Guidelines for Cup Drinking

I am happy to announce that Matthew is now drinking milk from a sippy cup and we are celebrating! Good-bye bottle!

Matthew's Occupational Therapist (OT), who is also a feeding specialist, offered some guidelines for cup drinking. This information is not exactly out of a text book. It is collective knowledge from an OT, Speech Therapist (ST) and Developmental Therapist (DT), who requested to remain anonymous. With their permission, I am sharing it with you (in green text). Keep in mind that these are just guidelines, not strict rules. Every therapist is different. Every family is different. Every child is different. We do what we have to do given our own set of variables.

How Do I Know When My Child Is Ready For A Cup?
Age 3-6 months - hold or supports bottle during feeding
Age 6-9 months - closes lips when swallowing
Age 9-12 months - closes mouth on rim of cup but may lose some liquid from corners of mouth
Age 12-18 months - may drink from a cup independently with frequent spills; sips liquid from a cup using straw
In general, a child is ready to use a cup if they can sit well and play/ manipulate toys in sitting.
A child should be able to drink from a cup without tipping head backwards to allow for a good swallow.

Types of Cups
Use or over use of sippy/spout cups may be a contributing factor in speech delays for some children.

If the sippy/spout cup has a valve, a child has to suck harder which can delay or interfere with the development of a good swallow pattern. It can also cause children to revert back to stronger backward-forward suckle movements of the tongue that they used with the bottle. This occurs when the tongue is placed more forward in the mouth vs. more in the back of the mouth. This may also interfere with oral development especially if there are other underlying oral issues.

The size of the spout on a sippy cup may not encourage as good of a lip seal, tongue placement, or lip placement as on an open cup. Good lip seal and strength, as well as tongue placement, are essential for producing some speech sounds.

What is Actually Recommended?
This varies from child to child as well as with routines of the family. In general, straw drinking or use of a small open cup is preferred. A small Tupperware 2 ounce container or small medicine cup may be used initially as they allow small amounts of liquid that are easy to handle. It is also good to use nectar or thicker drinks when starting out as they are easier to manage.

If you must use spill proof - straws or straw cups (e.g. sports bottle type) are a good alternative. They encourage good lip seal and overall good oral motor strength. If a spout cup is used, the most desirable type is the type without a valve such as the Tupperware thin (and smaller) spout or any type that has the shape of an open cup. These can be found on line at Talk Tools (Recessed Lid Cup) or Maddak, Inc. (Little Spill Drinking Cup).

Children need opportunities to learn to drink from an open cup. Practice (and spills that come with it) makes perfect! This helps stabilize the jaw which is very important in oral motor, feeding and speech development. You can start with just one ounce of liquid.

In my Breast to Bottle to Cup post on May 4, 2009, I wrote about how Matthew transitioned with drinking milk from breast to bottle and not having any success with milk in a cup. I tried many kinds of cups - sippy cups, straw cups, recessed lid cups - and appreciate the encouragement and suggestions I received through comments in Breast to Bottle to Cup. Matthew was fully capable of drinking water or juice from any of these cups. He just was not willing to drink milk from them. The one-meal-at-a-time transition method did not work as he just refused to drink and knew he was getting a bottle at the next meal anyway.

So, on June 1, my husband suggested that we just stop offering the bottle completely. Initially, I wasn't too sure about our new strategy but we did it. The change was met with much resistance and tears as we explained that we drink milk from cups. He unhappily resigned to drinking his milk from the sippy cup. His intake decreased as he was getting used to the change, but on the bright side, he ate more. It took two full weeks before he completely accepted milk from the sippy cup without protest. Now that he's used to the sippy cup, his milk consumption is back up. Over time, we hope to move to a cup without a spout, including straw cups. Baby steps.

A few examples of straw cups include: the Sip-Tip cup from Beyond Play, which allows you to pump the liquid up the straw; the Honeybear w/ Flex Straw from Beyond Play or Talk Tools; the Nuby Grip 'n Sip with Flip-It Straw from Target or Walmart, but be warned that this comes with a built-in valve which may make it difficult for some to drink (Matthew has not succeeded with this); a plain open cup with a straw (be prepared for spills!); and the Leakproof Juice Box made by Arrow Plastic Manufacturing Company, which I found in the plastic container aisle at Target.

On the one hand, we know that the sippy cup is not ideal because of the protruding spout. But on the other hand, it's our first baby step away from the bottle. And while Matthew's OT agrees that this is not ideal, she supports our decision to use the sippy cup for milk now and understands that we just have to do what works sometimes. In the meantime, Matthew still gets plenty of practice drinking juice or water from an open cup or through a straw.