safety and physiologic properties; (b) breastfeeding outcomes. Results Use of cup feeding resulted in more stable heart rate and oxygen saturation than bottle feeding with similar weight gain. Additionally, breastfeeding rates were higher at discharge with continued higher rates at 3 and 6 months post-discharge for cup fed infants. Conclusions Premature infants face more breastfeeding obstacles than term infants. The potential for cup feeding as an alternative to bottle-feeding for breast fed preterm infants is positively supported by these results It is fundamentally important for NICU professionals to establish a protocol, education and training for the potential use of this feeding method for this vulnerable population.

This is a preview of subscription content, log in to check access.

Fig. 1

References

  1. Abouelfettoh, A., Dowling, D., Dabash, S., Elguindy, S., & Seoud, I. (2008). Cup versus bottle feeding for hospitalized late preterm infants in Egypt: A quasi-experimental study. International Breastfeeding Journal, 3(1), 27. https://doi.org/10.1186/1746-4358-3-27.

    Article  PubMed  PubMed Central  Google Scholar 

  2. Academy of Breastfeeding Medicine Protocol Committee. (2009). ABM clinical protocol #3: Hospital guidelines for the use of supplementary feedings in the healthy term breastfed neonate, revised 2009. Breastfeeding Medicine: The Official Journal of the Academy of Breastfeeding Medicine, 4(3), 175–182. https://doi.org/10.1089/bfm.2009.9991.

  3. 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.

    CAS  Article  Google Scholar 

  4. Al-Sahab, B., Feldman, M., Macpherson, A., Ohlsson, A., & Tamim, H. (2010). Which method of breastfeeding supplementation is best? the beliefs and practices of paediatricians and nurses. Paediatrics & Child Health, 15(7), 427–431.

    Article  Google Scholar 

  5. American Academy of Pediatrics (AAP). (2009). Sample hospital breastfeeding policy for newborns. Retrieved from http://www2.aap.org/breastfeeding/curriculum/documents/pdf/Hospital%20Breastfeeding%20Policy_FINAL.pdf

  6. American Academy of Pediatrics. (2012). Breastfeeding and the use of human milk. Retrieved from http://pediatrics.aappublications.org/content/early/2012/02/22/peds.2011-3552.

  7. Anderson, J. W., Johnstone, B. M., & Remley, D. T. (1999). Breast-feeding and cognitive development: A meta-analysis. The American Journal of Clinical Nutrition, 70(4), 525–535.

    CAS  Article  Google Scholar 

  8. Association of Women’s Health Obstetric and Neonatal Nursing. (2007). Breastfeeding. Retrieved from file:///C:/Users/francie/Downloads/Resources-Documents-pdf-5_Breastfeed%20(3).pdf.

  9. Australian Breastfeeding Association. (2016). Retrieved from https://www.breastfeeding.asn.au/bfinfo/cup-feeding.

  10. Baby-Friendly USA, Inc. (2012). Baby friendly hospital initiative. Retrieved from http://www.babyfriendlyusa.org/eng/index.htm.

  11. Bier, J. A., Oliver, T., Ferguson, A. E., & Vohr, B. R. (2002). Human milk improves cognitive and motor development of premature infants during infancy. Journal of Human Lactation: Official Journal of International Lactation Consultant Association, 18(4), 361–367. https://doi.org/10.1177/089033402237909.

    Article  Google Scholar 

  12. Cloherty, M., Alexander, J., Holloway, I., Galvin, K., & Inch, S. (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: Official Journal of International Lactation Consultant Association, 21(2), 151–162.

    Article  Google Scholar 

  13. Collins, C., Ryan, P., Crowther, C., McPhee, A., Paterson, S., & Hiller, J. (2004). Effect of bottles, cups, and dummies on breast feeding in preterm infants: A randomized controlled trial. BMJ, 329(7459), 193–198.

    Article  Google Scholar 

  14. Collins, C. T., Makrides, M., Gillis, J., & McPhee, A. J. (2008). Avoidance of bottles during the establishment of breast feeds in preterm infants. The Cochrane Database of SystematicR Reviews. https://doi.org/10.1002/14651858.CD005252.pub2.

