Common combination feeding problems & concerns
If you have decided that combination feeding is the right choice for you and your baby, it’s not uncommon to have questions along the way. As with any feeding routine, you may encounter some challenges, and there are advantages and disadvantages whether you’re combination feeding with either expressed breast milk or baby formula alongside breastfeeding.
Here we’re taking a look at some of the most common combination feeding challenges and concerns, including some common tummy upsets and understanding those all-important feeding cues.
Here at Aptaclub, we’re here to support you and your baby on your feeding journey - whatever that looks like for you. If you’ve got any concerns at all about your baby’s routine whether combination feeding or otherwise, always seek advice from your GP, midwife or health visitor.
What are some of the most common combination feeding challenges and concerns?
For many parents, some of the most common challenges they encounter on their mixed feeding journey are:
Am I producing the right amount of milk for what my baby needs? It’s a common question for new mums. If you’re combination feeding with baby formula, maintaining your breastmilk supply can be a challenge.
As you make the transition to combination feeding, try to avoid dropping consecutive breastfeeds, and continue to give regular breastfeeds throughout the day and night. Because the amount of milk you produce works on a system of supply and demand (1) , spreading your baby’s bottle feeds out in this way will trigger your body’s cycle of milk production and help to ensure you maintain an adequate amount of milk for your baby.
It may also help to express your breast milk regularly in order to maintain your supply (2), and use the expressed breast milk in your mixed feeding routine. You can read more about maintaining and increasing your milk supply here.
Another reason to spread your baby’s bottle feeds is to avoid conditions like breast engorgement, which can lead to mastitis. This happens when your breasts become overfull, and may be more common if you’re combination feeding with baby formula.
If you experience this, try gently expressing a little of the excess milk by hand to make you more comfortable and ease any discomfort (3).
My baby won't take a bottle
It might take your baby a little time to adjust to combination feeding, simply because the teat of a bottle feels very different to your nipple. Learning to suck from a bottle is a new skill for your baby, so just follow their lead, be responsive, and go at their pace (4). Using a low flow teat can help to mimic the flow, ensuring that they take less milk all in one go and drink more steadily (5). With time and practice, your baby will get the hang of it.
Understanding your baby's feeding cues
When it comes to feeding your baby, you don’t need to follow a particular schedule, certainly in the first few weeks and months. Healthcare professionals instead recommend what is known as ‘responsive feeding’ or ‘feeding on demand’, which involves following their cues and feeding whenever your baby needs (6).
Feeding cues that your baby might display include (6):
- Opening their mouth or ‘rooting’ for a feed.
- Crying or becoming agitated.
- Sucking their hands and fingers.
Are there any disadvantages of combination feeding?
As we’ve explained above, any method of infant feeding can present challenges. Combination feeding is no exception.
If your mixed feeding involves exchanging some breastfeeds for baby formula, then your baby will not receive as many benefits as they normally would if they were exclusively breastfed. As such, their immune system may not be as well protected from certain infections (1).
In addition, due to the supply and demand nature of breastfeeding, the more bottle feeds you give, the more likely it is that your milk supply will reduce (7). If you notice this starting to happen, it can help to combination feed your baby with expressed breast milk, as expressing can support your milk supply.
On a practical level, mixed feeding will require some additional feeding equipment. For example, baby bottles, a breast pump, steriliser, and infant formula milk if you choose to use it.
Is combination feeding bad for my baby?
No, combination feeding is not bad for your baby.
It’s well documented that there are many, and every time you breastfeed, your baby will benefit from the antibodies it contains. The more you breastfeed, the more they’ll receive. However, at the end of the day, any breastmilk is better than none at all (8). As long as you follow the advice around how to support your milk supply when you’re mixed feeding, there’s no reason why it shouldn’t be a success for you and your baby.
If you’ve got any concerns at all, always speak to your GP, midwife or health visitor, who will be able to provide or signpost you to the breastfeeding support you need.
Advantages of combination feeding; benefits of mixing breastmilk and formula
Choosing to combine breastfeeding with infant formula has a number of advantages. In the first instance, whilst not at the same level as exclusive breastfeeding, your baby will still be getting some of the many benefits that breast milk has to offer. For example, the antibodies that support your baby’s immune system and help to protect them from various illnesses and infections (8).
Practically, mixed feeding with breastmilk and baby formula will enable your partner and anyone else you’re comfortable with to help with feeding your baby. Doing so will also give you the opportunity to get some rest if you need it or be away from your baby if you’re going back to work or have somewhere to go.
Do babies combination fed with formula as opposed to breast milk gain weight faster?
The rate at which your baby gains weight, as well as how much they’ll gain, depends on a variety of factors. Genetics, activity levels and whether they’re exclusively breastfed, formula or combination fed - these are all things that pay a part in your baby’s weight gain.
Whilst it’s not possible to overfeed a breastfed baby (9), this can happen with bottle fed babies because it’s harder for your baby to control the flow of milk. Try practising responsive feeding (10), follow their cues and be led by them. In addition, don’t worry if your baby doesn’t finish all of the milk in the bottle, they’ll let you know when they’ve had enough.
Can combination feeding cause tummy ache?
When baby’s drink from a bottle, they may inhale air which can cause your baby to feel uncomfortable. To avoid your baby taking in excess air, try(11):
- Winding your baby both during and after a bottle feed. You can read our helpful guide on this here.
- Keep the bottle in a horizontal position during feeding, as this will allow the milk to flow more steadily.
- Try not to rush feeds, giving your baby plenty of time to digest their milk.
