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The Ultimate Guide to Cup Drinking

5/27/2020

 
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Top left (clockwise) via Instagram: @n_and_cs_mom, @livvy_k.a, @tpaigemcintosh, @jackie_bosco

Updated May 2020

Confused about cups?

You're not alone! One of the most common questions on our Facebook group and Instagram is "How do I introduce a cup?" We know you have questions about cups given your child's specific age and stage, so we want to break it down step-by-step so you know exactly how to introduce various cups and what cups are appropriate for your child's age.

Note: the images in this post were used with permission from parents in Feeding Littles Group. Thank you to everyone who contributed images - we wish we could use them all! 

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@jenniferedlin

The big questions.

Before we get to teaching specific cups and how to progress to more advanced skills, we wanted to answer some important questions.
Q: When should I introduce a cup?
A: Around 6 months, when your baby starts food (Baby-led Weaning or Traditional Weaning/spoon feeding).


Q: What type of cup should I use first? 
A: An open cup, then a straw cup (see schematic and videos below).

Q: How do I know when to move on from an open cup to a straw cup? 
A: When your baby can successfully swallow a small amount of water from an open cup that you assist in holding. (They don't need to be able to do it independently to learn a straw cup.)

Q: What are your favorite straw cups and water bottles?
A: In each section below after the video, look for the links to individual sections of our Amazon Store for specific cup buying recommendations.

Q: What should I put in the cup?
A: Water or breast milk/formula.

Q: What about juice?
A: We only recommend juice for constipation (prune, pear, peach juice diluted with water). Otherwise, juice isn't necessary for babies and young children - fruit is a better option! 

Q: How much water can a 6 month old have?
A: No more than 1-2 oz - we don't want it to displace baby's milk feeds.

Q: Why should I offer some water at 6 months? Aren't breast milk and formula perfectly hydrating?
A: Yes, they are! However, water in a cup has a few important functions:
  1. Offering water in a cup helps wash down food.
  2. Teaching cup drinking is an important skill to learn for when baby is eventually weaned from the breast or bottle.
  3. A small amount of water helps prevent constipation when food is introduced.
  4. We want babies to like water so that when they're older they have a drive to drink it! 

Q: How much water can my baby drink?
A: In general, we recommend no more than 1-2 oz around 6 months and 3-4 oz max around 9 months. Around 12+ months baby can have as much water as they want but will likely still be drinking breast milk, milk and/or formula along with it (see last question about milk needs, below). Many pediatricians consider a water maximum (after 6 months) as number of ounces equaling baby's age in months; thus, no more than 7 oz of water for 7 months. For most babies this would be far too much water for them to also drink enough of their milk, but it's a nice maximum guideline if baby is sick or for some reason isn't drinking their milk.

Q: When should I ditch the bottle?
A: Start working on transitioning off the bottle around 11-12 months. It may take many months for your toddler to stop using the bottle entirely and transition to cups, but the biggest issue with prolonged bottle use is the potential effects on your toddler's teeth. If using a bottle before nap or bedtime, try to brush your toddler's teeth before they go to sleep. We have a detailed Milk and Weaning eBook included in our Infant and Toddler online courses that addresses all of this. It can also be purchased separately here.

Q: How much fluid do toddlers and older kid need?
A: Toddlers and kids need more fluid than you think! Below are averages recommendations of total fluid per day. Read more specifics about your child's needs - and how to calculate them if you'd like - here.
  • 1-3 years: 4-6 cups 
  • 4-8 years: 7 cups
  • 9-13 years: 9 cups (girls), 10 cups (boys)
  • 14-18 years: 10 cups (girls), 14 cups (boys)

Q: How much breast milk or formula should my baby (under 12 months) drink?
A: Babies will vary wildly in how much their bodies need for adequate growth and development. Some babies drink 26 oz a day, while others need over 40 oz. Most babies need at least 24 ounces of breast milk or formula until they're closer to one. This equates to 6-12+ breast feeds depending on baby's milk transfer. Talk to your doctor, dietitian or lactation specialist if you're concerned about how much milk your baby is drinking.