    Article  Google Scholar 

  15. Cristofalo, E. A., Schanler, R. J., Blanco, C. L., Sullivan, S., Trawoeger, R., Kiechl-Kohlendorfer, U., … Abrams, S. (2013). Randomized trial of exclusive human milk versus preterm formula diets in extremely premature infants. The Journal of Pediatrics, 163(6), 1592–1595. https://doi.org/10.1016/j.jpeds.2013.07.011.

    Article  PubMed  Google Scholar 

  16. Dowling, D., Meier, P., DiFiore, J., Blatz, M., & Martin, R. (2002). Cup-feeding for preterm infants: Mechanics and safety. Journal of Human Lactation: Official Journal of International Lactation Consultant Association, 18(1), 13–20. (quiz 46–49, 72).

    Article  Google Scholar 

  17. Eidelman, A. I., & Schanler, R. J. (2012). Executive summary: Breastfeeding and the use of human milk. Pediatrics, 129(3), 600–603.

    Google Scholar 

  18. Feldens, C. A., Vitolo, M. R., Rauber, F., Cruz, L. N., & Hilgert, J. B. (2012). Risk factors for discontinuing breastfeeding in southern Brazil: A survival analysis. Maternal and Child Health Journal, 16(6), 1257–1265. https://doi.org/10.1007/s10995-011-0885-7.

    Article  PubMed  Google Scholar 

  19. Flacking, R., Nyqvist, K. H., Ewald, U., & Wallin, L. (2003). Long-term duration of breastfeeding in swedish low birth weight infants. Journal of Human Lactation: Official Journal of International Lactation Consultant Association, 19(2), 157–165. https://doi.org/10.1177/0890334403252563.

    Article  Google Scholar 

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

    Article  PubMed  Google Scholar 

  21. Flint, A., New, K., & Davies, M. W. (2016). Cup feeding versus other forms of supplemental enteral feeding for newborn infants unable to fully breastfeed. The Cochrane Database of Systematic Reviews. https://doi.org/10.1002/14651858.CD005092.pub3.

    Article  PubMed  Google Scholar 

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

    CAS  PubMed  Google Scholar 

  23. Freer, Y. (1999). A comparison of breast and cup feeding in preterm infants: Effects on physiological parameters. Journal of Neonatal Nursing, 5(1), 16–21.

    Google Scholar 

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

    Google Scholar 

  25. Gunn, T. R., Thompson, J. M., Jackson, H., McKnight, S., Buckthought, G., & Gunn, A. J. (2000). Does early hospital discharge with home support of families with preterm infants affect breastfeeding success? A randomized trial. Acta Paediatrica (Oslo, Norway: 1992), 89(11), 1358–1363.

    CAS  Article  Google Scholar 

  26. 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  Google Scholar 

  27. Holmes, A., McLeod, A., & Bunik, M. (2013). ABM clinical protocol #5: Peripartum breastfeeding management for the healthy mother and infant at term, revision 2013. Breastfeeding Medicine: The Official Journal of the Academy of Breastfeeding Medicine, 8(6), 469–473. https://doi.org/10.1089/bfm.2013.9979.

    Article  Google Scholar 

  28. 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 

  29. Labbok, M., & Coffin, C. (1997). A call for consistency in definition of breastfeeding behaviors. Social Science & Medicine (1982), 44(12), 1931–1932.

    CAS  Article  Google Scholar 

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

    CAS  Article  Google Scholar 

  31. Levy, I., Comarsca, J., Davidovits, M., Klinger, G., Sirota, L., & Linder, N. (2009). Urinary tract infection in preterm infants: The protective role of breastfeeding. Pediatric Nephrology (Berlin, Germany), 24(3), 527–531. https://doi.org/10.1007/s00467-008-1007-7.

