Feeding how to: transitioning your baby to an open cup

First breast or bottle, then sippy cup, then baby drinks from an open cup, right? Not necessarily.  The sippy cup “stage” is losing favour with experts.

 

The widely accepted and current feeding recommendation is that babies be exclusively breastfed or bottle fed until four to six months of age. At this age, solid foods are introduced while the number and/or volume of breast and bottle feedings are reduced. This change in an infant’s feeding routine is an excellent time to introduce drinking from a cup. The Ontario Society of Nutrition suggests introducing an open cup between six to nine months of age, with the goal of being weaned from bottles by baby’s first birthday.  This fits with the timeline most recommended by dentists and paediatricians. Working towards drinking in something other than a bottle is important. Continued bottle use (beyond 12-18 months) can cause tooth decay and could cause your child to drink much more milk than necessary, leading to complications such as iron deficiency anemia and/or constipation.

 

Doing a quick google search on the subject of the cup transition will turn into a long, and overwhelming task of finding the perfect cup for your child. When I speak with parents of young children, they often are trying a wide range of sippy cups, open cups, mugs and bottles, some with more success than others.

 

Most babies have been exclusively breastfed or bottle fed for at least the first four months of their lives, and drinking in any other way can be a daunting task. It can take a child several weeks of daily use of a sippy or open cup before they start to understand how to drink from it. Just like learning to roll over, sit up, and crawl, learning to drink differently is a skill that will take time and practice (and patience from parents) to master. If a baby is 10 months and drinking exclusively by a bottle or from the breast, they will have a more challenging time reaching the goal of drinking from a cup by 12 months, compared to a baby who has had at least some experience with a cup starting before 10 months of age.  Some moms don’t feel there baby is “ready” to drink from an open cup when their baby is between 6 to 9 months. This may be true and your baby could be entirely unsuccessful in its attempts to drink from a cup in the first weeks. However, what is important is the introduction and repeated exposure of the open cup and not the initial success. Success will come with time as long as you keep giving your little one the opportunity to try.

 

There are so many types of cups for baby, what is the difference?

Transitional Cups

Transitional cups or training cups can be a helpful bridge between using a bottle or breastfeeding to using a cup. Features of a transitional cup includes a soft spout. Similar to a bottle or drinking from the breast, it usually doesn’t have a valve, and has handles for your child to grip onto (somewhat) independently. The downside of many of these cups is that they are still quite large, and if filled full of liquid, will make it almost impossible for your child to successfully lift and drink from. When using these cups, it’s best to add just a small amount of liquid (1-2 teaspoons) to start. As your baby gets the hang of it, you can gradually increase the volume.

Sippy Cups with Spouts or Straws

A sippy cup with a spout is similar for baby to drinking from a bottle, but the spout will usually be made of a harder plastic. If your baby is teething, they may have more fun chewing on the spout than drinking from it. These cups are frowned upon among dentists for a variety of reasons. Sucking on hard plastic may cause teeth to become misshapen and could result in future problems in speech.  Spouted sippy cups are convenient for parents as they minimize spills. They often have a (removable) valve that prevents the liquid from spilling out when baby drops or tips it. Removing the valve will allow the liquid to flow freely. With the valve in place, baby will actually have to suck from the spout similar to sucking from a bottle. If you decide on a cup like this, I suggest removing the valve.  

Some sippy cups have straws instead of a spout. More feeding experts recommend these types of spouted cups in lieu of the harder plastic spout. Straw sippy cups require your baby to suck the liquid up the straw. Some of these cups have a weighted bottom so your baby can drink from a straw from different positions and help avoid spills. Unlike the sippy cup with a spout, the straw will be more flexible, bending with the shape of a child’s mouth, thus having less of an impact on developing teeth.

Spoutless Sippy Cups

Spoutless sippy cups encourage drinking in a similar way to using an open cup and are a favourite among dentists. These types of cups may have a cut-out lid, similar to a disposable coffee lid, or may have a lid that creates a seal until the baby starts to bite down and drink out of it (ie. Munchkin 360).  Without a hard plastic spout, these spoutless cups don’t pose any risk to baby’s teeth. The biggest challenge with these cups is that they often take a little longer to be accepted compared to cups with spouts or straws.

Open Cups

The long-term goal for any child should be drinking from an open cup. The journey of getting here usually starts with the use of transitional cups or sippy cups, but it doesn’t have to. More and more experts are suggesting parents skip the sippy cup phase and start directly with an open cup around the time solids are introduced. Using miniature versions of open cups make this easier for small hands and mouths (ie. The Tiny Cup, Ezpz).  Other features of open cups to look for are that they are made from plastic or silicone (never glass) to help protect baby’s teeth. Medicine cups, dixie cups, and even plastic shot glasses are all great “open cup” options to start with as they fit small hands and the materials won’t hurt baby’s teeth.

Ok, we are ready for this. What do I offer baby to drink?

When offering a cup to baby, the most recommended liquid to start with is water.  Water is recommended because it’s the beverage of choice for quenching thirst and can be offered throughout the day without regards to feeding times, which is key for ensuring enough exposure. In additions, it will not contribute to dental problems, it will not impact appetite, and when it spills it won’t make a mess (and there will be spills. A lot.).  

For many babies, water works well and over time they will get the hang of it. For other babies, they may need a more enticing flavour or a thicker liquid. In these cases other fluids can be introduce after water has been offered for a number of weeks:

• Try flavouring water with oranges, berries, cucumber, kiwi, pineapple…you get the idea.
• Offer thin purees (think thin smoothies) as thicker fluids are actually easier to swallow.
• Offer breastmilk or formula at different temperatures (warm, room temperature, directly out of the fridge).
• Nutritive fluids should be paired with meals or snacks. If your baby is thirsty between these feeding times, water should be the only fluid offered.
• Juices should be avoided. The sugars in juices can fill up small tummies and provide little other nutrition.

My six month old is interested in liquids. How do we move from bottle to cup?

So what are you waiting for? If your child six months old or more, start today!

Pediatrician, Dr. Sheena Belisle suggests, “Start by offering a number of different cups to your child (open, sippy, etc.) especially during times of fluid refusal, bottle strikes, and illness”. Take your child’s lead on what cups they seem to take to best. Once you narrow it down to a few cups, just keep practicing. If you find that your strong-willed child refuses to adapt, try a tip from dental surgeon, Dr. Jess Milne, “Plan a weekend or week-long vacation and leave the bottle or sippy cup at home. Be sure the destination has lots of stimulation and distraction (waterpark, beach, rides, etc.) so they will be making the change in a new environment”.

When eliminating bottles remove one bottle at a time and replace it with a cup.  Start with the morning and afternoon bottles and leave the bedtime bottle for last. The bedtime bottle is generally the hardest for your baby to give up, and it will be easier to do this once the other feeds have been changed. As with any change and learning new skills, give your child time, practice, and encouragement. Cheer your child on throughout this journey by making a big deal of their achievements.

Making the transition to a cup is a big milestone for you and your baby. It means they are growing up and becoming even more independent. This phase may not come without drama, so keep these tips in mind to help support your child during this time. Start early, be consistent, try fluids other than water, aim to wean the bottle by 12 months, and applaud all their efforts.