Q: How much milk should my toddler or child drink?
A: This is a tricky question and depends on your child's overall diet. If you have our Toddler Course, head to Step 16: Calcium, Milk and Beverages. If your child is drinking cow's milk or an alternative milk, general guidance recommends no more than 16-24 ounces per day to allow your toddler or child to also eat enough food and not fill up too much on milk. Drinking too much cow's milk can increase a child's risk for iron deficiency anemia as well. Many moms continue to breastfeed far into toddlerhood, and some families choose not to use any milk after infancy. Feeding Littles firmly believes that there's no one right solution for every child - some kids thrive on cow's milk while others breastfeed far into toddlerhood. Some kids eat high-calcium, high-fat foods and get all of their calories from solid foods and no milk. Every child is different and will vary. Please refer to our Milk and Weaning eBook in both courses or here for more details about choosing a milk for your child.

Q: What about smoothies?
A: Smoothies are OK as of 6 months in small amounts, as long as they don't contain artificial sweeteners or herbs (found in protein powders). Most straw cups made for thin liquids are too narrow for smoothies and the thicker smoothie consistency gets stuck. Check out our smoothie cup video and product recommendations at the end of this list! 

How do I introduce cups to my baby?

We recommend an order of cup introduction to help your baby progress through specific oral-motor skills. 

Your baby only needs to learn to drink from two types of cups:
  • First, an open cup.
  • Next, a straw cup.
​
Above all else, make sure to start with an open cup first. It really helps your baby learn how to take a small bolus of liquid in their mouth and swallow. We recommend avoiding hard spout sippy cups - the rationale is described in the final video.

What about Miracle 360 cups? Parents like the 360 cup, which is similar to an open cup with a silicone membrane lid, because it is less likely to spill. In the past we recommended it as the third cup type to teach your baby. However, recently many feeding specialists have expressed concern about how some kids use this type of cup. Please head to the 360 Cup section in this post for more details.

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Step 1: Open cup with adult assistance

First, let's talk about how to teach your baby to drink from an open cup:
Why does Judy recommend open cups first?
When can my baby drink from an open cup without my assistance?

As your baby gets older and more experienced with an open cup, they will begin to hold it independently and drink on their own. Many of Judy's private feeding therapy clients are able to independently drink from an open cup by 10 months of age, but every baby is different.

To help your baby drink from an open cup on their own after they've practiced with you holding the cup:
  • Give baby a small amount of water in the cup and hand it to them with your hands over their hands ("hand-over-hand" technique). 
  • Help them guide the cup to their mouth and drink a small amount of water. Say "AHH" for them to repeat (this promotes swallowing).
  • With your hands over their hands, help them place the cup back on their tray or table. Putting the cup down gives them a break between sips of water that keeps them from drinking too much, too fast. 
  • Ask them if they want more - this is where sign language can help! 
  • Repeat until baby is doing this on their own! Practice, practice, practice.
​ 
To see our list of favorite open cups, click HERE in our Amazon Store.

When can we move onto a straw cup?


As soon as your baby successfully swallows from an open cup using your assistance, try a straw cup! We want your baby to be able to use both types of cups.

Step 2: Straw cup

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@thefierycrash
While open cups are wonderful for drinking at home, reusable straw cups are preferred by parents for water drinking while on the go because they're oftentimes leak-proof (or at least leak-resistant). Some people are moving away from disposable straws for environmental reasons, but it's still important to teach straw usage because most kids' cups utilize a reusable straw, and as you'll learn later that we don't want to use hard spout sippy cups for oral development and speech reasons. Straws also strengthen muscles in the mouth that are important for eating and talking. 

Some babies learn how to use a straw simply by placing one to their lips or by capturing some liquid in a straw with your finger and placing the other end in baby's mouth. Many babies, however, need a little help figuring out the straw. Below Judy will go through how she teaches straw usage with her clients. If your baby figures out a straw cup without issue, you can skip the Mr. Juice Bear/Honey Bear step, but it's very helpful for babies who don't figure out straws right away.
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Miss Avery Mae
Straw cup video 1: Mr. Juice Bear / Honey Bear
Find Mr. Juice Bear and the Honey Bear in our Straw Cup HERE in our Amazon Store.
Straw cup video 2: Take N Toss and assisted straw skills
Check out the Take N Toss cup HERE in our Amazon Store! 
Straw cup video 3: Independent straw cup drinking
Handles can be easier for baby to use, but they're not required. Check out our favorite  straw cups in our Amazon Shop HERE! 

