My 2 cents on Sippy Cups

Posted on Jul 11 2013 - 2:15am by cris

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I’ve been getting a lot of questions lately about sippy cups. So here’s my 2 cents…

As a Speech-Language Pathologist (SLP),

I have been taught to avoid sippy cups all together. The reason behind this instruction is based on the forward positioning of the child’s tongue when drinking from a sippy cup. This positioning, over time, may prompt some children to develop sound substitutions or a lateral lisp. This same argument often encourages weaning from the pacifier, bottle, and breast (ugh, I know, but stick with me) around the age of one.

Research suggests that children who use sippy cups may substitute /t/ for /k/, /d/ for /g/, -th- for /s/ or /z/ due to the forward tongue placement used when suckling.
For this reason, many SLPs recommend weaning from the nipple directly to a straw which utilizes a sucking pattern rather than suckling.

As a Certified Lactation Counselor (CLC),

I am a believer in extended breastfeeding, WAY beyond the child’s 1st birthday whenever possible. When a child breastfeeds or suckles, his tongue should extend over his lower incisors. This tongue placement is what saves mom from having her nipple chewed off during a good latch. Could this instinctual and natural motor pattern cause speech problems?

Babies all over the world breastfeed to an average age of 4.2 years. The majority of these children do NOT demonstrate lisps or sound substitutions.

As a mom,

I want my child to learn to drink from a cup that doesn’t spill, is easy to clean, and promotes his independence. I also want my child to transition from breast to cup and back to breast until HE is ready to wean.

So… What’s the answer?

First we must understand the difference between suckling and sucking.

In a suckle pattern, the primary movement is extend and retract. The tongue does not extend beyond the lips, remains flat and thin, and does not move laterally. Jaw opening and closing occur in conjunction with tongue movement. It’s rhythmical.

In a sucking pattern, the primary movement is up and down. The tongue is still contained within the mouth and remains flat and thin, but the tip elevates to the anterior hard palate. The movement is rhythmical, up-down cycles.

So where does this leave us in regards to the theory that extended use of the suckling pattern can lead to speech development delays?

  • One study showed that extended use of suckling outside of breastfeeding may have harmful effects on speech development in young children (Barbosa 2009).
  • Another study suggested breastfeeding may protect against language and motor skill delays in young children (Dee 2007).
  • “In addition to several benefits of breastfeeding, it contributes to a proper oral motor development and also avoids speech-language disorders, regarding oral motor system.” (Neiva 2003)
  • In a study at Aarhus University Hospital in Denmark, early language development was defined as “the ability to babble in polysyllables”. The research found that “the proportion of infants who mastered the specific milestones increased consistently with increasing duration of breastfeeding” (Vestergaard 1999).
  • “A positive correlation was found between duration of breast feeding and performance in tests of vocabulary and visuomotor co-ordination, behaviour score, and measurements of height and head circumference…Breast feeding had no discernable effect on speech problems during the first five years.” (Taylor 1984)
  • “There is another compelling benefit to exclusive breastfeeding: positive effects on the development of an infant’s oral cavity, including improved shaping of the hard palate resulting in proper alignment of teeth and fewer problems with malocclusions. The purpose of this commentary is to stimulate further research as well as to propose the importance of breastfeeding to developing and maintaining the physiologic integrity of the oral cavity…Having in mind that early weaning brings consequences to oral motor development, occlusion, breathing, and to children’s oral motor aspects, we have to emphasize the importance of breastfeeding. The encouragement of this practice and the proper sucking pattern is the basis for the prevention of speech-language disorders, as far as the oral motor system is concerned.” (Palmer 1998)

Now that we’ve ruled out extended breastfeeding as a contributor to speech delays and oral motor deficits, let’s discuss the options for teaching your child to drink from a cup…

Sippy Cup: A cup with a spout on the lid that can be soft or hard. There is usually a valve mechanism to prevent spills that can be removed for cleaning (good luck with that). The issue with these cups is that a child suckles the spout much like they would a pacifier or bottle which can prevent the tongue from moving into a more natural position for speech development (Remember the difference between suckle and suck?).

Straw Cup: A cup, lid, straw set with an anti-spill valve located in the straw or lid. These are a MAJOR pain to clean and are prone to grow all sorts of lovely bacteria. A straw cup promotes sucking, strengthens cheek and lip muscles, and develops a new motor pattern in your little one. The straws are also fun to chew on…BEWARE, this new knowledge may cause some confusion and biting when breastfeeding. Personally, I recommend holding off on introducing a straw to your breastfed child until he is at least 12-18 months old.

Toddler Training Cup/ Rim Cup: A cup with a twists in/on lid. The valve system is in the lid itself to prevent spills. The baby sips on the cup rim with only a minimal amount of sucking required. Drinking from a cup rim promotes appropriate tongue positioning. Just make sure they are not supporting the cup with their tongue. Drinking from a training cup also encourages lip retraction or spreading and there is little to no confusion when returning to the breast. This is the option we use and have found the Sassy Grow Up Cup easy to clean with only 3 pieces.

