When it comes to feeding your baby, there are a number of options to choose from. As well as exclusive breastfeeding or formula feeding, you might be giving some thought to combination feeding.
Here we’re taking a look at combination feeding, and providing some expert advice about how to do it, when to start and the things you need to know.
What is combination feeding?
Also known as ‘combi feeding’ or ‘mixed feeding’, it simply means that you’ll be feeding your baby from both the breast and from a bottle (1).
The bottled milk you use when combi feeding can be expressed breast milk or baby formula, It’s entirely your choice. You can find more information about expressing and storing breast milk here.
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Reasons for combi feeding
There are a variety of physical and emotional reasons why you might want to explore combi feeding, and for many new parents, it’s reassuring to know that this is an option.
Some of the most common reason parents choose to combi feed are (2):
- Difficulties with breastfeeding, for example concerns around milk production, or experiencing conditions such as mastitis. It might be that you wish to supplement breast feeds until breastfeeding is established and you’re receiving the right breastfeeding support.
- Returning to work or being away from your baby for a period of time. Combi feeding will enable your partner or other family members to feed your baby when you’re not there.
- Sharing the infant feeding routine. Combi feeding will enable others to be involved, which can be very helpful if you need to get some rest.
- Your baby was bottle fed at birth, but you now wish to breastfeed.
Things to know before switching to combination feeding your baby
Before you switch to combination feeding, it’s always worth discussing your options with your midwife, health visitor or other healthcare professional. They’ll be able to provide you with any breastfeeding support you might need, and give you some practical advice about how to make your combi feeding journey a success. As with most things, combination feeding has both its benefits and its challenges, and you can find further advice about both here.
Whether you decide to combi feed with expressed breast milk or infant formula, the main thing is to introduce the change gradually. A gentle transition to combination feeding allows both your baby and your body to adapt to the new routine (1):
Babies who are used to exclusive breastfeeding will need to learn to suck a little differently, drinking milk from baby bottles is a new skill, and they may take a little time to adapt. Remember that all babies are different, and will take to combi feeding in their own way and at their own pace.
The switch to combi feeding is also a change for your body. To ensure that your baby is getting enough breast milk, and depending on how you choose to combination feed, your body may need to produce more or less milk. Transitioning gradually will help you to manage your milk production, and avoid issues such as engorgement and mastitis (1).
When to start combination feeding?
The NHS advises that it’s generally best to wait until breastfeeding is fully established before you introduce mixed feeding (2). There’s no way to pinpoint how long it will take for you to fully transition to combi feeding, but the NHS states that it can take a few weeks (1).
Combination feeding from birth
You can combine breast and bottle feeding from birth if you wish to do so, and many parents find that combi feeding is the option most suited to their family life. However, there are some things to consider before making any decisions here.
In the early days and weeks after your baby is born, your body is establishing your milk production and supply. Combi feeding with infant formula milk can have an impact on your milk production and the amount of breastmilk you produce. Ultimately, this can result in your body producing less milk.
To help overcome any challenges here, using a breast pump to regularly express milk during the day and at night time will help you produce the amount of breastmilk that your baby needs. It can also help when breastfeeding to try different positions. That way you can give your baby the best chance of latching onto your breast to feed. We’ve got plenty of advice when it comes to breastfeeding positions and you can take a look here.
The benefits of breastmilk for your baby are well documented. It’s worth bearing in mind that if you combination feed with formula milk, whilst they will still receive some of the benefits of breastmilk, they won't be as much as if they were an exclusively breastfed baby.
Introducing formula feeding
If you’ve decided to combination feed your baby using breastfeeding and formula milk, it’s important to know that the amount of breastmilk you produce is determined by the amount of milk your baby needs. Once you start using baby bottles to introduce formula milk, your milk production will reduce. This won’t happen instantly, and that’s why a gradual reduction in breastfeeds is recommended.
Transitioning to combi feeding slowly will also help to prevent your breasts becoming engorged. If you notice that this is starting to happen, you might find that gently hand expressing a little of your breastmilk will relieve any pressure and discomfort.
Establishing a Mixed Feeding Routine
Introducing a mixed feeding routine can take some time for your baby to get used to. If your baby is used to exclusive breastfeeding, baby bottles will feel very different to your nipple. For this reason, you might want to use a slow-flow teat, to help overcome any nipple confusion and to mimic the flow of your breastmilk (2). Do your best to stay calm and relaxed, and be patient with both yourself and your baby as you embark on this new infant feeding journey.
Below you’ll find some other suggestions that might help you to establish a successful mixed feeding routine:
- Aim to introduce your baby’s bottle feeds when they’re content and not too hungry.