    Article  Google Scholar 

  32. Maastrup, R., Hansen, B. M., Kronborg, H., Bojesen, S. N., Hallum, K., Frandsen, A., … Hallstrom, I. (2014). Breastfeeding progression in preterm infants is influenced by factors in infants, mothers and clinical practice: The results of a national cohort study with high breastfeeding initiation rates. PLoS ONE, 9(9), e108208. https://doi.org/10.1371/journal.pone.0108208.

    CAS  Article  PubMed  PubMed Central  Google Scholar 

  33. Maayan-Metzger, A., Avivi, S., Schushan-Eisen, I., & Kuint, J. (2012). Human milk versus formula feeding among preterm infants: Short-term outcomes. American Journal of Perinatology, 29(2), 121–126. https://doi.org/10.1055/s-0031-1295652.

    Article  PubMed  Google Scholar 

  34. Malhotra, N., Vishwambaran, L., Sundaram, K., & Narayanan, I. (1999). A controlled trial of alternative methods of oral feeding in neonates. Early Human Development, 54(1), 29–38.

    CAS  Article  Google Scholar 

  35. Mannan, I., Rahman, S. M., Sania, A., Seraji, H. R., Arifeen, S. E., Winch, P. J., Darmstadt, G., & Baqui, A., Bangladesh Projahnmo Study Group (2008). Can early postpartum home visits by trained community health workers improve breastfeeding of newborns? Journal of Perinatology: Official Journal of the California Perinatal Association, 28(9), 632–640. https://doi.org/10.1038/jp.2008.64.

    CAS  Article  Google Scholar 

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

    CAS  Article  Google Scholar 

  37. McKinney, C. M., Glass, R. P., Coffey, P., Rue, T., Vaughn, M. G., & Cunningham, M. (2016). Feeding neonates by cup: A systematic review of the literature. Maternal and Child Health Journal, 20(8), 1620–1633. doi:https://doi.org/10.1007/s10995-016-1961-9.

    Article  PubMed  PubMed Central  Google Scholar 

  38. Merewood, A., Brooks, D., Bauchner, H., MacAuley, L., & Mehta, S. (2006). Maternal birthplace and breastfeeding initiation among term and preterm infants: A statewide assessment for massachusetts. Pediatrics, 118(4), e1048–e1054.

    Article  Google Scholar 

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

    CAS  Article  PubMed  Google Scholar 

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

    CAS  Article  Google Scholar 

  41. Neo-BFHI The Baby-friendly Hospital Initiative for Neonatal Wards: Three guiding principles and ten expanded steps to protect, promote and support breastfeeding (2015). Retrieved from http://www-conference.slu.se/neobfhi2015/Neo-BFHI_Core_document_2015_Edition.pdf.

  42. Newman, J. (1990). Breastfeeding problems associated with the early introduction of bottles and pacifiers. Journal of Human Lactation: Official Journal of International Lactation Consultant Association, 6(2), 59–63.

    CAS  Article  Google Scholar 

  43. Okamoto, T., Shirai, M., Kokubo, M., Takahashi, S., Kajino, M., Takase, M., & Oki, J. (2007). Human milk reduces the risk of retinal detachment in extremely low-birthweight infants. Pediatrics International: Official Journal of the Japan Pediatric Society, 49(6), 894–897.

    Article  Google Scholar 

  44. Palmer, M. M. (1993). Identification and management of the transitional suck pattern in premature infants. The Journal of Perinatal & Neonatal Nursing, 7(1), 66–75.

    CAS  Article  Google Scholar 

  45. Quigley, M. A., Henderson, G., Anthony, M. Y., & McGuire, W. (2007). Formula milk versus donor breast milk for feeding preterm or low birth weight infants. The Cochrane Database of Systematic Reviews. https://doi.org/10.1002/14651858.CD002971.pub2.

    Article  PubMed  Google Scholar 

  46. Righard, L., & Alade, M. (1992). Sucking technique and its effect on success of breastfeeding. Birth (Berkeley, Calif.), 19(4), 185–189.

