Birth to Three, Oral-Motor & Feeding, Tips and Tricks, Uncategorized

Open cup drinking 101 (and tips for the sippy)

open cup

I’ve revamped another post, this time on open cup drinking. What exactly is open cup drinking? Plain and simple, drinking from a regular cup – no fancy bells or whistles, not a sippy cup or straw.

What should I expect when first introducing a cup to my child with Down syndrome?

Learning to drink depends on a number of readiness factors including muscle control, coordination, and sensory needs. Not every child will have difficulty drinking from a cup.

When should I try cup drinking?

I advise my families to start practicing with an open cup when the child has developed head and trunk control for sitting. I also look to see if the child has the ability to pick-up and willingly release or give items. For instance, can your child pick up blocks and put them in a bucket? The reason for this is very important. Why expect a child to maintain grasp on a cup and put it down on their tray if they don’t have the motor skills to coordinate this movement? It’s setting you and your child up for frustration and failure. Increase success by waiting until your child has a well-coordinated drop-release and follows the direction “give to me” when you show them an open hand cue.

In children with DS I’ve found the sweet spot for open cup introduction is closer to 18 months. Yes, I know there are rock stars out there who took cups at 7 months and are learning to crochet at two. Keep in mind I’m talking about open cup drinking. In our culture we start sippy cups and straws earlier than the open cup.

I’m a bit nervous about the whole thing. Any tips?

First, a child’s sized-cup may be too big for your toddler’s mouth. A medicine cup (without medicine of course) or Dixie bathroom cup (use plastic, not paper) is smaller and easier for you to hold and control the flow into your child’s mouth.

Second, fill with a liquid your child enjoys and is able to drink (e.g. formula, milk, apple juice, etc.). Initially a slightly  thicker consistency like a yogurt beverage or apricot nectar juice may help the child learning to drink from a cup for two reasons

  1. It will be easier for you to control the flow. Think about a time you accidentally tipped your glass too far and spilled water down your chin (I hope that’s not just me…)
  2. Thicker liquids don’t move as quickly in the mouth; therefore, the inside of the mouth has prolonged contact with the liquid. This in turn increases the child’s awareness of  the liquid (more sensation) and gives them slightly more time to coordinate and perform a swallow.

Your child may need you to provide chin support they are first learning to drink. To provide support place your  thumb under his chin and index finger under the lower lip.

To pace the liquids correctly, make sure your child’s lower lip maintains constant contact with the rim of the cup. Tip up for sipping and down when they take a pause. This helps them establish the an appropriate drink-pause rhythm needed for successful cup drinking.

When your child first learns to drink from a cup liquid loss is expected. Chewing on the rim or an open/closed rhythm to the mouth is observed. This is because the child has not yet mastered jaw stability. Switching to a cup requires a child to learn and use a new pattern for drinking. They change from the up-down movement and lip seal used with the breast or bottle to in-out tongue movements with minimal lip closure. One sign your child is ready to drink from a cup is based on his feeding skills. Is he able to take bites off a whole cracker? Do they bite through and chew smaller pieces of a whole cookie? The ability to hold the mouth in open and closed positions is a necessary first-step in cup drinking.

What about the sippy cups? Do you recommend them?

Oh, I just knew you’d ask! I am a realist and very practical when it comes to feeding. I do use sippy cups with children (audible gasps from therapists everywhere). There isn’t one cup I love. It really varies on the skills of the child. Some children do better with a firmer valve, others with a soft spout. I also really like the many cups that allow the child to drink from the rim without spilling much (Avent, Playtex, and Sassy each have versions). I also like the Reflo cup available at Whole Foods.

If the cup has a valve, take it out. Save it. When introducing the sippy, you want your child to practice without the valve. This allows him to control the flow and to develop sipping skills. With the valve in they’re continuing the old pattern of sucking used with a nipple. Once they’ve learned to sip without the valve, use it when you really need to avoid spills. We (therapists) want to advance skills to a more mature pattern of swallowing. This is why sippy cups and valves are considered taboo. They can prolong the nipple-like swallow patterns we’re trying to diminish. But…if you’re going for a drive in the car…well, you can make your own decision!

I use sippy cups to transition from the bottle between 12 and 18 months in children with DS provided motor milestones for sitting are in place. Typically we start fading out 1 bottle during the day working toward fluids in the cup all day with exceptions at morning and night. The evening bottle is usually the last to go.

Please, please don’t feel guilty if your 18 month old (or nearly 2-year-old) is still taking a bottle. Be patient. This will take time (months). Your child won’t go to prom with a bottle!

Bottle feeding is a time of comfort and bonding for infants. As they gain independence the dynamics of meal time change. Adults socialize over food and drink, as your child grows he will want to be included in the action. Cup drinking is a great way to positively influence independence and social-language skills surrounding meals.

5 thoughts on “Open cup drinking 101 (and tips for the sippy)”

  1. Thank You for the article. My son is 5 and has down syndrome. I have been using cups with straws since 3 just because of his low muscle tone. I am going to start trying the sassy cup.

  2. My daughter is 20 months old, has mosaic Down syndrome and has been using sippy cups for about five months now. Her main issue is she doesn’t know how to slow down when she drinks so she doesn’t cough and sputter. Thin liquids are harder for her. We have ruled out aspiration in the past with a modified barium swallow and based on her clinical picture. I would like tohelp her learn to control the flow of thin liquids so she doesn’t cough and sputter as much. I have a couple of questions: 1) If I start open cup drinking with something thick like yogurt, won’t that teach her a slower swallow pace where she wo’nt be practicing the right swallow that she needs with water? 2) She uses short straw cups to help with tongue retraction but we do have some spout cups we use also. How do I know whether soft or hard spout is best for her? 3) Are there any videos that show someone helping a child with open cup drinking I could see? Thank you

  3. Great article. Thanks! Still working on this with my 3.5 year old. He can do the lip closure and hold the cup, but I cannot get him to tip his head back for anything (he gets a lot of water in his face when I wash his hair). Any tips for getting him to tip his head back?

    1. Kris, For cup drinking the head should remain in a neutral position (not extended or tucked). Try having him practice tilting the cup up and down. You can practice with a washable baby doll. In the tub, laminate a picture one of his favorite TV characters or another preferred picture. Stick to the ceiling above his head and have him look up when it’s time to rinse. When I was little I had to look up when my mom said, “It’s a bird, it’s a plane, it’s Super Grover!”
      Other than that, a folded washcloth held over the eyes works well to block water and shampoo. Best of luck!

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