I recently asked a question on Instagram: When did your little one move from breast / bottle feeding onto a cup? Of 34 responses around a third of parents binned the bottle by 12 months, a third gradually moved from breast / bottle feeding onto milk and water from a cup between six and 18 months, and a third continued with either breast or bottle feeds (especially at bedtime) for around two years or longer. All of this is normal.
In the UK, the term weaning is often used to describe starting solid foods, whereas in other countries it’s used to describe the end of breastfeeding. I think it’s helpful to think of weaning as the transition from a milk-only diet (breast or formula milk) onto other foods alongside a gradual reduction in milk volume until a baby is eating and drinking mainly the same things as the rest of the family. The World Health Organisation recommends that babies are introduced to solid foods and a cup at around six months and that breastfeeding should continue for up to two years or longer alongside this. From a nutritional perspective, milk (breast or formula) provides the right balance of nutrients for the first six months but beyond this babies need a range of foods (especially iron-rich foods) to meet the needs of their growing bodies. They also need to learn to eat a range of textures and flavours, to be safely exposed to possible allergens and to learn the social skills that come with eating together. So we know that adding solid foods is important, but what about stopping bottle or breastfeeding…
When should babies start drinking from a cup?
Some babies are cup-fed from day one but most begin the gradual transition from bottle or breastfeeding onto drinking from an open cup from six months or older. This picture is of my little girl having a go at drinking water from an open Doidy cup at about seven months.
Yes, it was messy. We only really used the open cup for play to start with and usually used a free-flow beaker with a flip-top spout when we were out and about (we liked the basic Tommee Tippee one). It definitely took a few months for her to get the hang of drinking from a cup, and only really now at two and a half is she very confident with a completely open tumbler.
The UK NHS advice is:
“If you're bottle feeding, it's a good idea to introduce a cup rather than a bottle from about six months. By the time your baby is one, they should have stopped using bottles with teats. Otherwise, they may find it hard to break the habit of comfort sucking on a bottle.”
My son was combination-fed and I did follow this recommendation, switching to cow’s milk in a cup when he turned one. But both my kids were breastfed for longer than a year and I know it’s not always easy to stop using a bottle, especially before naps and bedtime.
I think it’s a real challenge to give parents practical and realistic advice on this, so I asked Feeding & Swallowing Specialist Speech Therapist Stacey Zimmels, of Feed Eat Speak (@feedeatspeak) and Lecturer in Oral Microbiology Dr Samantha Byrne, also known as The Tooth Fairy, to help.
Why is it important to transition from bottle to cup?
The main reason for this is to protect children’s teeth. Milk is generally a great choice for teeth but it does contain natural sugars. Oral health expert Samantha explained:
“When young children drink from a bottle, the liquid in the bottle can tend to pool around the child’s teeth. If the liquid in the bottle contains any sugar, the bacteria in the mouth can turn this sugar into acid which can lead to tooth decay. Drinking from a cup prevents this from happening. Choosing water and milk over juice and soft drinks is also important to help limit the amount of free sugar that children consume.”
Why are there recommendations to continue breastfeeding beyond one year, but to stop drinking milk from a bottle?
This is definitely more of a grey area! The World Health Organization’s recommendation - that breastfeeding continue for up to two years and beyond - is based on general health benefits, including reduced risk of infection (which is particularly important in developing countries). Stacey, a Feeding & Speech Therapist and trainee IBCLC lactation consultant, explained that breast milk offers much more than nutrition for a toddler. It can be a source of comfort and reassurance too.
Children who are breastfed generally have lower levels of tooth decay than children who are bottle fed past the age of one year (ref). However, there is some evidence that breastfeeding on-demand past the age of 12-24 months, particularly during the night, may be associated with an increased risk of tooth decay, too (ref).
So, whether you are breast or bottle feeding, it’s important to take steps to protect your little ones’ teeth. For parents breastfeeding past a year, Samantha advises:
“choosing water or plain dairy milk to drink, fluoridated water and toothpaste can help keep your child’s risk for tooth decay low while still obtaining the health benefits associated with breastfeeding. The best person to give you advice will be your dentist who will assess your child’s risk for tooth decay and help you with information on preventing tooth decay, so you can continue to breastfeed beyond 12 months.”
What can parents do if they’re struggling to transition away from a bottle?
Stacey offered some really practical tips on this:
Change the place that the milk is offered and offer it in a cup in the new place, e.g. if usually given before bed in the bedroom offer after dinner at the table in a cup.
If this step is too much for your little one you can split it. Offer half the milk in a cup after dinner and give a smaller amount by bottle at bedtime and then gradually reduce the bedtime volume.
You can involve the child in choosing a cup and making it special an event. Something new and exciting.
You could “give” the bottles away to a new baby.
(I tried the last tip when I was struggling to get my son to give up his dummy at nap time - we eventually agreed to give it to the “dummy fairy” who would pass it on to a baby in exchange for a toy. It worked a treat!)
Samantha offered some specific tips on the bedtime bottle feed:
“One of the big concerns with prolonged bottle feeding is children falling asleep with a bottle. When this happens, the liquid in the bottle tends to pool around the teeth. Also, when we sleep, we make very little saliva. Saliva is important for helping protect teeth from tooth decay. The combination of low saliva and the sugar in milk or juice in a bottle can be disastrous for teeth. If your child is used to falling asleep with a bottle the best thing to do is try to break the connection between the bottle and bed-time. If your routine is milk at bedtime, try to serve it in a cup and then brush teeth before bed. As a mum who had babies who were very hard to get to sleep I know how hard making a change like this can be, but it is worth persisting!”
Free-flow and open cups are messy. Are there any alternatives?
Non-spill beakers with a valve aren’t recommended because they require a sucking action similar to drinking from a bottle. While open cups or free flow beakers are ideal, both Samantha and Stacey agreed that they’re messy. Stacey said “the Munchkin 360 is a great alternative to an open cup” and Samantha agreed:
“my boys often used a straw cup to stop dinner floating in a pool of water. They did always seem to make a mess regardless though! There are some new cups available such as the Munchkin Miracle cup which could be a good option to prevent spills while learning to drink from a cup.”
While learning to drink from an open cup is important for both dental health and oral-motor development, the main thing is to find something that works for both you and your child. You might need to try a few different cups before you find the right one, and to try at different times of the day. What’s important is making gradual progress and taking steps to take care of your little one’s teeth as you go along. For more information on this, have a look at Childsmile.