    CAS  Article  Google Scholar 

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

    Article  Google Scholar 

  48. Roze, J. C., Darmaun, D., Boquien, C. Y., Flamant, C., Picaud, J. C., Savagner, C., Claris, O., Lapillonne, A., Mitanchez, M., Branger, B., Simeoni, U., Kaminski, M., & Ancel, P. Y. (2012). The apparent breastfeeding paradox in very preterm infants: Relationship between breast feeding, early weight gain and neurodevelopment based on results from two cohorts, EPIPAGE and LIFT. British Medical Journal Open. https://doi.org/10.1136/bmjopen-2012-000834.

    Article  Google Scholar 

  49. Schanler, R., Shulman, R., & Lau, C. (1999). Feeding strategies for premature infants: Beneficial outcomes of feeding fortified human milk versus preterm formula. Pediatrics, 103(6 Pt 1), 1150–1157.

    CAS  Article  Google Scholar 

  50. 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  Google Scholar 

  51. Simpson, C., Schanler, R., & Lau, C. (2002). Early introduction of oral feeding in preterm infants. Pediatrics, 110(3), 517–522.

    Article  Google Scholar 

  52. Sisk, P. M., Lovelady, C., Dillard, R., Gruber, K., & O’Shea, T. (2007). Early human milk feeding is associated with a lower risk of necrotizing enterocolitis in very low birth weight infants. Journal of Perinatology: Official Journal of the California Perinatal Association, 27(7), 428–433.

    CAS  Article  Google Scholar 

  53. Sullivan, S., Schanler, R. J., Kim, J. H., Patel, A. L., Trawoger, R., Kiechl-Kohlendorfer, U., Chan, G. M., Blanco, C. L., Abrams, S., Cotton, M. C., Laroia, N., Ehrenkranz, R. A., Dudell, G., Cristofal, E. A., Meier, P., Lee, M. L., Rechtman, D. J., & Lucas, A. (2010). An exclusively human milk-based diet is associated with a lower rate of necrotizing enterocolitis than a diet of human milk and bovine milk-based products. The Journal of Pediatrics, 156(4), 562–567. https://doi.org/10.1016/j.jpeds.2009.10.040.

    CAS  Article  PubMed  Google Scholar 

  54. United Nations Children’s Fund (1999), Breastfeeding: foundation for a healthy future. Retrieved from https://www.unicef.org/publications/files/pub_brochure_en.pdf.

  55. Vohr, B. R., Poindexter, B. B., Dusick, A. M., McKinley, L. T., Wright, L. L., Langer, J. C., & Poole, W. K., NICHD Neonatal Research Network (2006). Beneficial effects of breast milk in the neonatal intensive care unit on the developmental outcome of extremely low birth weight infants at 18 months of age. Pediatrics, 118(1), e115–e123.

    Article  Google Scholar 

  56. World Health Organization. (2012). Exclusive breastfeeding. Retrieved from http://www.who.int/nutrition/topics/exclusive_breastfeeding/en/.

  57. World Health Organization. (2014). Global Nutrition Targets 2025: Breastfeeding policy brief. Retrieved from http://www.who.int/nutrition/publications/globaltargets2025_policybrief_breastfeeding/en/.

  58. Yilmaz, G., Caylan, N., Karacan, C. D., Bodur, I., & Gokcay, G. (2014). Effect of cup feeding and bottle feeding on breastfeeding in late preterm infants: A randomized controlled study. Journal of Human Lactation: Official Journal of International Lactation Consultant Association. https://doi.org/10.1177/0890334413517940.

    Article  Google Scholar 

Download references

Author information

Affiliations

Authors

Corresponding author

Correspondence to Frances Penny.

Ethics declarations

Conflict of interest

The authors declare that they have no competing interests.

Rights and permissions

Reprints and Permissions

About this article

Verify currency and authenticity via CrossMark

Cite this article

Penny, F., Judge, M., Brownell, E. et al. Cup Feeding as a Supplemental, Alternative Feeding Method for Preterm Breastfed Infants: An Integrative Review. Matern Child Health J 22, 1568–1579 (2018). https://doi.org/10.1007/s10995-018-2632-9

Download citation

Keywords

  • Breastfeeding
  • Preterm
  • Cup feeding
  • Alternative feeding
  • Infants