Can combination feeding cause colic?
There is no definitive, known cause for colic in babies. One thought is that it may be because young babies find it harder to digest the milk they drink, leading to discomfort in their tummy(12). Colic is very common, affecting as many as 1 in 5 babies in the first 6 months, and your baby can experience it whether they’re breast, formula or combination fed(13).
As a parent, dealing with colic can be very difficult, not to mention exhausting. You can find lots of helpful advice about colic here, but if you have any further concerns or need some support, always speak to your health visitor for advice and reassurance.
Can combination feeding cause constipation?
When you first introduce infant formula to your baby, it’s not uncommon for them to become constipated. This is because baby formula is harder to digest than breast milk, and it can take your baby a little time to adapt to the change (14). You can find more information about constipation in babies here.
Does combination feeding affect my baby’s poop?
Breastfed babies typically poop more frequently than formula fed babies. As such, if you’re combination feeding, you might notice that your baby poops less frequently.
However your baby is fed, monitoring their nappies and becoming familiar with the frequency of their wees and poos is a good idea. That way, you’ll be reassured that they’re feeding well and getting the right amount of milk, as well as being able to recognise any changes that might need to be checked.
Does combination feeding cause more wind in babies?
Formula milk may cause more wind in babies than breast milk fed babies. Additionally, when babies drink from a bottle they inhale more air bubbles than when they drink from the breast and this may also cause more wind. Winding your baby regularly during and after feeds can help prevent discomfort from wind in babies7. Read the Aptaclub guide to winding your baby here.
Can combination feeding cause reflux?
Reflux can happen in breastfed, formula fed or combination fed babies, and occurs because the muscle at the bottom of your baby’s food pipe is still developing (15). Sometimes, commonly when their tummy is full, some milk and stomach acid is allowed to pass through this muscle, causing your baby to bring up milk during or after their feed.
Reflux can be very stressful to deal with, and it’s important that you’re getting the support you need. Always speak to your GP or health visitor about any concerns you have, and you can find more information and reflux and how to manage it here here.
Will mixed feeding affect the latch of my baby when switching between breast and bottle?
Whether or not mixed feeding will affect a baby’s latching ability when breastfeeding is a common question for many parents.
If you’ve decided that mixed feeding is the right thing for you and your baby, it’s good to be aware that your baby will find it very different feeding from a bottle than from the breast. Latching onto a bottle to feed requires a shallower or closed-mouth latch, which isn’t always as effective for breastfeeding (16).
To help your baby avoid what is known as ‘nipple confusion’ and ensure that they become confident when latching onto the breast, it’s recommended that you wait until breastfeeding is fully established before introducing a mixed feeding routine.
If you’d like more breastfeeding support, always speak to your midwife or health visitor. They’ll be able to provide you with the advice you need and may even suggest speaking with a lactation consultant who can provide more information and guidance around your baby’s latch.
- NHS Start4Life. Milk supply. Available at https://www.nhs.uk/start-for-life/baby/feeding-your-baby/breastfeeding/breastfeeding-challenges/milk-supply/ [Accessed: July 2023]
- 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]
- 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]
- 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)
- NHS (2021) 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 Start4Life. Feeding on demand. Available at https://www.nhs.uk/start-for-life/baby/feeding-your-baby/bottle-feeding/bottle-feeding-your-baby/feeding-on-demand/#:~:text=Signs%20of%20hunger&text=try%20to%20find%20something%20to,start%20wriggling%20and%20getting%20restless [Accessed: July 2023]
- 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.
- NHS Start4Life. The Benefits of breastfeeding. Available at https://www.nhs.uk/start-for-life/baby/feeding-your-baby/breastfeeding/the-benefits-of-breastfeeding/ [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=You%20cannot%20overfeed%20a%20breastfed,re%20hungry%20or%20need%20comfort [Accessed: July 2023]
- UNICEF (2016) Responsive Feeding: Supporting close and loving relationships. Available at: https://www.unicef.org.uk/babyfriendly/wp-content/uploads/sites/2/2017/12/Responsive-Feeding-Infosheet-Unicef-UK-Baby-Friendly-Initiative.pdf [Accessed: 21st November 2021]
- NHS (2021). Bottle feeding advice. Available at https://www.nhs.uk/conditions/baby/breastfeeding-and-bottle-feeding/bottle-feeding/advice/ [Accessed: July 2023]
- NHS (2022). Colic [online] 2018. Available at https://www.nhs.uk/conditions/colic/
[Accessed: July 2023]
- NHS Start 4 Life. Breastfeeding challenges - Colic [Online]. Available at: https://www.nhs.uk/start4life/baby/breastfeeding/breastfeeding-challenges/constipation/ [Accessed: July 2023]
- NHS Start4Life. Breastfeeding challenges – Constipation (online). Available at https://www.nhs.uk/start-for-life/baby/feeding-your-baby/breastfeeding/breastfeeding-challenges/constipation/#:~:text=It's%20quite%20common%20for%20your,cope%20with%20digesting%20new%20things [Accessed: July 2023]
- NHS (2021). Reflux in babies. Available at https://www.nhs.uk/conditions/reflux-in-babies/ [Accessed: July 2023]
- NHS The Royal Wolverhampton NHS Trust. Breastfeeding frequently asked questions. Available at https://www.royalwolverhampton.nhs.uk/services/service-directory-a-z/infant-feeding/breastfeeding-frequently-asked-questions/ [Accessed: July 2023]
Last reviewed: 24th March 2022
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