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      How to combination feed

      Transition underlid leaflet father feeding baby with bottle at home

      How to combination feed

      Learn more about combination feeding schedules and routines, how much formula to use and more with a little help from Aptaclub.

      How to combination feed your baby

      You can successfully combination feed your baby using expressed breast or formula milk given in a bottle alongside your breastfeeding. You may wish to speak with your midwife or health visitor for support deciding what the best way to combination feed is for you1.

      Establishing breastfeeding may take several weeks, commonly between 6-8 weeks, and it is advisable to get confident with latching your baby to the breast before moving onto introducing a bottle to your baby and combination feeding. This is recommended because in the early weeks your body is establishing it’s milk supply and introducing bottles during this time may therefore lead to a lower milk supply2.

      There are some things you will need to bottle feed your baby:3

      • A steriliser
      • Feeding bottles
      • A breast pump if using expressed breast milk
      • Formula if using formula milk

      You can read more about the things you will need here.

      How to introduce combination feeding

      It is usually best to gradually introduce combination feeding once you have established breastfeeding. A gentle transition into combination feeding allows both your baby and your body to adapt to the change. It is important to remember that both breast and bottle feeding are new skills for both mothers and babies and therefore may take a little time to establish.1

      You could start combination feeding by swapping one breastfeed for a bottle feed at a time of day that works well for you and do this for a few days before replacing a further breastfeed with a bottle feed if you wish.

      It is important you continue to breastfeed or express breast milk regularly day and night to maintain your breast milk supply whilst combination feeding your baby.

      When to start Combination Feeding?

      In this video, Midwife Pip talks about when and how to introduce combination feeding. Learn about establishing breast milk supply ahead of bottle feeding, and how to gradually introduce bottle feeding to allow time for your baby & milk supply time to adapt.

      How much formula to use for combination feeding?

      The best guide is your baby. Learning and responding to your baby’s feeding cues will help you to work out when your baby has had enough or when they would like some more milk.4

      Responsive bottle feeding will also help ensure your baby drinks the right amount of milk for them, you should not force your baby to finish a bottle of milk. Remember that your baby’s needs and therefore appetite for milk will change day by day so do not worry if they take more from the bottle on one day than another.

      Allow your baby to take the lead on the amounts for combination feeding and to take how much milk they want at each feed. You can read more about how much and how often to bottlefeed your baby here.

      Combination feeding and overfeeding – can I overfeed my baby?

      It is possible to overfeed your baby when using bottles to feed, overfeeding means your baby receives more milk than their stomach and intestinal tract can digest.

      Bottle fed babies are at an increased 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. Newborn babies developmental limitations make them extra vulnerable to overfeeding.

      Recognising and only offering your baby a bottle when they display hunger cues can help to prevent overfeeding. When bottle feeding your baby, be patient and feed them slowly observing for signs they may want a break in their feed and allowing them to do so. Practicing responsive bottle feeding and not forcing your baby to finish a bottle will help to prevent overfeeding.3,5

      Combination feeding schedule

      It is important that you work to a routine that suits your family but that will also ensure your breast milk supply is maintained without causing your breasts to be overfull or engorged.1,6

      Your combination feeding schedule will depend naturally on how many bottles you give your baby. Spacing your baby’s bottles out between breastfeeds is a good way of ensuring your body’s supply and demand cycle for milk production is maintained and your breasts are emptied often enough that they do not become uncomfortable and engorged.

      Often, parents will utilise a combination feeding routine that allows some extra sleep for the breastfeeding mum so you may want to give a bottle for the last feed at night or the first feed in the morning for this.

      Combination feeding at night

      Just like with your daytime combination feeding routine, your breasts require regular stimulation at night to maintain your milk supply. With this in mind, it is important to not switch all your night time feeds to formula milk and to continue to support your body’s supply and demand cycle for breastmilk by feeding your baby at the breast overnight or expressing milk overnight.1,7

      Often, if a breastfeed is missed overnight you may wake up with very full or engorged breasts and in this case, you should feed from the breast to ensure you are more comfortable and reduce your risk of complications such as mastitis.

      Combination feeding at night can provide a valuable opportunity for parents to gain some extra sleep so exploring this routine may be helpful.

      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. 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]
      2. 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]
      3. 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]
      4. 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]
      5. 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.
      6. 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]
      7. 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.

      Last reviewed: 24th March 2022
      Reviewed by Pip Davies

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      Questions about feeding and nutrition?

      Our midwives, nutritionists and feeding advisors are always on hand to talk about feeding your baby. So if you have a question, just get in touch.

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