Step 3: Bigger kid cups - water bottles, heavier cups, etc.

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@iamjrhew
As your child progresses, they may be ready for a "real" water bottle or "big kid" cup! These larger cups and water bottles are great for daycare, preschool or the diaper bag because they're less likely to leak and hold more liquid. 

Some things to consider with heavier or larger water bottles:
  • Can your child lift it, or is it too heavy?
  • Can they open the top and drink from it independently?
  • Are their hands big enough to wrap around the water bottle?

If you've answered "yes" to these questions, it may be time for a "big kid" cup! 

Our Straw Cup Amazon list has lots of water bottles for kids 16-18+ months, including our favorite brands Contigo, Hydroflask and Yeti. If you're looking for even bigger water bottles for kids 4+ years, head here. 

Note: a hard or wider straw as found in the Contigo, Hydroflask and Yeti cups do not pose the same oral-motor concerns as a hard spout sippy cup. They are still straws and promote a normal suck pattern.

What about smoothie cups?

Parents in our Facebook Group always ask about smoothie cups. Check out what Judy recommends, below.
Check out our favorite smoothie cups HERE.

What about the Munchkin 360 cup?

As we explained above, we used to recommend the Miracle 360 cup for parents who wanted a more spill-proof option that mimicked an open cup. However, recently some feeding therapists have noticed that the 360 cup can contribute to problematic drinking patterns in some kids:
  • Some kids use excessive jaw movements to get the liquid out of the cup. (This is called jaw protrusion.)
  • This cup may cause your child's tongue to rest in the front of their mouth (anteriorly). With "normal" drinking patterns, the tongue is not meant to stick forward.
  • Some children tip their head back when they drink from the 360 cup. When they tip their head back, it forces their tongue to work in an abnormal pattern.
But we love the 360 cup! Should we stop using it?

  • Developmentally, it's important for your child to drink from an open cup and a straw cup.
  • If they're using a 360 cup, try to switch to an open or straw cup for the majority of their cup drinking.

If your child cannot or will not drink from anything but a 360 cup, here are some tips:

  • Pull off the silicone top lid of the 360 and offer it to your child with water or milk in the cup. This turns it into a modified open cup. Your child may need some time to learn to modify their drinking pattern and neck position.
  • Note: ensure that your child is sitting upright when drinking from a cup. If they were used to drinking it reclined or laying down, modifying the cup may cause the liquid to pour out onto them. 

Why do we avoid sippy cups?

Learn why Judy doesn't recommend hard spout sippy cups. With all the cup options available there's no need for traditional sippies! 

Bloopers....

As you can imagine, this post took us a bit of time to create, so we decided to have a little fun with it. Feeding Littles presents: "The Most Important Cups for Your Kitchen."
For the record, this was a joke...we do NOT recommend teaching your kiddo to drink from a flask. Or a wine glass. Joke. Seriously.

We hope this has helped you decide what cup to use for your kiddo! Cheers!

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Feeding Yourself After a New Baby

1/3/2020

 
Feeding Littles | No matter how a new baby has entered your life, it can be really difficult to find time to feed yourself. Here's some ideas from feeding professional moms to keep yourself fed during this time of transition.

It’s so important for YOU to eat when you have a new baby! Whether you’re breastfeeding, formula feeding, exclusively or partially pumping or using a feeding tube, whether your baby came to you via your own birth, surrogacy, fostering or adoption, YOU NEED TO EAT TOO! Taking care of a baby, no matter your circumstance, is physically grueling, and fuel is required to make it happen. Of course, some days that fuel is coffee and candy.

We wanted to provide you with some ideas to help keep yourself fed:
  • Focus on feeding your baby and accept help to feed yourself. It's OK to ask your partner, family and friends to bring you food. Keep in mind that babies seem to get hungry the second you sit down to eat - be ready to feed them too!
  • Keep portable snacks near your favorite feeding spot. Trail mix, dry cereal, durable fruit, nuts, and other favorite snacks are key when baby is eating and you get hungry, too!
  • If loved ones bring large containers of food, transfer it to smaller single-serving containers or bags and freeze what you can't eat right away.
  • Babywear! It will free up your hands to cook and eat. Just make sure you're not eating anything too hot in temperature! Don't be surprised if some food drops on your baby.
  • Foods that can be eaten with one hand (wraps, salads, burritos, smoothies) may be easier if you get stuck in a long nursing, bottle feeding, or pumping session.
  • Take advantage of grocery or food delivery apps and services. This is the time of your life when you need them the most.
  • Breastfeeding increases your protein and water needs. Hard boiled eggs, nuts, Greek yogurt, beans, fish, peanut butter, and meat are great sources of protein. Stash water bottles or cups of water wherever you feed baby.
  • Your Instant Pot or slow cooker will be your friend - try to prep ingredients when baby sleeps (or ask a loved one to do this) so you can pour and cook!
  • Screen shot menus for your favorite restaurants and keep them in a file on your phone. If someone wants to pick you up food, you'll know just what to order.

