Simple Steps to Transition from a Bottle to Cup

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So what do you really need to know about transitioning baby from a bottle to a cup?

The whole concept may seem daunting at first (especially if you’re a new mom) but I promise it’s not as complicated as you may think.

You can start teaching your baby to learn to drink from a straw and an open cup a little before or around the age of one year. It will just take some practice, a lot of repetition and a good role model along the way, too.

Firstly, whether you’re breastfeeding or bottle-feeding, please know that your child doesn’t need a transition period on a sippy cup in between breastfeeding/bottlefeeding and drinking from an open cup. That might come as quite a surprise to many parents, since sippy cups are such a mainstay in our toddler society today. Clever baby product marketers have convinced today’s generation of parents that transitioning from breast or bottle to the sippy cup is just part of the developmental process. However, from a therapists perspective, sippy cups are both completely unnecessary and also counter-productive to the development of strong oral motor skills.

Just to clarify, a sippy cup is a toddler cup with 3-4 tiny holes used as liquid spouts, that were developed sometime in the 1980s (by an engineer, mind you) to prevent toddlers from spilling their milk. They were never developed to teach a child any sort of skill. They were developed to keep parents floors clean.

“Why say no to a sippy cup?” you might ask?

  1. They Promote Oral Motor Passivity
    Well, for starters, sippy cups teach children to use their mouths passively and not actively (in other words, they almost have to do nothing to obtain liquid from the sippy cup) which both weakens and provides no oral motor input to the mouth. Oral motor input from a straw, an open cup or even from food can provide “awakening” sensory input to the mouth for better speech and language as well as feeding, chewing and swallowing skills. To the contrary, with sippy cups, a child is essentially doing nothing with their mouths and receiving little to no sensory feedback.

  2. They Can Promote Poor Oral Motor Habits
    Besides teaching children to not actively participate in the drinking and swallowing experience, they also teach the child to propel their tongue forward into a forward resting posture, which negatively impacts speech and swallowing skills. In a child who also uses a pacifier very frequently past one year, combined with frequent use of a sippy cup, this forward resting posture of the tongue can definitely become an issue with either feeding or speech.

If you occasionally use a sippy cup, I don’t think it should be a problem. However, if your child uses it every day and also constantly uses a pacifier, these issues I mentioned above can definitely become an issue.

So, what should I use instead?

Well I’m sure glad you asked, friend! There are SO many other great cups for toddlers out on the market today that will teach real life drinking and swallowing skills and wont interfere with speech and language development at all.

Don’t worry, some of these cups are spill proof too!

Here’s the two main pointers to look for in a good cup for your toddler:

  • Look for cups with either a straw or those that promote an open-cup drinking pattern

  • Look for open cups that are are good fit for the size of your toddlers hands

  • Avoid spouted cups at all costs

    Here are just a few of my favorite cups that I recommend below. Click on the image to purchase.

My favorite activities to teach drinking skills

  1. Teach your child the art of pronation/supination (flipping the wrists up and down - a skill necessary for bringing a loaded cup to the mouth and drinking from it). Here’s how: In the bath, give your child two cups (different colored cups work best). Model to them how to pour water from one cup to the next and say “pour, pour,” while you do this. This will help your toddler to learn that holding the cup upright keeps the water in. It also helps to stabilize the muscles in the wrists for cup drinking.

  2. Teach your child how to carry an open cup and not spill it by practicing outside with a loaded cup. Fill up a bucket with water and give your child a cup. Have them dip the cup into the bucket and fill it with water and then carry it to another location to pour it out. This teaches your child all of the skills mentioned above.

  3. Teach your child how to drink from a straw. You can do this by cutting a small straw in half, dipping it into water and placing the tail end into your childs mouth and slowly releasing. This will teach your child that water comes out of a straw. After they have mastered this passive skill, its time to practice it actively. Model straw drinking for them and show them how you close your lips around the straw and suck. When you drink some water up, make a refreshed sound like, “Ahhh.” (kids love games like this.) Have them continue to practice closing their lips around straws and sucking and keep on practicing. Larger straws work best at first, as baby is still learning the art of lip closure.

