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      Common combination feeding problems & concerns

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      Common combination feeding problems & concerns

      Learn more about common concerns surrounding combination feeding including advantages and disadvantages of combination feeding together with Aptaclub.

      Common combination feeding challenges and concerns

      • Breastmilk supply: Maintaining your breastmilk supply if combination feeding with formula can be a challenge for some. Spreading your baby’s bottle feeds out and ensuring you still give regular breastfeeds through the day and night to trigger your body’s supply and demand cycle of milk production will help ensure you maintain adequate breastmilk for your baby. You can read more about this here.1,2
      • Breast engorgement: Longer intervals between breastfeeds may also cause your breast to become overfull and lead to engorgement. Should this happen, you can gently hand express off some of the excess milk to make you more comfortable.3
      • Baby won’t take a bottle: Breastfed babies may take time to learn to drink from a bottle as they need to suck a little differently than from the breast.  Every baby is an individual and so they may take to combination feeding differently and at different speeds. Being patient and practicing responsive bottle feeding will help.4

      Understanding your baby’s feeding cues

      In this video, Midwife Pip talks about common feeding cues a baby will display; clear signs showing that they’re hungry. Learn more about the early, mid, and late feeding cues, that include your baby opening their mouth, or “rooting”, crying, or being agitated. Midwife Pip explains how to feed newborn babies based on their early feeding cues, rather than following a rigid feeding schedule.

      Are there any disadvantages of combination feeding?

      If exchanging some breastfeeds for formula milk then your baby will not receive as many antibodies and so their immune system may not be as well protected from certain infections.2

      Due to the supply and demand nature of breastfeeding, meaning the more your baby breastfeeds the more milk your produce, introducing formula bottle feeds may reduce your milk supply.3

      Bottle feeding requires you to obtain some additional equipment such as a steriliser, feeding bottles and either a breast pump or formula.

      Is combination feeding bad for my baby?

      Combination feeding is not bad for your baby, any breastmilk for baby’s is better than none and the more breastmilk you give, the more antibodies they will receive. It is just important to ensure you follow the advice to support your milk supply. 2,5

      Advantages of combination feeding; benefits of mixing breastmilk and formula

      Combination feeding also has some advantages for parents. The benefits of mixing breastmilk and formula are often around enabling partners to be involved with feeding your baby and giving breastfeeding mothers some more time to rest.2

      Combination feeding may also allow your baby to be fed by someone else if you are returning to work.

      Do combination formula fed babies gain weight faster?

      Babies gain weight at different rates and baby weight gain varies depending on many factors such as genetics, activity level and whether they are breastfeeding, formula feeding or combination feeding.  Bottle fed babies are at risk of overfeeding because it is harder for your baby to control the flow of the milk and it is easier for you to accidentally pressure them to drink more milk than they need. Practicing responsive bottle feeding with your baby will help to prevent overfeeding.2,6

      Can combination feeding cause tummy ache?

      When babies drink from a bottle they inhale more air than they do drinking from the breast, this trapped air can cause tummy ache in babies, so it is important to wind your baby during and after a bottle feed.7

      Can combination feeding cause colic?

      There is no definitive, known cause for colic in babies. It is thought that it may be because young babies find it harder to digest milk leading to discomfort in their tummy. Babies who are breastfeeding, formula feeding, or combination feeding may get colic and it is most common in the first 6 months8. To read more about Colic in babies read here.

      Can combination feeding cause constipation?

      Constipation in babies can be caused by the change from breastmilk to formula milk as their digestive system adapts. If babies are not feeding enough, they may become dehydrated which may also lead to constipation9. You can learn more about constipation in babies here.

      Does combination feeding affect my baby’s poop?

      Breastfed babies typically poop more frequently than formula fed babies. When combination feeding with formula your baby may poop less often. Monitoring your baby’s nappies and noticing regularly wee’s and poo’s is a good sign that they are feeding well whether that may be breastfeeding, formula feeding or combination feeding.2

      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?

      Breastfed, formula fed or combination fed babies can all develop reflux. Reflux occurs because the muscle at the bottom of your baby’s food pipe is still developing and sometimes, commonly when their tummy is full, some milk and stomach acid is allowed to pass through this muscle and can move back up again. Feeding your baby little and often, burping regularly and keeping them upright after feeds may all help symptoms of reflux10. Learn more about reflux in babies here

      Pip Davies

      pip-headshot-medium.png

      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.

      Read more

      Read more

      1. Britton, C., McCormick, F., Renfrew, M., Wade, A. and King, S. (2007) Support for breastfeeding mothers. Cochrane Library. Available at: https://www.nhs.uk/conditions/baby/breastfeeding-and-bottle-feeding/bottle-feeding/combine-breast-and-bottle/ [Accessed: 24th November 2021]
      2. 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]
      3. 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.
      4. 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).
      5. 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]
      6. 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]
      7. UNICEF (2021) Guide to Bottle Feeding Leaflet. Available at: https://www.unicef.org.uk/babyfriendly/baby-friendly-resources/bottle-feeding-resources/guide-to-bottle-feeding/ [Accessed: 22nd  November 2021]
      8. NHS (2021) Breastfeeding challenges. Available at: https://www.nhs.uk/start4life/baby/feeding-your-baby/breastfeeding/breastfeeding-challenges/colic/#anchor-tabs  [Accessed: 21st  November 2021]
      9. NHS (2021) Breastfeeding challenges. Available at: https://www.nhs.uk/start4life/baby/feeding-your-baby/breastfeeding/breastfeeding-challenges/constipation/#anchor-tabs [Accessed: 21st  November 2021]
      10. NHS (2021) Breastfeeding challenges. Available at: https://www.nhs.uk/start4life/baby/feeding-your-baby/breastfeeding/breastfeeding-challenges/reflux/ [Accessed: 21st  November 2021]

      Last reviewed: 24th March 2022
      Reviewed by Pip Davies

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      Your baby's future health begins here

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