e-Library of Evidence for Nutrition Actions (eLENA)

Cup-feeding for low-birth-weight infants unable to fully breastfeed

Every year, more than 20 million infants are born weighing less than 2500 g – over 96% of them in developing countries. These low-birth-weight infants are at increased risk of early growth retardation, infectious disease, developmental delay and death during infancy and childhood.

Low birth weight can be a consequence of preterm birth, or due to small size for gestational age, or both. In addition, a small proportion of low-birth-weight infants are born at term and are not small for gestational age.

Interventions to improve the feeding of low-birth-weight infants are likely to improve the immediate and longer-term health and well-being of the individual infant and have a significant impact on neonatal and infant mortality levels in the population.

WHO recommends that low-birth-weight infants should be fed mother's own milk. If these infants cannot be fed mother's own milk, they should be fed donor human milk (in settings where safe and affordable milk banking facilities are available or can be set up) or standard infant formula.

Low-birth-weight infants who are unable to breastfeed can be fed by alternative oral feeding methods such as bottle-feeding or cup-feeding. Studies comparing these methods have shown that cup-feeding improves exclusive breastfeeding rates at discharge but these benefits are not sustained. Cup-feeding is also associated with prolonged hospital stays. However, as cups are easier to clean than bottles, cup-feeding could potentially reduce the risk of severe infections such as diarrhoea.

WHO recommendations

Low-birth-weight infants who need to be fed by an alternative oral feeding method should be fed by cup (or palladai, which is a cup with a beak) or spoon.

This is one of several WHO recommendations on feeding of low-birth-weight infants. The full set of recommendations can be found in 'Full set of recommendations' and in the guideline, under ‘WHO documents’ below.

WHO documents

GRC-approved guidelines


Systematic reviews used to develop the guidelines
Related Cochrane reviews
Clinical trials

Last update:

2 December 2014 10:28 CET

Category 1 intervention

Guidelines have been recently approved by the WHO Guidelines Review Committee


There is not yet any implementation information related to this intervention in GINA

Essential Nutrition Actions

This intervention is supported by Essential Nutrition Actions targeting the first 1000 days of life.