What is combination feeding?
When it comes to feeding your baby, you have many options including breastfeeding, formula feeding and combination feeding. Combination feeding simply means feeding your baby both from the breast and from a bottle (1). Many new parents wonder if they can combine breastfeeding and bottle feeding so it is reassuring to know that you can. The bottled milk may be of expressed breast milk or of formula milk, it is your choice as to how you combination feed your baby.
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Things to know before switching to combination feeding your baby
Combination feeding may be a good feeding choice for a variety of practical or emotional reasons. If you wish to explore what feeding choices may be best for you and your family, it is a good idea to chat to your midwife or health visitor1.
Some of the common reasons why parents may choose to combination feed are2:
- Difficulties initially with breastfeeding, so using bottle feeds to help supplement breast feeds until breastfeeding is established.
- Returning to work or being away from your baby and therefore needing someone else to be able to feed them.
- Wishing to share some of your baby’s feeds with your partner, this may be useful to allow you to gain some rest and to help support their bonding.
- Having started bottle feeding from birth but now wish to breastfeed.
Before you start combination feeding there are a few things to consider, such as benefits and potential challenges when adopting combination feeding. You can read more about these here: /baby/diet-and-
nutrition/bottlefeeding/common-combination-feeding-questions-and-concerns.html. Whether you decide to introduce a bottle of expressed breast milk or formula milk to your baby it is a good idea to make this change slowly and gradually. A gentle transition into combination feeding allows both your baby and your body to adapt to the change3:
Babies who are used to breastfeeding will need to suck a little differently to drink milk from a bottle and so this may take some time to adapt to. Every baby is an individual and so they may take to combination feeding differently and at different speeds.
A mothers’ body will also need to get used to this new way of feeding and depending on the combination feeding choice you make her breast milk supply may need to increase or decrease to meet your baby’s demand. Transitioning gradually will help ensure that a mother does not have issues with engorgement if she has too much milk or troubles with a low milk supply.
When to start combination feeding?
It is generally best to focus on establishing your breastfeeding before introducing a bottle and combination feeding your baby. The time scale for this will vary for each family but will usually take around 6- 8 weeks1, 3
Combination feeding from birth
You can combine breast and bottle feeding from birth should you wish, and some parents will find that combination feeding from birth is the option best suited for them1, 4.
However, it is useful to know that this could cause some breastfeeding challenges:
- In the early days and weeks your body is establishing your milk supply, and this may be impacted by combination feeding with formula milk. Breastfeeding and expressing breast milk regularly day and night time will help to boost your breast milk supply.
- You and your baby are also learning how to breastfeed, and it can take time to establish good positioning during feeds and to ensure your baby is latched well to the breast.
- If you choose to combination feed your baby with formula milk your baby will still receive some of the antibodies in breastmilk some of the time but not as many as if you are only combination feeding only using breast milk.
Introducing formula feeding
If you have decided to combination feed your baby using breastfeeding and formula feeding combined, it is important to recognise that your breastmilk supply is determined by your babies breastfeeds. Your breastmilk production will reduce as you start to introduce formula feeds to your baby, but it does not happen instantly, and therefore gradually introducing formula is advised4.
Taking this transition into combination feeding slowly will also help to prevent your breasts becoming engorged, should you notice this happening you can gently hand express just enough milk off to relieve the pressure, you do not want to fully empty the breast as this will act as stimulation to produce more milk5:
Combination feeding when your baby is still hungry after breastfeeding
Knowing you are feeding your baby enough when breastfeeding is not always easy, and it is something that worries many parents. Understanding your baby’s feeding cues will help you to work out if your baby is hungry. You can read more about feeding cues and a hungry baby here.
It is reassuring to understand that your new baby is growing quickly and so they often have a great appetite. It is also common in the first 12 months for your baby to have frequent growth spurts where they may be hungrier on some days. This does not mean you are not producing enough milk it is simply normal baby behaviour. Feeding for your baby is also a source of comfort and so babies may feed for comfort rather than due to hunger6.
If you are concerned about your breast milk supply, it is important to speak to your midwife or health visitor.
Supplementing with expressed breast or formula milk after breastfeeding may be a helpful way to combination feed your baby.
