Love the Unexpected

One of the first things I remember our cleft team emphasizing with us after the birth of our son, was how important it was going to be for him to be able to drink from an open cup before his palate repair surgery.

Palate repair surgery is a big milestone for cleft babies and it’s not a minor undertaking. Afterward, the roof of baby’s mouth needs to be protected as much as possible. With such a high traffic area, this can be challenging. The protocol may vary from clinic to clinic, but the guidelines we were given included that baby would need to be off the bottle and able to drink solely from an open cup: no spouts, straws or anything else requiring suction.

At the time, we had a lot of other priorities on our radar, so I filed it away as a checklist item for a future day and we continued on our merry way.

But man, does that surgery creep up quickly.

At our six month follow-up, I was reminded that it was about time to start introducing the cup. Okay, I thought, we can do this. Solids had gotten a rocky start, but maybe the cup would be different. If you’d like to know more about our adventure with solids, check out my article Top tips for introducing solids with cleft palate.

Spoiler alert: the cup was not different.

Every kid is different, and I truly hope that if you’ve been working on a transition to an open cup, it’s going super smoothly.

If that hasn’t been your experience, here a few ideas that helped us say goodbye to the bottle and feel confident walking into that surgery.

1. Start small

A big part of what made introducing an open cup so challenging, was the amount of mess that it created.

There’s no way to totally avoid this, but one tip that we received was to start with a small amount of liquid, especially in the early days.

In the beginning, your goal isn’t to have your baby drinking full portions of formula in a single day. First, they need to develop the skill of taking in and swallowing liquid in a way that’s different than what they’ve been used to. Starting with a little bit of liquid gives them the chance to develop this skill without getting a face full of formula and the mess that comes with it.

When I say a small amount, I’m talking like a sip. For a while I used a Dr. Brown bottle cap with just a drop of formula. A medicine cup was another recommendation that I was given.

Starting small helped us to get going in the right direction, but the trouble we found with the cups themselves was that they were a little too slippery for baby to handle.

This brings me to my second recommendation: try lots of cups!

2. Try a variety of cups

Admittedly, this can be a bit of a frustrating search. I’ll link our favourite cups, as there were a couple that ended up being game changers for us. In saying that, what worked for our son, might work for your little person…or might not. By all means, give them a shot!

I’m not suggesting that you go out and buy every open cup out there from the get-go. That would be overwhelming for both of you and honestly, expensive.

Instead, start with one that you think might work. If they take to it – amazing! If not, think about what it is that might not be working.

The first cup we started with was the Munchkin Splash Toddler Cup, with a training lid, and the Dr. Brown bottle cap I mentioned before.

The Munchkin cup was less messy than the cap but we found that our son had some trouble finding the right place on the lid to drink from. With both “cups”, they were made of slippery plastic that made it hard to grip well, causing lots of spills and not a whole lot of formula making it into his mouth.

Once we noticed this, we switched to these PandaEar silicone cups, which provide a much better grip but are still nice and small. It allowed us to add enough liquid for him to be able to sip without needing to tip the cup way back but not so much that we ended up with puddles on the floor.

Admittedly, these cups weren’t a slam dunk right away. We used them a lot after our son had comfortably developed his drinking skills but it took some time to get there.

At this point, we’d been working at the cup for almost two months. In a desperate plea to one of my Facebook groups, I asked for suggestions on what had worked for their children. That’s when we discovered the Reflo Smart Cup. Let me tell you – it was a life saver.

The issue with all open cups and babies learning to drink is how quickly the liquid comes out of the cup. It’s really hard for babies to learn to control that flow. Enter the Reflo. Designed as an open cup, it has a simple insert that fits down into the cup and helps slow down the liquid as it comes out.

We added on a pair of Dr. Brown silicone bottle handles, which fit the Reflo and made it easier for our little guy to handle.

This ended up being the cup that finally got our son drinking consistently, which was super exciting. Still, there were a couple other factors that aided in that success.

As he got more confident drinking, we were able to introduce more variety in the cups he used. He even eventually learned to drink from the Miracle 360 Trainer Cup (with the valve) – but we had to be careful that this wasn’t the only cup he had exposure to since it would be off limits after surgery.

3. Try thicker liquids

To be honest, I hadn’t really thought much about what should actually be in the cup when started introducing it.

Our dietitian advised against water, since it’s actually one of the harder liquids to learn to drink. We also needed to make sure that even though he was moving away from the bottle, he was still getting his nutritional needs met from his formula.

