I’m ready to start open cup drinking when I’m around 6 months old, alongside my solids journey. Open cup drinking is a great opportunity for me to practise my mature swallow pattern, to join in at mealtimes, learn the life-long skill of cup drinking and become more independent. Cup drinking also helps me become more familiar with a way to keep hydrated when I’m over 12 months.

Why is my position for eating and drinking important?

If my body is well supported during mealtimes:

• I can eat and drink more safely.
• I feel more comfortable which means I can sit for longer and my growing muscles won’t get tired.
• I can communicate with you better.
• I can use my hands more easily to manipulate food and utensils, like a cup.
• I can move my mouth (my jaw, tongue, lips etc) more efficiently.
• I can do all of these things when I am in midline (my head or body aren’t leaning to one side or the other). It’s also helpful if I am at a height that supports my elbows on the table or on my highchair tray (you may need to pop padding like a folded towel or some foam under my bottom to boost me up).

Your position at my mealtimes is just as important. If you are on my level (not standing up above me) I find it so much easier to connect with you. It builds my trust in you, it’s easier for you to see what I’m communicating, and I can see you better so I can model off you as well. It’s also safer for me, when my head tilts back, my airway is more open and it’s easier for liquid and food to enter it.

How do my feeding and swallow skills develop over the first year?
When I am born, I will use a suckle pattern at the breast or bottle. During my first year of life this suckle pattern will slowly begin to be replaced by a mature swallow pattern, though it will continue to develop over may years. A mature swallow pattern is when I use an up/down sucking action with the tip of my tongue elevating up behind my top teeth and then moving liquid and food back to swallow.

What cup is best suited for me?
A small cup that matches my small mouth and my small hands is ideal. So, think along the lines of a shot glass or medicine cup size. If after a while I am having difficulty with holding this size cup, a cup with handles may be helpful for me

How can you help me learn to drink from a cup?
You can support me to learn to drink from a cup in a few different ways. At first, it’s likely I won’t be able to pick up the cup and bring it to my own mouth. Below are two different ways you can teach me to drink from a cup:

Option one: take a small cup and fill it to just below the rim. Hold the cup up in front of me and say, “drink”. You can also use the Key Word sign for “drink” to help me understand. Bring the cup toward my upper lip but wait for me to lean in or bring my lower jaw up to the cup. You can also use the Key Word sign for “drink” to help me understand. Tilt the cup slightly to help me drink some but make sure you tilt it back up, so I don’t get too much.

This option works well for when I’m learning that liquid comes out of cups. It may also be helpful if I’m tipping my head back too much when drinking.

Option two: take a small cup and fill it with a small amount of liquid (a sip sized amount). Hold the cup up in front of me and say, “drink”. You can also use the Key Word sign for “drink” to help me understand. Bring the cup toward my lower lip but wait for me to lean in or bring my lower jaw up to the cup. Again, you following my message that I want to drink, which I send by leaning forward or opening my mouth,
is responsive feeding. Tilt the cup to help me get the liquid.

This option may work well if I’m sipping too much liquid. A little coughing is to be expected but should decrease over time with practise. This option may also work well when I want to try to bring the cup to my mouth myself and I’m tipping it out.

With both options, give me enough for one swallow and then tilt the cup back up to give me a chance to swallow and then reoffer another sip. After I am doing well with taking one sip, you can tilt the cup so I can take multiple sips at a time and then tilt cup back up.

If I am coughing a lot with thin liquid, try some puree in the cup to slow the flow down for me. Slowly add water to the puree to thin it out as I get the hang of it. Again, some coughing is normal while I’m learning but if I’m coughing with most mouthfuls and/or my coughing frequency isn’t changing, please reach out to a feeding speech pathologist and your general practitioner/paediatrician.

There are other signs and symptoms that I’m not managing with fluids that are great to be familiar with. These are called signs and symptoms of aspiration. Aspiration is when liquid or food enter the lungs. We all aspirate a little from time to time but if it happens often and with large amounts it can cause serious respiratory illnesses.

Signs and symptoms of aspiration may include:

• frequent hiccups after eating and drinking
• recurrent respiratory infections
• recurrent fevers after eating/drinking
• changes in breathing, faster breathing or breathing stops
• eyes opening wide and stress cues
• frequent coughing
• wheezing
• eyes watering or red
• breathing and or voice sounds wet/gurgly 
• frequent gagging
• skin turns a bluish colour 
• vomiting 
• back arching
• weight loss

Written by Jamie Williams Paediatric Speech Therapist.
Find her on Instagram @nourished.babes