Doctors’ Notes


Bottles, Nipples, Cups, and Straws

Feeding a warm, sleepy baby in your arms is a pleasure cherished by every parent. Before you can get to that point, though, there are a myriad of choices. Some moms decide to try adoptive breastfeeding. With patience and support, this may be a viable option. But the reality for most adoptive parents will be bottle-feeding. But…

…Which bottle to use? Which type of nipple? Sippy cups or straws? Can a certain bottle really make a baby less fussy or a better sleeper? What’s just marketing hype, and what really matters?


A walk down the feeding aisle of any baby store will introduce a bewildering array of options. There are bottles that claim to be most like breastfeeding, or to reduce gassiness by their shape or design. There are bottles with disposable liners, BPA-free plastic bottles, and glass bottles.

For most infants, any of these options will work. All babies have gassy times, but for those who are very fussy, reducing the amount of air they swallow while feeding may be helpful. Most of the bottles that tout special venting systems do the job — though many of these consist of seven or eight separate parts that must be cleaned and reassembled after each use. Air intake can also be reduced by using a bottle with a tilted shape or soft liners from which air can be expressed. Disposable drop-ins offer convenience, especially when traveling with an infant, but have obvious environmental consequences.

Bisphenol A (BPA) is a chemical used to harden plastics, which may be harmful to the developing hormonal systems of infants and young children. While studies to answer this question are ongoing, it seems prudent to avoid the chemical in the feeding tools and toys of young children. Look for products labeled “BPA-Free,” and avoid plastics with the recycling number “7,” which may contain BPA. Glass bottles are one way to avoid plastics altogether, but have obvious safety dangers once babies are strong enough to grab the bottle themselves.


Nipples offer many choices, as well. Most healthy newborns can use any nipple, although smaller, slower-flow “newborn” nipples may fit your baby’s mouth & feeding pace best.  Work up to larger, medium-flow nipples when your baby reaches 4-6 months, or if she seems frustrated by not being able to get enough milk. Older infants may already be accustomed to one type of nipple, and refuse others.

When bringing home an older infant, start with what your child is used to. Latex is soft and pliable, so it may work best for babies who are small or have a weak suck. Latex can become gummy and tear easily over time though, presenting a choking hazard, so be sure to replace old nipples regularly. Silicone nipples may last longer, but they are firmer, requiring a stronger suck.

Infants and toddlers with medical problems may have special feeding needs. Preemies and babies with very small mouths will require smaller (and often softer) nipples; babies who need thickened formula will need nipples with cross-cut, larger openings to allow easier flow. Children with unrepaired cleft palates are unable to generate suction in their mouths, and so need an elongated, softer nipple that occludes the opening in the roof of the mouth, and allows the parent to compress the nipple, pushing formula into the baby’s mouth. Babies who have been fed previously by propped bottles or who have neurologic problems may have difficulty coordinating the muscle movements to suck and swallow, and can benefit from softer, flatter orthodontic nipples. Babies with heart or breathing difficulties, who tire easily while feeding, will benefit from softer, slower-flow nipples. Consult with your child’s pediatrician or an occupational therapist trained in feeding problems to learn more about your child’s medical feeding needs.


Infants can begin learning to drink from a cup by about six months. Cup drinking requires more coordination of tongue and palate muscles, and helps to develop the ability to chew and swallow solids.

Sippy cups with softer, shorter spouts or a rim (like a travel mug) are best, since longer, harder spouts may alter the positioning of the tongue against the palate, creating swallowing difficulties in some children. Valves can help to prevent spills, but make it hard for new cup users to extract the liquid. Removing the valve initially will make it easier, and once a child is happily using the cup, the valve can usually be reintroduced successfully.

Straws are another nice option. Most children can suck from a straw by about nine months, although parents may need to squeeze liquid up the straw at first. Straws work well for children with difficulties coordinating their swallowing muscles, since it requires very similar movements to swallowing solids.

Provide milk, as well as water, in the cup, so that the child doesn’t learn that milk only comes from a bottle. Infants and young children don’t need juice — it provides empty calories, and leaves residue that can create cavities on young teeth.

Things to Remember

Most infants are ready to leave a bottle behind by about 12 months, although parents adopting older infants or toddlers can continue to use the bottle as a bonding tool. Many children will snuggle into a parent’s arms for a bottle, and use a cup to provide themselves with a drink.

No child should be put to bed with a bottle or a cup, and parents should always clean a child’s teeth after feeding, before placing the child in bed to sleep.

While the array of options can be daunting, it’s important to remember that the tone you set with feeding your child is far more important than the specific tools you use. Cuddle your baby while bottle feeding, enjoying plenty of eye and skin-to-skin contact. Eat together at the table with your older child, and early in your time together, be the one to provide the food, so that she comes to trust you to meet her needs.

Remember that happy and relaxed family mealtimes will be remembered far longer than the specific bottle or cup you used.

Dr. Sarah Springer, a Kids Plus Doc, serves as the Medical Director of Adoption Health Services of Western Pennsylvania.