We know that feeding a baby is emotional, especially in those early months. Hugs those of you struggling with your feeding experience. We are sending you a big virtual high five for the amazing job you’re doing!

Look below to see photos from some members of our Clients Only Group on Facebook as they feed themselves in various way. Notice food dropped on babywearing babies, dads rocking the bottle (or getting their grub on), combo feeding mamas sneaking in a few bites of food while they feed baby a bottle after a breast feed, new moms finally eating after birth, it’s all wonderful and it all represents our own unique stories as parents.

Thank you to the hundreds of parents who contributed photos - what a fun thread to read! It was such a great reminder that we are all doing our best and are all in it together!!


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Expert Tips for Boosting your Milk Supply

11/1/2019

 
Feeding Littles | Certified lactation consultant shares the tops three things you can do to boost your breastmilk supply. She also shares how to determine if your milk supply is actually low.

Using a pump can help with supply.

National Breastfeeding Month is a time we talk about breastfeeding and milk supply, but we wanted to share a few milk supply tips from the lovely Stephanie Nguyen, RN, MSN, WHNP-C, IBCLC, owner of Modern Milk and amazing Nurse Practitioner/IBCLC. 

First off, a word on milk supply: many moms think their supply is low, but in actuality it’s just fine! True low supply is when you are not making enough milk to meet baby’s needs or baby isn’t gaining weight. Ask yourself these questions.
  1. Is baby gaining weight?
  2. Does your baby seem satisfied after nursing? (Keep in mind that cluster feeding is normal, especially during growth spurts!)
  3. Does your baby have at least 6-8 wet diapers/day?
If you answered yes to these questions, chances are your milk supply is fine! If you’re concerned about any of these questions, seek out your local IBCLC.

Perhaps you’re pumping and need a boost or you’re working on improving milk supply per your pediatrician. Here are Steph’s top 3 things you can do NOW to boost your supply!
  • Add in some extra pumping sessions! Squeezing in some 10 minute pumping sessions during the day (try after the first morning feed or before you go to bed) can help increase your supply. Breastmilk is a supply and demand system, so the more milk you remove from your breasts (from nursing and pumping) the more milk your body will make!
  • Try a hospital grade rental pump (like a Medela Symphony or Ameda Platinum). They are much more efficient at removing milk from the breasts and stimulating your milk supply than regular pumps. These pumps can be a lifesaver for working moms who pump a lot - many say it is the only reason they were able to maintain their supply after returning to work.
  • Power pump! This is an hour long pumping session where you alternate pumping and breast massage. Pump and massage your breasts for 10 minutes, then turn off your pump and just massage your breasts for 10 minutes, repeat until you reach an hour. Try doing this 1-2x day for 3 days for best results. This is best when done using a hands-free pumping bra and watching Netflix.

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Should my baby hold their own bottle?

7/18/2019

 
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Camden, 5 months - @whitneyharte

Does my baby need to be able to hold their own bottle?

Foodie Judy here - welcome! Megan and I have the privilege of interacting with thousands of families on Instagram and our private Feeding Littles Clients Only Facebook Group for those who have taken our online or in-person courses. One question we have heard often is, "Should my baby be able to hold their own bottle?"

The short answer: yes. We want babies to be able to hold their own bottle, as doing so is an important skill and strength-building exercise that develops their hands at a midline position. However, for a variety of reasons we always want to hold/supervise baby as they bottle feed - more on this later.

Note: taking milk from a bottle is a skill that many exclusively breastfed babies never need to do. Some babies never accept a bottle and go straight to a cup. If your baby doesn't need to or won't take a bottle, they're not missing a key developmental skill as long as they're also practicing "hands to midline" in other capacities. More on this below.