  4. Vibration input prior to practicing drinking can be helpful for younger babies or kids with low muscle tone. You can use a vibrating toothbrush for this. Simply touch a vibrating tip of a toothbrush to your childs mouth prior to drinking or eating or you can hand your toddler the brush themselves and let them explore it with their mouth independently. This will help waken up the mouth prior to feeding or drinking for better oral motor skills and awareness of the mouth in general.

  5. These honey bear cups are amazing for teaching straw drinking skills.
    You can find them here.

-Ashley





Baby's First Year - Age Appropriate Milestones for 10-12 Months

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You are (hopefully) fully baby proofed and getting used to this baby on the move situation.  Your baby should be crawling and pulling to stand, and most babies typically take their first steps sometime within a month or so of their first birthdays.  Your baby is now learning to respond to simple verbal cues and loves to look at pictures in a book.   They are also able use their hands to manipulate (and get into) EVERYTHING in sight. 

Life is really flying by for you and your baby in their first year of life. 

It seems like this 10-12 month age bracket is such a huge growth time frame and as I remember, teething situations can make babies sleeping and moods a little tricky.  My best piece of advice is to bring yourself and baby outside for some fresh air and a new, fun environment to learn in (and distract from the teething pain.)

  • This guideline has been developed through clinical experience and in combination with references Peabody Developmental Motor Scales 2 + The Beery VMI.  
  • Reminder: Focus on your child’s strengths, not weaknesses.  Focus on if your child is making an overall forward progression instead of making sure your child makes EVERY milestone according to plan (you can easily drive yourself and your baby crazy.). Relax and enjoy these fleeting moments!

Gross Motor Skills

Crawling Milestones

  • 9-11 months: independent crawling
  • 10-12 months: crawls on feet and hands (bear crawl)

Standing/Walking/Cruising

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  • 9-10 months: pulls to stand + steps sideways when supported
  • 9-10 months: lowers to sit without falling (from a supported standing position)
  • 10-12 months: walks with both hands held
  • 11-13 months: walks with one hand held
  • 11-13 months: stands independently for 1-3 seconds
  • 11-14 months: begins to walk independently (2-3 steps)
  • 11-14 months: stands independently while playing (hands free) 
  • 13-15 months: walks independently (without support)
  • 13-15 months:  squats down and back up again (controlled)
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Visual Motor + Visual Perceptual Skills

  • 0-10 months: looks closely at tiny object
  • 10-11 months: pushes and rolls a ball
  • 0-11 months: throws things just to see what will happen
  • 0-12 months: enjoys looking at pictures in a book
  • 10-12 months: imitating of an adult is established (i.e. will tap spoon, clap hands, put things in, scribble with a crayon etc after an adult demos)

Fine Motor + Grasp Development

  • 0-9 months: claps hands/brings objects together at midline to bang
  • 0-10 months: points at objects with index finger
  • 10-11 months: crawls while holding 1 object in hand (helps to strengthen arches of the hand
  • 10-12 months: begins to grasp objects with thumb opposed to first 2 fingers with visible open space in the palm and arm off table (emerging tripod grasp/3 jaw chuck)
  • 0-11 months: plays with musical instruments with hands such as banging drums or shaking rattles
  • 0-11 months: tears paper
  • 9-11 months: with intentional release established, baby can put 3-7 cubes into a cup or container
  • 0-12 months: places and releases objects into another's hand upon request (i.e. "can I have the cup?")
  • 0-12 months: opens and begins to turn pages of a book with hard pages
  • 0-12 months: holds thick crayon with fisted grasp/cylindrical grasp, attempts to make a mark on paper

Self Help Skills

  • 9-11 months: removes socks and shoes
  • 12 months: helps to remove simple clothing items/holds out arms legs to help
  • 12 months: can follow simple directions from an adult (sit down, come here, put in, give me the, etc) 
  • 12 months: can hold cup and drink with some spillage
  • 12 months: can bite through a soft texture (soft toast, cookie, etc)

Red Flags
Talk to your pediatrician if you have any concerns with the following:

