Rachael Pierce, MS, CF-SLP
Speech-Language Pathologist Clinical Fellow
Please share an overview of cup introduction and appropriate milestones.
Cup drinking can be introduced around 6-8 months old or approximately one-month after the child is able to feed from a spoon. The best cup to start with is a cut-out cup (Nosey Cup- see link in additional references) or a wide-mouth cup. These cups prevent the cup from touching the child’s nose which may encourage hyperextension (tilting back) of the head. A cup with a regular edge and a recessed slit or holes in the lid can also be used. These types of cups help the child maintain a slow liquid flow while cup drinking. There is a lot of research available that advises against the use of a sippy cup. These cups were invented to prevent messes and are not necessary for a child’s development of cup drinking. Sippy cups actually promote the anterior movement of the tongue rather than a posterior movement which is the next step for cup drinking. If the child must use a sippy cup there are better sippy cups than others. These cups are listed later in the blog. Sippy cups should be discontinued around 10-months old.
Why is it important to introduce using a cup?
It is important to introduce cup drinking to allow the child to continue along the oral-motor developmental stages of feeding and drinking. Introducing cup drinking creates disassociation between the jaw and the tongue which is an important step for the development of a mature swallow as well as a mature chewing pattern as the tongue must begin moving independently of the jaw.
What can a parent(s) do to promote meeting the appropriate milestones in order to use a cup?
How to introduce cup drinking:
The parent/caregiver should be at eye-level with the child. The mouth of the cup should be placed on top of the tongue during initial learning stages. The cup should be placed firmly at the corners of the child’s mouth to increase stability and sensory information from cup. The cup should be full enough to prevent the child from tilting their head back to get liquid. Initially, the liquid should be slightly thickened (milkshake type consistency); once the child demonstrates proficiency, thinner liquids can be attempted. The parent/caregiver should always provided support to the bottom of the cup to assist the child with flow regulation as well as appropriate positioning.
When should a parent(s) be concerned about their child’s development- if the child is not using a cup by a certain point?
Red Flags include liquid is coming out of the child’s nose when they are drinking, a child is coughing every time they are drinking, or difficulty making complete lip closure on cup resulting in liquid loss from lips while drinking. If the child displays any of these symptoms while cup drinking a referral should be made for a Speech-Feeding evaluation. If a child continues to demonstrate difficulty with cup drinking (e.g. cup refusal, inability to transition from breast feeding/bottle feeding, etc.) after multiple introduction attempts a parent should seek a referral for therapy as well.
How can feeding therapy provide assistance?
Feeding therapy can address difficulties with bottle/nipple transition to cup drinking, assist with bilabial lip closure on cups, assist with correct positioning for cup drinking, increased safety for cup drinking, and assist with prevention of aspiration on liquids.
Are there any specific cups you would recommend to parents for introducing using a cup?
Yes, please refer to the below cup options:
Anything else you’d like us to know?
It is very important to monitor the child’s position while they are cup drinking to prevent aspiration. The child should be in an upright position preferably in a chair with good back support. It is extremely important for the child to avoid tilting their head back while they drink; they can be encouraged to tilt their head slightly downward as this naturally protects the airway. The child should also only be taking single sips at a time; do not allow them to take multiple swallows as this can decrease safety. A child should be monitored at all time while drinking to ensure they are maintaining safe positioning and drinking.
Recommended References to Learn More: