Monday, May 4, 2009

Breast to Bottle to Cup

19 months old tomorrow and Matthew still drinks his milk-based formula (for toddlers 9-24 months old) from a bottle. I have discussed most (if not all) the possibilities to switch him over to a cup completely with his Occupational Therapist (OT), Developmental Therapist (DT) and Speech Therapist (ST). We don't have any strong concerns about his oral motor tone. I think it boils down to his emotional attachment to the bottle. Perhaps he gets some kind of comfort or satisfaction from bottle drinking? I initially tried offering milk in a cup at snack time, you know, cut back one meal at a time. My efforts to wean him off the bottle have always been met with little hands pounding the food tray and waving away the cup. How does one be persistent enough with this without turning snack time or any mealtime into a milk battle? Why couldn't this be as easy as the transition from breast to bottle?

Yes, I was able to successfully nurse for 9 months and supplemented with pumped milk in a bottle. We used standard Dr. Brown's bottles, recommended to us by one of the specialists at the hospital when Matthew was born. Sure, there were concerns about the bottle promoting tongue protusion, a common issue for kids with Down syndrome. I had considered switching him to other bottles but I didn't. Why mess with something that was working well? The Dr. Brown's bottle seemed to prevent colic, spit-up, burping and gas (as it advertised). More importantly, Matthew was gaining weight so we knew he was getting enough. Matthew suckled and latched on well but there were many times when he would tire easily or fall asleep. This was expected though. Because of his low muscle tone, it took more effort for him to nurse. So I always pumped after nursing to make sure he also got the hindmilk he needed. Weaning him seemed to happen naturally as I began to pump more than nurse. Eventually I supplemented with formula when I wasn't producing enough. I think the fact that Matthew was already introduced to the bottle early on (starting when he was in the Special Nursery at the hospital) and that it was easier to drink out of the bottle helped him transition as easily as he did.

As every mom with a special needs child knows, the age ranges in lists of developmental milestones for typically developing kids do not apply. 'Stage Not Age' at Down Syndrome New Mama also points this out. The developmental chart in 'An Overview of the Development of Infants with Down Syndrome (0-5years)' available at Down Syndrome Online estimates 20 months as the average age that a child with Down syndrome would drink from a cup, with the age range being 12 to 30 months.

I introduced him to water in a Munchkin brand sippy cup Munchkin brand sippy cupand water in a clear open cup clear open plastic cupwhen he was around 8 or 9 months old with the goal of weaning him off the bottle by the time he turned 1. The new goal is "when he's ready". It's not that he won't drink from a cup at all. He can drink juice and water from his sippy cup and an open cup, with fairly good lip closure at the rim. But he flat out refuses milk in a cup. I've even tried other special cups without the spout, since the spouted sippy cup may encourage tongue protusion just like the bottle. He hasn't warmed up to any of these cups yet. The clear and pink ones are called Little Spill cups that Matthew's OT got for him to try. The only place I have found them is at Beyond Play online. They also have flexi cups (not pictured here) but Matthew only tossed around the one he had. The Playtex cup is available at Target.

Little Spill cupLittle Spill cup with handlesPlaytex toddler cup

In the back of my mind, I know he will agree to drink milk from a cup. Just 'when he's ready'.


The Cooking Ninja said...

Does he has a toy or a blanket that he's attached to? Will that help him to transit from bottle attachment to a toy or blanket?

McTriplet Mommy said...

Hang in there. He will get it! Sorry this is so frustrating. :(

Take care,

PS - love the new layout! :)

ds.mama said...

Great informational post. I have a typically developing 2 1/2 year old who is still on the bottle at bedtime, naptime, and sometimes first thing in the morning. He can drink from a cup... He just doesn't want to at those times because he is soothing himself (plays with his hair while he drinks too!) My little ds girl will probably be off the bottle before him, lol.

Anyway, with my older kids, I picked one meal to focus on a cup. I explained that we drink from a cup at lunch. Even if they refused the cup, I did not replace it with a bottle. Eventually they accepted this and I added another time of the day and so it went.

Maybe you could try the Mr. Juice Bear cup with a straw. They have it at beyond play.

You are right about the "when he's ready" part because overall I think it is a choice our kids make more than a learning how to do it thing.

Tara said...

Our little one with Ds is only 3 mos. old, so I have no experience there, but he is our sixth child, so I'll chime in anyway. :) My almost 2yo. typical son did this, too. He would take juice and even water from a cup, but not milk. What finally worked was to change the milk from formula to cow's milk...and add sugar. Shocking, isn't it?! In my defense, I only sweetened it for a week, with progressively less sugar (corn syrup) each time. But, it did the trick! :)

Btw, your little guy is too cute!

Ria said...

Cooking Ninja,
He does have a lion blankie (plus a back-up one) but he likes it for naptime & bedtime. Thanks for the idea though.

McTriplet Mama,
Thanks! I'll be adding more pics to the slideshow too. Stay tuned!

DS Mama,
Thanks for the suggestion. I actually have the Sip Tip cup from Beyond Play. Matthew won't drink out of that either. I haven't given up on it yet. I have a question: What do you do if your kid won't drink the milk from the cup at all since offering the bottle at lunch was not an option? Would you just offer something else to drink later on in the day so they don't get too thirsty?

Hmm... I didn't think about adding sugar. I'm trying to transition Matthew from milk-based formula to whole milk now too. But I've been mixing whole milk with his formula, maybe a 1oz:3oz ratio and he doesn't mind it. He didn't care for whole milk by itself. Sugar... hmmm...

I really appreciate all your comments! Keep 'em coming!

Jill said...

Hey Ria...our boys are the same age, and Nate hasn't had a bottle since around 17 months or so. What started his transition was introducing a straw! I put milk in a drinking glass with a bend-y straw. He was so enthralled with the experience that he forgot he was drinking milk and by the time he realized it, he was used to it!!

Ria said...

Jill, Thanks for the straw suggestion. I'll try that. He drinks juicy juice through a straw so maybe he'll like drinking milk from a straw. We shall see.