  • Noticeable flat spot on posterior (back) head or on either side
  • Pelvis asymmetry in sitting and crawling (i.e. uneven sitting posture)
  • Baby seems floppy or weak
  • Baby seems tight or stiff
  • Baby continues to scoot or use alternative locomotive pattern (such as hips rotated to one side or dragging one leg)
  • Baby doesn't make eye contact
  • Difficulty pulling to stand or standing independently by 12 months
  • Not weight bearing evenly when walking (I.e shifting weight onto one leg and dragging the other)
  • Difficulty grasping smaller items
  • Babies hands or one hand has a weak grasp
  • Baby always stands on tippy toes
  • Baby never mimics or imitates actions of adult (clapping, etc)
  • Baby doesn’t play appropriately with toys (Ie rake puzzle pieces out, push buttons, shake rattles, drop items into containers, etc)
  • Coughing throughout a meal or when drinking
  • Limited diet (prefers the same foods at every meal)
  • Frequent gag response to new foods or non-preferred foods
  • Excessive fluid intake but minimal food intake

**Dont worry if your baby shows signs of anything above ONE or even a few times! Only if a consistent pattern is noticed in a certain area should you feel the need to be concerned.  What I’m trying to say again here is, don’t make a mountain out of a molehill!

See also

Baby's First Year - Age Appropriate Milestones for 7-9 Months

Baby's First Year - Age Appropriate Milestones for 4-6 months

Baby's First Year - Age Appropriate Milestones for 0-3 Months

Babies First Year: Age Appropriate Milestones for Age 0-3 Months

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As a therapist, I know more than anyone how developmental milestones can be a stress point for new moms.  I worried a lot with my first child and tried diligently to make sure he met all his milestones on time.  With my second, however, I was much more relaxed.  I knew she would reach them on her own time frame. 

Every child is uniquely made.  While he/she may excel in one area, they might struggle with another set of skills.  That's the way we all are, isn't it?  Wired to have strengths and weaknesses?  Interests, passions and then those things you couldn't care less about?  

I get asked a lot of questions from friends about milestones and what is normal for each age.  I thought it would be helpful for those parents or caregivers out there to have a G U I D E L I N E for general milestones for each age group.  But please, use it just as that.  Don't stress yourself out if your child is a little behind in one area.  That is okay!  Let them develop when they are ready by learning through play.  However, if you see that your child is quite behind in one or more areas (gross motor skills, visual motor + perceptual skills, and fine motor skills) then talk to your pediatrician about your concerns.  Maybe there is something going on that needs a little more investigation.  

So enjoy! Pass this along to friends and send me any questions or concerns you may have.

This guideline has been developed through clinical experience and in combination with references Peabody Developmental Motor Scales 2 + The Beery VMI.  

Gross Motor Skills

Prone/On-Tummy:
Tummy time or what we call the prone position is one of the most important positions in which babies begin to learn anti-gravity movements.  While it doesn't always tend to be babies favorite past time, there are so many easy ways to make tummy time more fun.  See my previous post The Importance of Tummy Time & How to Make it Less Miserable for some helpful tummy time hints!  If your child cannot yet lift their head up against gravity, be sure to supervise them at all times while in this position.  But don't let your worries rob your child of this important developmental position.  It is truly the basis for all gross motor and fine motor developmental skills. 

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Tummy Time Tip *Use a rolled towel under their chest

  • 0-2 months: baby can lift face off floor briefly (1-2 seconds) 
  • 0-3 months: baby should be able to lift and turn head to both sides & is beginning to be able to lift both head and chest off of floor by weightbearing on their hands and forearms (this skill should be established by 4 months)

Supine/On-back:
Though tummy time gets all the spotlight (for good reason), there are some important developmental skills your baby is learning while on their back too!  I would just advise caution against letting baby spend too much time on their back and especially in car-seats the first few months to avoid plagiocephaly deformities and torticollis.  