First, let's discuss midline position, why it's critical in your child's development, and how to help promote bringing hands to midline or crossing midline.

What is "midline" and why does it matter?" 

The midline is an invisible line from the top of our head to bottoms of our feet, separating the two sides of the body. We cross that imagery line any time we move a foot, hand or eye into the space of the other foot, hand or eye. We also cross the midline with our tongues when we use the tongue to laterally move food from one side of our mouths to the other.
 
The ability to freely cross the midline allows us to do almost every daily life activity, including bathing, brushing our teeth and hair, driving a car, using a keyboard or playing sports. Midline is necessary for visual tracking. We rely on visual tracking for reading, as our eyes must continually cross the midline as they scan the page. Watch a young reader as they learn to read a simple book: at first, they may have to turn their head slightly as they read the book, then they progress to pointing to the works as their heads stay mostly still. Eventually they no longer need to point to the words as their eyes do all of the work - crossing midline has become automatic.

Not only is crossing the midline essential, but it's also important for your baby to be able to hold objects at midline. When toddlers can't hold their own cup, they struggle to stay hydrated. Babies who can't successfully hold food at midline may have trouble learning how to self-feed. Check out baby Bryson (7 months), below, holding his own water cup at mealtime. (For more on water and hydration needs in babies, toddlers and kids, click here.) 
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Bryson, 7 months - @saram0221
Thus, the reason why we want baby to eventually hold a bottle is because it leads to holding other objects like water cups, food, toys and eventually books, crayons and pencils in their hands. It's part of a progression that eventually supports independence and learning.

OK, so midline is important...but how do we develop it during bottle feeding?

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Beckett, 7 months - @elizaj27
Around 3 months of age, babies begin to notice touch inputs in their hands as they take shape of an object like a rattle, toy, bottle or breast. By 4-6 months, babies begin to transfer objects from hand to hand. This is a very exciting fine motor milestone - you may notice that your baby practices this repeatedly. It's essential in their development of a sense of midline. 
 
Since we know hands at midline are important, here are some techniques I use to help babies work toward holding their bottle - and eventually other objects - at midline when you are holding them for a feeding. We always want to hold/supervise babies with bottles.


  • When holding and feeding your baby using a bottle, encourage your baby’s hands toward the midline of their own body. This is help with baby self-regulation and state control needed to stay engaged with the sucking process.
  • While feeding your baby with a bottle, help bring your baby’s hands towards your hands - they may even be able to hold onto one of your fingers. Not only is it great for their fine motor development, but it's such a sweet memory to cherish! 
  • Gently guide your baby's hand to the bottle using a hand-over-hand technique.. 
  • If your baby becomes easily distracted during a bottle feed, add a rubber band or hair tie to the near top of the bottle (examine it for safety first). This little added texture can help your infant be a little more interested in the feed, stay more engaged, and participate for longer periods of time. It also stimulates their hands to locate this texture.
  • We all eat better when our feet are supported. If your baby's arms don’t come to midline or if they reach behind them during a feed, gently draw their arms to midline and put a pillow or arm under your baby's feet. Adding stability in this way allows for increase movement and forward reaching for the bottle or your finger.
  • As your baby begins to open their hands during a feed, teach them to gently pat the bottle with their hand.​

I'm breastfeeding. Does my baby need to hold a bottle? How can I develop their hands at midline?

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@jenn.newm
Some breastfeeding moms choose to not give a bottle of expressed milk to baby and go straight to a cup when offering water (6+ months). Perhaps mom doesn't respond well to a pump or baby refuses a bottle. If your baby doesn't ever take a bottle, they're not missing out on a developmental skill. They don't need to learn how to drink from a bottle to be a successful self-feeder and cup drinker. 