- Try letting your partner or a family member give your baby their bottle. That way your baby won’t be able to smell your breastmilk.
- Be led by what your baby needs, and don’t worry if your baby doesn’t finish all of the milk in the bottle. If you’ve got any concerns around your baby getting enough breastmilk or formula or you’ve got questions about your baby’s weight, always talk to your midwife and health visitor for advice.
- Try the different positions when feeding, particularly ones that you might use when breastfeeding, and that bring your baby close so that you can cuddle them as you feed (2).
Use a breast pump to express your milk between feeds (2).
Combination feeding when your baby is still hungry after breastfeeding
Wondering whether your baby is getting enough breastmilk is common for new parents, so if this is something you’re asking yourself, you’re certainly not alone. In time, you’ll come to recognise your baby’s needs and cues when it comes to feeding, and this will help you to work out when they’re hungry and when they’ve had enough. You can read more about that here.
In the first 12 months of your baby’s life, they grow very quickly. Regular growth spurts can mean bigger appetites, and you might find that your baby is hungrier on some days than they otherwise might be. This is perfectly normal, and doesn’t mean that you’re not producing enough breastmilk. Remember also that some babies enjoy feeding as a source of comfort, and may be feeding because of that rather than due to hunger (3).
Combination feeding when breast milk supply is low
Low breast milk supply is a very common concern amongst parents, and it’s only natural for you to want to produce the amount of milk your baby needs. If you’ve got any concerns at all about your milk production, be sure to seek advice from your midwife, healthcare professional or lactation consultant, so that they can provide the advice and breastfeeding support that you need.
Breastmilk production is triggered by a system of supply and demand. The more breastmilk your baby demands, the more your body produces (4). There are two powerful hormones involved in this amazing supply and demand cycle; oxytocin and prolactin. When you’re close to your baby, your body produces oxytocin which triggers the release of your breastmilk. Then, when your milk stores become emptied, a hormone called prolactin is released which stimulates your milk production (5). If you’re worried that your milk supply is low, you might find that combi feeding and supplementing with expressed breast or formula milk is helpful.
There are a number of things you could try in order to increase the amount of milk you produce. For example (4):
- Expressing milk in between or after a breastfeed can help to stimulate the supply and demand cycle and boost your milk supply.
- Feed as often as your baby needs.
- Practice skin to skin with your baby as often as you can.
- Offer both breasts when feeding.
You can find more information on increasing your breastmilk supply here.
My baby won't take their bottle
It’s not uncommon for babies who have been exclusively breastfed to resist taking breastmilk or formula milk from a bottle. As we’ve said above, a bottle teat is very different to the breast, and some babies experience what is known as nipple confusion. Being gentle and patient is key as your baby gets used to their new combi feeding routine.
Which feeds to stop first when combination feeding
When transitioning to combi feeding, you’ll need to decide which breastfeeds to drop first. This will depend on your infant feeding routine, and what you want to achieve. For example, if you’d like to get some more sleep through the night and let someone else do the feeding, it makes sense to introduce a bottle feed before bedtime, or first thing in the morning.
You may want to avoid dropping consecutive feeds, as this result in a reduced milk supply or breast engorgement. Staggering your bottle feeds within your babies breastfeeds will usually lead to a smoother transition into combination feeding for both you and your baby.
- NHS (2023). How to combine breast and bottle feeding. Available at https://www.nhs.uk/conditions/baby/breastfeeding-and-bottle-feeding/bottle-feeding/combine-breast-and-bottle/ [Accessed: July 2023]
- NHS Start4Life. Introduction to mixed feeding. Available at https://www.nhs.uk/start-for-life/baby/feeding-your-baby/mixed-feeding/introduction-to-mixed-feeding/ [Accessed: July 2023]
- NHS (2023). Your breastfeeding questions answered. Available at https://www.nhs.uk/conditions/baby/breastfeeding-and-bottle-feeding/breastfeeding/your-questions-answered/#:~:text=Your%20baby%20feeds%20for%20comfort,to%20do%20with%20your%20needs [Accessed: July 2023]
- NHS Start4Life. Milk Supply. Available at https://www.nhs.uk/start-for-life/baby/feeding-your-baby/breastfeeding/breastfeeding-challenges/milk-supply/#:~:text=Did%20you%20know%3F,may%20start%20producing%20less%20milk [Accessed: July 2023]
- Lee, S. and Kelleher, S. (2016) Biological underpinnings of breastfeeding challenges: the role of genetics, diet, and environment on lactation physiology. American Journal of Physiology, Endocrinology and Metabolism. 311 (2), pp. 405- 422.
Last reviewed: 24th March 2022
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