How to combination feed

When it comes to combi feeding, you can choose to¹:

• Bottle feed with expressed breast milk alongside breastfeeding
• Start formula feeding with a bottle alongside breastfeeding

It’s entirely up to you which option you choose, and it’s important that you do what works best for you and your baby. 

If you do decide to start combi feeding, here are some of the things you’ll need:

• Baby feeding bottles and teats
• A breast bump (if you’re combi feeding with expressed breast milk)
• Infant formula (if you’re combi feeding with baby formula)

You can also shop around for other things to make your experience of combination feeding easier, such as an electric steriliser to keep bottles free from harmful bacteria.

You can start combination feeding as early as it feels right for you – even from birth if you choose.

But health professionals advise establishing an exclusive breastfeeding routine before introducing a bottle to allow your baby to get used to latching and to help build up your breast milk supply².

Before making any changes to your baby’s feeding routine, it’s always worth having a chat with your midwife, health visitor or other healthcare professional to get the support you need.

Both breast and bottle feeding are new skills that you and your baby will need to learn together at first. While it’s natural to feel frustrated if things don’t go smoothly straight away, try to be patient while you get things established.

If you do decide to introduce bottle feeding into your routine, it’s a good idea to do so gradually to help you and your baby get used to the transition and to help prevent potential issues like mastitis¹.

Try swapping just one breastfeed for a bottle at first, and then go from there. It’s up to you which feed you decide to swap first, depending on what works best. If you want to get more rest and a little ‘me’ time, you might choose to let someone else give your baby a bottle for their last feed at night or first feed in the morning.

Other things that can help your baby get used to bottle feeding include²:

• Using a slow-flow teat which mimics the flow of your breast milk (most reputable baby bottle brands sell compatible slow-flow teats)
• Try to use the same positions for bottle feeding and breastfeeding
• Allow other people to give your baby their first bottle feeds so that your baby can’t smell your breastmilk

In short, yes, combination feeding can affect your breastmilk supply. Breastfeeding works on a supply and demand basis, meaning the more you breastfeed, the more milk your body produces³. So if you plan to continue breastfeeding alongside bottle feeding, it’s important to breastfeed or express your breast milk regularly to maintain your supply.

In the early days and weeks after your baby arrives, your body is establishing your milk supply, and introducing formula feeds too early can interfere with this⁴. Whether you decide to introduce bottles of baby formula when combi feeding, or use bottles of expressed breast milk, your body will need to learn to produce more or less milk to produce the right amount of breast milk for what your baby needs.

No matter how you choose to feed your baby, their cues are the best guide to how much to feed them.

Look out for signs that your baby might be telling you that they’re hungry, like wriggling, opening and closing their mouth, and trying to find something to suck⁵. Feed your baby every time they show signs of hunger to make sure they’re getting enough to grow and develop (this is called responsive feeding).

When bottle feeding, your baby will tell you when they’ve had enough. Follow their cues and don’t try to force them to finish a bottle if they become restless, as this can lead to stress and overfeeding².

While it’s not possible to overfeed a breastfed baby⁶, it is possible to overfeed a baby that’s bottle-fed. Bottle-fed babies are at an increased risk of overfeeding because it’s harder for your baby to control the flow of the milk, which results in them taking more milk than they need.

One of the considerations of mix feeding a baby can be the risk of overfeeding. You can use a technique called paced feeding to help prevent overfeeding and give your baby more control. To do this⁵:

• Keep their bottle nearly horizontal to stop the milk from flowing too quickly
• Watch your baby carefully for signs that they’re ready to stop or take a break
• If your baby gets upset, try putting the teat back in their mouth but tilting the bottle away slightly to slow down the flow and all your baby to such for comfort

If you have any concerns about how much milk your baby is getting, your midwife and health visitor are there to help.

It can be quite a balancing act to find a combination feeding schedule that fits around you and your family, but also ensures that you can produce enough milk for your baby.

Ultimately, your combination feeding schedule will depend 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 that your breasts are emptied often enough that they do not become uncomfortable and engorged.

For most women, returning to work after having a baby often means they won’t be able to breastfeed during the day. That means that whoever is looking after your baby while you’re at work will likely have to bottle feed them, either with formula milk (they can make up a bottle when they need it with powder or ready-to-drink formula) or your breast milk (which you can express and store a little in advance). 

When you’re with your baby in the morning or when you’re back from work in the evening, you can breastfeed them to help maintain your milk supply and prevent engorgement.

Remember this is just an example. It’s a good idea to try different things and find a combination feeding schedule that works for you. 

Combination feeding at night can be a great way to share the feeding routine and gain valuable extra sleep. But whatever your combination feeding schedule looks like, you’re likely to need to express or breastfeed overnight to avoid waking up with uncomfortable, engorged breasts⁷.

Yes, feeding your baby a mix of breastfeeding and formula feeding is called combination feeding, and it’s a popular option for parents.

No, mixing expressed breast milk and formula milk is not recommended.

This is a combination feeding schedule that a lot of parents explore, but there are a few things to consider before deciding that this is the right thing for you. 

Whilst many women find it easier to express milk in the morning as their breasts are full from producing milk overnight, this can lead to engorged breasts and conditions such as mastitis. 

The other thing to consider here is your breast milk supply. If you wish to combine breastfeeding during the day and introducing a bottle of formula as a top-up at night, it’s likely that you’ll still need to express your breast milk during the night⁸, at least at the start of your new routine. Reducing nighttime breastfeeds gradually will allow both your body and your baby to adapt to the new routine. 

If this is something you’re thinking about, have a chat with your midwife, health visitor or lactation consultant for advice.

You might have heard that feeding with a bottle of formula during the night will help your baby to sleep better or for longer, but there’s no guarantee that this will be the case². In general, babies tend to want to feed more at night. This is because at nighttime, your breasts produce higher levels of: 

• Prolactin - the hormone that promotes milk production⁹
• Melatonin - the hormone that promotes sleep¹⁰

Feeding your baby from the breast or with expressed breast milk during the night may help your baby get back to sleep more quickly after feeding. 

In addition, it’s important to find a combination feeding schedule that helps to maintain your milk supply and ensures that your body continues producing the amount of milk your baby needs. Ultimately, the best way to achieve that is to regularly breastfeed or express your breast milk both during the day and overnight.

Nipple confusion is a term sometimes used to describe babies’ difficulty switching between breastfeeding and bottle feeding. This is because the sucking pattern needed for each is slightly different. That’s why it’s important to be patient and give yourself and your baby time and space to get used to combination feeding.

You may notice some changes in your baby when you first switch to combination feeding, such as a little bit of constipation and wind while they get used to the change. You might also notice that your baby’s poos become firmer, darker, and smellier if you introduce formula milk into their feeding routine¹¹.

Keep a close eye on your baby and their nappies to get a better idea of what’s normal for them. If you’re worried at all, you can always speak to your midwife or health visitor.