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  • 0-2 months: baby should be able to raise legs off of the floor or mat
  • 0-2 months: baby should begin kicking legs
  • 0-2 months: in supine position (on back) baby can bring both hands simultaneously to midline of chest or face
  • 0-3 months baby should be able to turn head to both sides
  • 0-3 months: baby should be able to kick feet and pushes against objects
    Other:
  • 3 months - baby should push legs down when feet are placed on a surface
  • When placed on either right or left side, baby should be able to roll from their side to their back
  • Rolling from back to tummy is a more involved skill but begins around 2 months (should be established around 5 months)

Visual Motor + Visual Perceptual Skills

At birth, babies' eyes and visual systems aren't fully developed.  In fact, the visual system is one of the last systems to develop.  Significant development occurs within the first few months of life as the eyes begin to work together and visually track and focus on objects and faces.

  • 0-2 months: occasional eye crossing is normal
  • 0-1 months: babies like black and white objects/patterns more than color because the high-contrast of the colors is easier for their underdeveloped eyes to see
  • 0-2 months: baby really can only focus on objects placed about 6 inches from their face
  • 0-3 months: baby should be able to focus on an object placed 12 inches from their face
  • 2-3 months: when lying supine (on their back), baby should be able to track/follow with eyes a brightly colored object or rattle across the mid-line of their body
  • 2-3 months: while seated on caregivers lap, baby should be able to track/follow a ball rolled from one side to the other (crossing mid-line of their body)
  • 2-3 months: baby looks at his/her own hands and feet
  • 2-3 months: looks into caregivers face with interest & responds to a smile with a smile
  • At 3 months, they will begin attempting to reach for objects and toys but unable to reach and grasp or obtain object yet

Fine Motor + Grasp Development  

Fine motor and grasp development begins rather slowly, especially within the first three months.  During this time period, primitive reflexes override babies ability to really use their hands much and their hands are mostly in a fisted position.  The fisted posture of the hands (called a palmar reflex) should begin to go away around 4-6 months of age and this is when baby begins to volitionally reach for and grab objects.   

  • 0-1 months: baby holds hands in tight fists when resting on back
  • 0-2 months: baby can maintain grasp on an object (I.e. rattle) for about 30 seconds when object is placed in hand, does not yet reach
  • 0-2 months: open and shut hands (but not necessarily intentionally)
  • 3 months: can bring both hands to mouth at mid-line 

Self-Help + Feeding Skills

Within the first two months of life, a deep latch (for breastfed babies) should begin to emerge and by 3 months, it should be established.  Talk to a lactation consultant if baby is having difficulty breastfeeding and be sure to check for tongue ties.  There are a lot of nursing positions that make deep latch easier for newborns.

  • Baby is dependent on caregiver for all activities of daily living
  • Baby communicates hunger, fear or discomfort through crying

Red Flags

Talk to your pediatrician if you have any concerns with the following:

  • Baby having difficulty with latch or sucking patterns on breast or bottle (choking frequently on milk or uncoordinated suck and swallow)
  • Baby not following moving objects with eyes around or at 3 months 
  • Baby not startled by loud sounds or responding with movement (head turning) to sounds such as door opening, talking, dog barking
  • Very notable head tilt to one side with difficulty turning head in one direction (noticable mostly in carseats, preferred sleeping patterns)
  • Pelvis asymmetry (i.e. trunk rotated left while pelvis/hips rotated right)
  • Baby not making eye contact or smiling in response to an adults presence
  • Baby not bringing hands to mouth
  • Baby can not maintain grasp on an object
  • Unable to hold head up off of floor or mat when placed on tummy

Finger Marble Maze

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This little Finger Marble Maze has been with me since I began practicing OT and it never lets me down!  The children use their fingers to pinch the marble from one side of the maze to the other side.  The idea of this activity is to encourage an appropriate pencil grip.  

All you need to make this Finger Marble Maze is: 

  1. two blue pieces of felt
  2. brightly colored thread
  3. a sewing machine
  4. 1 marble
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Here is all the different skills this maze addresses.

  • Encourages an appropriate Triopd Grasp by strengthening the three fingers involved (thumb, index and middle finger)
  • Strengthens the muscle of the thumb (thenar eminence) for better prehension skills
  • Finger Isolation (sometimes the child uses the index or thumb to push it through vs pinch)
  • Bilateral coordination (using both hands together in a coordinated way)
  • Crossing midline which helps to synchronize the left and right hemispheres of the brain
  • Visual tracking skills
  • Attention
  • Task Perseverance