That said, there was just something about straight formula being offered in a cup instead of a bottle that never appealed to our son.

We had to get creative in how we offered it. What we found worked best was to blend up a little smoothie: formula from our Brezza, with a little piece of banana and a strawberry mixed in to help mask the flavour enough to make it palatable.

It also created a thicker liquid, that when put in the Reflo cup, poured out nice and slowly, making it easy for our son to drink. Though I tried a few times to offer just formula once he seemed to be getting the hang of the cup, we never did get to the point where he would drink it straight.

At this point, our son was twelve months old, so we started doing a combination of whole milk in the morning and evening, with formula smoothies offered at mealtimes. He continued to grow well and gain weight, so this, in addition to the solids he was eating, seemed to meet his nutritional needs.

4. Be consistent

I started gently introducing the cup around 7 months, but since we were still struggling with solids at that point, I didn’t put too much focus on it. Around 9 months, I was getting a little panicked that were weren’t further ahead and started working on it in earnest. We didn’t have a date for the surgery yet but I knew it could be as early as 12 months and three months didn’t seem like a whole lot of time to get to where we needed to be.

At that time, we were doing four bottle feeds and were offering three meals per day. I started offering a little bit of formula (I.e. 60 mls or less) at meal times and stuck to our same bottle feeding schedule, since I knew more was being spilled than consumed.

We stuck to this schedule and continued to offer the cup at every meal. There were many discouraging days throughout those months. A lot of cups were picked up and dumped, but still, we continued to offer it.

Eventually, through consistency and the adjustments we made along the way to help him learn the skill of drinking, we started to see progress.

5. Start scaling back the bottle

It’s hard to eat when you’re not hungry. Once we started to see that our son was capable of drinking, we still had some trouble increasing the volume that he was getting, to the point where it could replace a bottle.

This created a bit of a catch-22. Continuing to give him the same volume of bottles meant he wasn’t hungry enough to drink much at meal time but if he didn’t drink enough at mealtime, we worried about him going hungry by scaling back the bottle.

As much as I hated the idea of my little guy being hungry, I knew something had to give somewhere in our deadlock. So, we started gradually. The mid-morning bottle was the easiest to eliminate. Between his bottle at wake-up time and a good breakfast, he was able to make it fairly easily to lunchtime. Sure enough, once we took out that bottle, we noticed his smoothie intake at lunchtime increase.

The next to go was the afternoon bottle. Again, this one wasn’t too hard to take out of the equation. We opted to serve supper a little earlier, and since he was still getting a bottle before bed, we didn’t find he missed it.

The ones I was most nervous about eliminating were the morning and evening bottles but the transition wasn’t as hard as I thought it’d be. The Miracle 360 cup ended up working well for us in weaning off these feeds.

Starting with the morning feed, we offered a cup of milk in place of the bottle and he was more than happy to take it. Once we’d comfortably completed that transition, we did the same with the evening bottle and didn’t face too much resistance.

We found that once he’d developed the skill for drinking out of the open cup, the transition off the bottle was the easiest part of the whole journey. In total, it took about three weeks to complete. We took it slowly, ensuring that he was compensating with enough milk and formula after each bottle was taken away, before moving on to eliminating the next one.

6. Be patient

Like most of the feeding challenges that we’ve faced with cleft lip and palate, our son didn’t start drinking successfully from an open cup overnight. It took a lot of spills, dumped cups, and frustrating days when I thought we would never make progress before we got to the point where he could reliably take in enough liquid to start weaning him off his bottle.

But just like each one of those challenges, slowly but surely, he did eventually get the hang of it. So, stock up on smocks, lay down some towels and try to have fun! It’s exciting to see your baby learn a new skill and though it might take some time, each baby step of progress is something to be celebrated.

Conclusion

Weaning a baby off their bottle and transitioning to an open cup isn’t always easy or straightforward. It certainly isn’t a recipe for a tidy kitchen. But, it’s a necessary step in preparing for palate repair surgery, and it isn’t an impossible task – as much as there may be days when it feels like it!

If you’re walking through that transition now, I hope it’s an easy one – but if you’re feeling like it’s been one long ride on the struggle bus, then I hope some of these tips help to smooth out some of the wrinkles. At the very least, know that you are not alone! You’re doing an amazing job and someday all the hard work will be behind you, while your little one sips their cup with ease.