Intended for healthcare professionals


Effect of bottles, cups, and dummies on breast feeding in preterm infants: a randomised controlled trial

BMJ 2004; 329 doi: (Published 22 July 2004) Cite this as: BMJ 2004;329:193
  1. Carmel T Collins (collinsct{at}, research nurse/midwife1,
  2. Philip Ryan, associate professor2,
  3. Caroline A Crowther, professor3,
  4. Andrew J McPhee, deputy head of neonatal medicine4,
  5. Susan Paterson, research midwife5,
  6. Janet E Hiller, professor2
  1. 1 Department of Nursing and Midwifery Research and Practice Development, Women's and Children's Hospital, 72 King William Road, North Adelaide, South Australia, 5006, Australia
  2. 2 Department of Public Health, University of Adelaide, Adelaide, South Australia, 5005, Australia
  3. 3 Department of Obstetrics and Gynaecology, University of Adelaide, Adelaide, South Australia, 5005, Australia
  4. 4 Department of Neonatal Medicine, Women's and Children's Hospital, 72 King William Road, North Adelaide, South Australia, 5006, Australia
  5. 5 Department of Neonatal Services, Mercy Hospital for Women, Clarendon Street, East Melbourne, Victoria, 3002
  1. Correspondence to: C Collins
  • Accepted 6 May 2004


Objective To determine the effect of artificial teats (bottle and dummy) and cups on breast feeding in preterm infants.

Design Randomised controlled trial.

Setting Two large tertiary hospitals, 54 peripheral hospitals.

Participants 319 preterm infants (born at 23-33 weeks' gestation) randomly assigned to one of four groups: cup/no dummy (n = 89), cup/dummy (n = 72), bottle/no dummy (n = 73), bottle/dummy (n = 85). Women with singleton or twin infants < 34 weeks' gestation who wanted to breastfeed were eligible to participate.

Interventions Cup or bottle feeding occurred when the mother was unable to be present to breast feed. Infants randomised to the dummy groups received a dummy on entry into the trial.

Main outcome measures Full breast feeding (compared with partial and none) and any breast feeding (compared with none) on discharge home. Secondary outcomes: prevalence of breast feeding at three and six months after discharge and length of hospital stay.

Results 303 infants (and 278 mothers) were included in the intention to treat analysis. There were no significant differences for any of the study outcomes according to use of a dummy. Infants randomised to cup feeds were more likely to be fully breast fed on discharge home (odds ratio 1.73, 95% confidence interval 1.04 to 2.88, P = 0.03), but had a longer length of stay (hazard ratio 0.71, 0.55 to 0.92, P = 0.01).

Conclusions Dummies do not affect breast feeding in preterm infants. Cup feeding significantly increases the likelihood that the baby will be fully breast fed at discharge home, but has no effect on any breast feeding and increases the length of hospital stay.


  • We thank the women and their infants and the nursing, midwifery, and medical staff of the following hospitals who participated in the trial: Barmera, Blackwood, Ceduna, Flinders Medical Centre, Gawler Health Service, Kapunda, Lyell McEwin, Modbury, Naracoorte, Port Lincoln, Port Pirie, South Coast District, The Queen Elizabeth, Wallaroo, Western, Women's and Children's (South Australia); Alice Springs, Royal Darwin (Northern Territory); Bairnsdale, Ballarat Base, Bendigo, Box Hill, Central Gippsland Base, Colac Community Health Services, Dandenong, Diamond Valley Community, Frankston, Geelong, Goulburn Valley Base, Hamilton Base, Kilmore and District, La Trobe Regional, Leongatha, Mitcham Private, Monash Medical Centre, Mount Waverley Private, Mt Alexander, Mt Alvernia Mercy, Northern, Northpark Private, Peninsula Private, Sandringham and District Memorial, Seymour District Memorial, South Eastern Private, St John of God Health Care, Sunbury Private, Sunshine, The Angliss, The Mercy Hospital for Women, The Valley Private, Wangaratta District Base, Warrnambool and District Base, Werribee Mercy, West Gippsland, Wimmera Base, Wodonga (Victoria). This study was conducted while CTC was a PhD candidate at the University of Adelaide.

  • Contributors CTC initiated the study, formulated the research questions, designed the study, wrote the study protocol and applications for funding, was the principal investigator for the study, undertook recruitment and data collection, entered the data, conducted the data analysis, and drafted the paper. She is guarantor for the paper. PR advised on design and conduct of the study, supervised the statistical analysis, and contributed to the writing of the paper. CAC and AJMcP participated in protocol design and contributed to the interpretation of results and writing of the paper. SP undertook recruitment, participated in data collection, and contributed to the interpretation of results and writing of the paper. JEH contributed to the interpretation of results and writing of the paper. A Moorehead and A Watkins gained the collaboration of the Mercy Hospital for Women and obtained funding from Mercy Hospital for Women Nurses Research Fund.

  • Funding Mercy Hospital for Women Nurses Research Fund. CTC received a two year midwifery fellowship from the Women's and Children's Hospital Foundation.

  • Competing interests None declared.

  • Ethical approval Approval was given by the recruiting hospitals research and ethics committees.

  • Accepted 6 May 2004
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