You asked for it! Sippy cups

Quick COVID Update

Very quick update on child care COVID.

First, I wanted to flag that in general the COVID-Explained team is keeping our post on child care updated here. This post includes all the crowd-sourced data we have (will be updated as of this morning in the tracking sample), anything we can pull from the media on outbreaks and anything states individually report. It’s a long post, but you can hopefully find what you are looking for.

Second, I wanted to flag this CDC report out of Rhode Island on COVID-19 in child care settings. RI has had settings open since June 1, with 666 programs open with capacity for over 18,000 children. In the period June 1 - July 31, they had 52 confirmed or suspected COVID-19 cases, 30 in children and 22 in staff. Nearly all of these cases did not seem to be linked to the child care setting. There is one real outbreak (5 kids, 5 adults) in a setting which didn’t appear to be adhering to the guidelines.

I read this as both encouraging in terms of very, very small numbers of cases and a good illustration of the importance of careful guidelines, including masking, screening and so on. Their full set of guidelines is here.

Sippy Cups!

(Huge thanks on this post to Speech Language Pathologist Sara Toogood).

I was recently reviewing some of my pre-pandemic newsletter notes, reflecting on a time when I thought I’d mostly write about topics like juice and baby sunscreen. But one jumped out at me. My notes say: “sippy cups - just use straw?” And I wondered, what did I really mean there?

For the uninitiated, sippy cup image below. It’s a commonly used transitional drinking cup for toddlers. There’s the bottle or breast and, then, the next step is the sippy. I, myself, have owned many a sippy cup.

However: the internet is a cautionary tale. Take the article: “Why Your Toddler’s Sippy Cup Should Come with a Warning Label” or, even better, “The Hidden Dangers of Baby Bottles, Pacifiers and Sippy Cups.” Despite the fact that every other parent seems to be using these products, maybe you should skip them?

First, what is the value of the sippy cup? Why not just have your child us a regular cup right away? In short, spills. Kids are not great at using cups and they routinely knock them over. Sippy cups cannot spill (much) and certainly if you want something to carry around when you’re out in the stroller, you do not want to have an open cup. Unless your kid is a wizard, you’ll have an empty cup and a wet kid.

On the flip side, what’s the worry? Basically, it’s twofold. First, there is the problem of cavities. If you fill your child’s sippy with juice or soda, and then they are constantly sucking on it, there is a lot of opportunity for sugar to get in their teeth. The best way to avoid this is to only use sippy cups for water. In general, the recommendation is for kids to have only milk and water. I can get into this another time, but even if you think an occasional orange juice is not going to send your child down the road to delinquency, you might as well keep it out of the sippy, where it will make things gummy and hard to clean.

The other concern is that use of a sippy cup will interfere with mouth development, related to either ability to eat other foods or speech. This concern is rooted in the mechanics of how swallowing develops. Infants swallow using a “suckle-swallow” pattern where the tongue moved liquid or food from the front to the back of the mouth. Around a year, a more adult swallowing pattern develops, where the tongue tip moves to the top of the mouth and then food is propelled with a tongue wave into the back of the mouth.

This adult swallowing pattern is important for eating foods with different textures, and for developing speech (not language - this has nothing to do with understanding, but the mechanisms of producing understandable speech).

Why would a sippy cup matter here? The mechanics of using a sippy cup involve using the suckle-swallow pattern common in infancy, not the more adult swallow pattern. The idea is that if you use a sippy cup too much, it could impede this development. A similar problem could arise with prolonged pacifier use.

These facts about the mechanics of drinking with a sippy cup and the general swallowing patterns are simply true. Evidence from children with Down Syndrome has linked use of pacifiers and bottle feeding (both of which also encourage the infant swallowing pattern) to feeding issues. And speech pathologists who work with children with speech or swallowing issues do point to the possible links with sippy cups.

Having said this: we do not have any large scale data linking sippy cup usage to speech or swallowing difficulties. That is to say, if you were looking for a study which showed that children who use sippy cups are more likely to lisp, or less likely to eat a variety of foods, you would not find it. Moreover, millions and millions of children use sippy cups and for the most part they have typically developing speech and swallowing patterns. If the effect of sippy cups was very large, it seems likely we’d see it more directly.

In the end, there may be mechanical reasons to think that using a sippy cup all the time may not be ideal, and if your child does have problems swallowing, it seems possible it is something to look at it. But the evidence does not, to me, seem strong enough to shun use of sippy cups all together. And they are a convenient way to keep kids hydrated, which is also important. As usual, there is no perfect solution.

I will say that with our second kid we moved right to straw cups. I would liked to say it was because of science, but actually it was because of my family’s intense desire to simplify our stuff. By the time Finn was old enough for a cup, we had a lot of straw cups for Penelope (like this Safe Sippy or these Take and Toss cups which are I guess meant to be disposable but which I have had for about 8 years). The idea of then also having separate cups for Finn felt annoying.

Straws also have the advantage that if you forget your kid’s cup, you can usually find a straw. And straw usage enables further transitions. We now have moved the entire family, including Jesse and I, to Nalegene bottles, which we identify with Name Bubbles labels. It’s only slightly awkward when people at work ask me why my water bottle has a giant sticker with my name on it.

Weigh in!

Keep the thoughts coming. I cannot write back to everyone but I do read all of your emails, I promise.

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