Cup: As an SLP and CLC, I believe this to be the best possible option. As a mom, it’s a pain in the arse. Easy to clean, but unfortunately not spill proof. Drinking from a cup allows your child to set his own pace (when guided) and promotes an ideal tongue and jaw position and movement during drinking.

In a perfect world, we could take the time to cup train our children without worrying about spills or time restraints…In reality, we must do the best we can.

Babies and children don’t need to drink every moment of every day. In fact, carrying around a cup all day may contribute to early weaning due to your child beginning to seek comfort in the cup rather than breastfeeding. I recommend keeping a spill proof cup in the diaper bag for meals on the go and rehydration during play, but restrict at home drinking to the kitchen from a cup rim whenever possible. Spills happen, but they’re easier to prevent and contain if monitored and restricted to one space.

*These are merely my thoughts on the matter. All children are different and what works for some, may not work for all. Many children develop persistent sound substitutions regardless of our best efforts and require speech therapy. If you are concerned about your child’s speech development, contact your pediatrician for a SLP consult.

References to support my 2 cents…

Huang YY,Gau ML, Huang CM, Lee JT. Supplementation with cup-feeding as a substitute for bottle-feeding to promote breastfeeding. Chang Gung Med J. 2009 Jul-Aug;32(4):423-31.

Barbosa C, Vasquez S, Parada MA, Gonzalez JC, Jackson C, Yanez ND, Gelaye B, Fitzpatrick AL. The relationship of bottle feeding and other sucking behaviors with speech disorder in Patagonian preschoolers. BMC Pediatr. 2009 Oct 21;9:66.

Dee DL, Li R, Lee LC, Grummer-Strawn LM. Associations between breastfeeding practices and young children’s language and motor skill development. Pediatrics. 2007 Feb;119 Suppl 1:S92-8.

Neiva FC, Cattoni DM, Ramos JL, Issler H. Early weaning: implications to oral motor development (Review). J Pediatr (Rio J). 2003 Jan-Feb;79(1):7-12.

Vestergaard M, Obel C, Henriksen TB, Sorensen HT, Skajaa E, Ostergaard J. Duration of breastfeeding and developmental milestones during the latter half of infancy. Acta Paediatr. 1999 Dec;88(12):1327-32.

Taylor B, Wadsworth J. Breast feeding and child development at five years. Dev Med Child Neurol. 1984 Feb;26(1):73-80.

Palmer, B. The Influence of Breastfeeding on the Development of the Oral Cavity: A Commentary. Journal of Human Lactation. 1998;14(2):93-98

A big thanks to kellymom.com for providing a place to easily locate endless research on all things breastfeeding.

 

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6 Comments so far. Feel free to join this conversation.

  1. Kelly July 12, 2013 at 10:01 pm - Reply

    Another issue that you don’t touch on with sippy cups is the risk to teeth. My oldest fell at 13 months while sipping on a sippy cup and slightly chipped her front tooth. This could’ve happened while carrying a toy also but I think sippies spend more time in the mouth in general. Great article and very informative.

  2. Laura July 13, 2013 at 8:43 pm - Reply

    Thanks for this article! It is perfectly timed for me, as I have been weighing my options before buying some cups. The twins are bottle-fed but they love drinking from a cup and I think they are ready start transitioning from bottles to cups.

  3. BB July 14, 2013 at 11:08 pm - Reply
    • cris July 15, 2013 at 2:05 am - Reply

      Oh yeah! Those are cool too. I think I’m addicted to buying and trying cups. I recently cleared the cabinets of a few that we’ve tried and failed…I filled a shopping bag! I need to seriously curb my sippy cup, etc. addiction (are there meetings for that?). At 11 months (today!) my son is drinking from a regular cup rim with just a bit of assistance. Truly the end of an era! 😉

  4. Mandy July 17, 2013 at 3:01 am - Reply

    When should a bottle fed child attempt to make the transition to a cup and in what progression – straw, to rimmed, to cup and leave out the zippy cup? Our son is 9 months old. I tried a sippy cup a few days ago and he was not a fan.

    • cris July 17, 2013 at 3:12 pm - Reply

      Great question. I usually recommend introducing a cup of your choice when baby starts solids (after 6 months). I like to drink with meals, so I encourage my kids to do the same. That’s not to say that they will get the hang of right off the bat, but if you are giving baby solids 1-3 times per day, it’s a great time to practice with a cup. I encourage you to try and skip the sippy cup, but understand that even I allowed them from time to time with my daughter who really struggled with other cups. Conversely, my son started with a Sassy Grow Up cup (I wish these had been available when my daughter was learning) around 9 months and can now (2 months later) drink from a regular cup with some help. Straw cups are good too, as they teach important oral motor skills…and these skills come in handy when you stop at a restauraunt for lunch and realize you forgot to toss baby’s cup in the diaper bag. However, be sure and find a straw cup with minimal parts as they can be a real hassle to clean and keep track of. You may need a bit of trial and error, but find a cup (or 2 or 3) that works well for him and go from there. Best of luck!

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