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Sharon Trotter RM BSc

Midwife, Breastfeeding Consultant and Neonatal Skincare Advisor

MIDIRS 2012 - Infant feeding
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Midirs draft article on infant feeding

The full reference for this draft article is: Trotter S (2012). MIDIRS reviewer comments on Keim et al (2012). MIDIRS Midwifery Digest 22(4):528.

Commentary on:

Keim SA, Fletcher EN, TePoel MRW, McKenzie LB (2012). Injuries associated with bottles, pacifiers, and sippy cups in the United States, 1991–2010. Pediatrics. 14 May 2012 [Online].

‘Maybe the time has come to reflect on the potential consequences of this seemingly innocuous trend on our children’s health. Are lidded cups even necessary?’ (Trotter 2006).

After reading Keim’s paper focusing on injuries associated with bottles, pacifiers, and sippy cups, my earlier thoughts on this subject have come back to haunt me.

My research covered the potential for bottles and sippy cups to disrupt the establishment of breastfeeding and associated concerns, but I did not address the wider issue of personal injuries. The American study, while comprehensive, confines itself to documenting the physical injuries sustained by children under three years who attended emergency departments during the twenty year period from 1991-2010. The authors suggest their goal is to raise awareness, educate parents and professionals and to encourage manufacturers on how to redesign safer products in the future.

As a passionate advocate of exclusive baby-led breastfeeding for at least the first six months of life, as recommended by the World Health Organization (WHO 2003), I feel the need for bottles, pacifiers and sippy cups must be questioned.

However it is sobering to read that there remain over 2200 injuries each year with the majority of cases (66.4%) affecting one-year-olds. Almost all injuries occur in the home (98.8%) which points to a need for national safety campaigns being implemented with falls being most common mechanism for injury while using bottles, pacifiers and sippy cups.

The DH advises that babies over one year old should not drink from bottles (DH 1994). I would go further, suggesting that parents supervise a child while drinking, preferably during mealtimes. My own research suggests that the introduction of open cups as soon as possible after weaning begins at six months of age, has the potential to positively affect many aspects of a child’s development.

Notwithstanding the obvious physical risks raised by this paper (soft tissue injuries, dental caries and burns), it is important to mention the wider issues of: speech development, fostering god eating habits, and the more worrying complication of iron deficiency due to children ‘grazing’ on sugary drinks and refusing to eat a balanced diet.

The Keim et al findings are useful and strengthen my theory that children should progress to using open cups as soon as weaning begins. This paper also highlights additional risks and areas of concerns that I had not considered.


Department of Health (DH)(1994). Weaning and the weaning diet: report of the working group on the weaning diet of the Committee on Medical Aspects of Food. London: HMSO.
Trotter S (2006). Cup feeding revisited. MIDIRS Midwifery Digest 16(3):397-402
World Health Organization (WHO)(2003). Global strategy for infant and young child feeding. Geneva: WHO.

Sharon Trotter, Midwife and Independent Mother and Baby Consultant





© Sharon Trotter 2013
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