It's still important for breastfed babies to bring their hands to midline while feeding. Below are some techniques I use with my breastfeeding clients to help promote hands to midline:
​
  • While breastfeeding your baby, help bring their hands towards your hands. They may even be able to hold onto one of your fingers. One of your best breastfeeding memories may come from your baby grasping your finger for the first time. 
  • Help your baby bring their hands to the breast as they nurse. You can place your hands over their hand to help relax and encourage their hands to stay in this position. As your baby gets older, they may begin to squeeze or manipulate the breast to get the milk to flow faster - this is normal (and very smart of them, no)? ​
  • We all eat better when our feet are supported. If your baby's arms don’t come to midline or if they reach behind them during a feed, gently draw their arms to midline and put a pillow or arm under your baby's feet. Adding stability in this way allows for increase movement and forward reaching for the bottle or your finger.
  • As your baby begins to open their hands during a feed, teach them to gently pat the breast with a hand-over-hand technique. ​Patting during feeds can establish a calming rhythm that can help babies focus on eating.
  • Some moms wear teething necklaces made of safe materials that also help their babies focus during breastfeeds.

My baby can hold their own bottle? Can I just let them do their own bottle feeds? 

Once your baby has the ability to hold their own bottle, many parents want to let them bottle feed independently without holding baby. You may see babies drinking bottles independently and wonder if your baby is "too old" to be held for bottle feeds. 

​
I'm a realist. I bottle fed my children and work with parents every day in my private practice. I completely understand that sometimes it's just easier to hand baby their bottle in the stroller at the zoo and let them do their thing once they're able to hold it themselves. We always come from a place of gentle education without judgment. Take this information and do what works best for your family.

The concerns I have regarding independent bottle feeding are two-fold:
  1. Safety issues
  2. Less bonding and interaction

Safety

The flow of a bottle can be fast, and sometimes babies can't keep up with it or can't pull the bottle away while drinking. This is why it's especially important to avoid propping a bottle for baby to drink. When a baby is unsupervised while drinking a bottle, their risk of overeating or choking on the liquid is increased. Furthermore, a baby drinking on a completely flat surface like in a crib has an increased risk of ear infections, as milk can pool in their mouth and flow back into their Eustachian tubes. 

Note: if you are breastfeeding, laying a baby flat during breastfeeds (for example, while side lying) does not carry the same ear infection risk because milk doesn't pool in their mouth the same say.

When babies drink from a bottle while sitting straight up (e.g. in a high chair) they have to tilt their head back to drink, which leads to poor sucking skills. If your baby needs milk while seated, we recommend working on a cup instead of a bottle. Start with an assisted open cup and work to a straw or other cups as described in this post.

Bonding and Interaction

Bottle feeding, like breastfeeding, is meant to be an interactive experience. Similarly to family meals with solid foods, bottle feeding time is an opportunity to bond. Holding your baby while they bottle feed - even if they hold their own bottle - promotes communication, language, social interaction, eye contact, rhythm (if you rock or sway), trust in their caregivers, and a sense of security. Encourage them to hold their own bottle when they're ready, but I encourage you to hold them at a 45 degree angle and interact with them while they bottle feed.

What if my baby won't sit still for bottle feeds?

Older babies (7-12 months) start to get mobile and may not want to sit still for a bottle feed. If they have been crawling, cruising or walking with their bottle it can be hard to get them interested in cuddling during bottle feeds. Sometimes their refusal to sit still may tell us more about their development than we realize.
  • If your baby will only take a bottle when distracted by screen time or while moving, they may be ready for a cup for at least a few of their milk feeds.  
  • Be consistent with routines. Your baby will be more calm and focused when they know what to expect. Many babies have their best bottle intake first thing in the morning, before naps and before bed. Use that time to snuggle and bond if baby will let you.
  • Many babies don't eat or drink as well when they're teething. Watch your baby for signs of dehydration (low urine output, dry lips/mouth, tearless crying) and talk to your doctor ASAP if you suspect that your baby may be dehydrated.
  • Trust your gut. Sometimes poor bottle drinking is related to bigger concerns like digestive problems, sensory issues, oral-motor weakness etc. Work with your provider if you suspect something is up, and don't hesitate to reach out to your state's Early Intervention Program (if you're in the US) to schedule an evaluation. 

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    Authors

    Megan and Judy, co-owners of Feeding Littles, bring you helpful info on food, nutrition, picky eating, and feeding young children. Megan McNamee MPH, RDN is a Registered Dietitian Nutritionist based in Scottsdale, Arizona. Judy Delaware, OTR/L is an Occupational Therapist specializing in feeding therapy with children 3 and under in Boulder, Colorado. Megan and Judy are both moms of two and love helping families develop a healthy appetite for all foods! 

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