Combination feeding when breast milk supply is low
Low breast milk supply is a very common concern amongst mothers and combination feeding with expressed breast milk can be a good way to increase your breast milk supply if it is low. To learn more about improving your breast milk supply read this.
Breastmilk production is triggered by supply and demand, this means the more demand your body feels for milk the more it produces. Therefore, expressing milk in between or after a breastfeed will stimulate this cycle and help to boost your milk supply6.
There are 2 powerful hormones working to stimulate the supply and demand cycle. When you are close to your baby your body produces oxytocin and this hormone triggers the release of your milk. Then when you milk stores become emptied a hormone called prolactin is released and this hormone stimulates your milk production7.
My baby won’t take their bottle
Being gentle and patient can really help you to introduce a bottle to your baby, remember that the teat will feel different to the nipple so your baby will take a little time to adjust1, 8.
Some helpful ways to encourage your baby to take a bottle are:
- To try to introduce your bottle feeds when your baby is content and not too hungry.
- It may also help if someone other than you bottle feeds your baby as they will not smell of your breastmilk.
- Be patient, don’t feel your baby has to finish all of the milk in the bottle and be led by them.
Which feeds to stop first when combination feeding
Which breastfeed you stop first when introducing a bottle through combination feeding will depend on your aims from introducing a bottle and your individual routine. If you wish to introduce combination feeding to your baby to allow the breastfeeding mother more sleep or rest, then it may make sense to introduce a bottle for your baby’s last feed at night or first feed in the morning 1, 9.
It is best to avoid consecutive bottle feeds as this will mean less breast stimulation through breastfeeding and may therefore cause some issues such as 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 mum and baby.
Combination feeding with expressed breast milk
In this video, Midwife Pip explains the benefits of combination feeding with expressed breast milk as well as breastfeeding. Learn how combination feeding can allow for additional feeding freedoms, as well as useful advise on how to store and express breast milk.
Pip is a practicing Midwifery Sister with many years of experience supporting families through pregnancy, birth, and the postnatal period. Pip is enthused by empowering women with evidence-based, honest information through her Online Your Pregnancy Journey and Antenatal Education Courses. Pip is also the founder of the Midwife Pip Podcast as she believes quality information should be accessible to all.
- NHS (2019) 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: 25th November 2021]
- Britton, C., McCormick, F., Renfrew, M., Wade, A. and King, S. (2007) Support for breastfeeding mothers. Cochrane Library. Available at: https://pubmed.ncbi.nlm.nih.gov/17253455/ [Accessed: 24th November 2021]
- Grummer-Strawn, L., Scanlon, K. and Fein, S. (2008) Infant feeding and feeding transitions during the first year. Pediatrics. 122 (2), pp. 25-27.
- Kent, J., Prime, D. and Garbin, C. (2012) Principles for maintaining or increasing breast milk production. Journal of Obstetricians, Gynecologists and Neonatal Nurses. 41 (1), pp. 114-121.
- Creinsek, M., Taylor, E., Michener, K. and Stewart, F. (2020) Interventions for preventing mastitis after childbirth. Cochrane Library. Available at: https://www.cochranelibrary.com/cdsr/doi/10.1002/14651858.CD007239.pub4/full [Accessed: 22nd November 2021]
- NHS (2021) How to breastfeed. Available at: https://www.nhs.uk/start4life/baby/feeding-your-baby/breastfeeding/how-to-breastfeed/burping-your-baby/#anchor-tabs [Accessed: 22nd November 2021]
- 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.
- Maxwell, C., Fleming, K., Fleming, V. and Porcellato, L. (2020) UK mothers' experiences of bottle refusal by their breastfed baby. Maternal & Child Nutrition. 16 (4).
- Pados, B., Thoyre, S. and Galer, K. (2019) Neonatal Eating Assessment Tool - Mixed Breastfeeding and Bottle-Feeding (NeoEAT - Mixed Feeding): factor analysis and psychometric properties. Maternal Health, Neonatology and Perinatology. 5 (12), pp. 1-15.
Last reviewed: 24th March 2022
Reviewed by Pip Davies
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