Combination feeding isn’t often suggested as a feeding options to parents but it’s something that worked really well for us. This guide will explain how to start combination feeding as well as answering all of your questions on mixed feeding with breastmilk and formula.
What is Combination Feeding?
Combination feeding, sometimes called mixed feeding or mix feeding, involves feeding your baby using both the breast and a bottle.
Can You Mix Formula and Breastmilk?
Yes! Lots of parents who combination feed do so by feeding a mixture of breastmilk, either always directly from the breast or sometimes expressed and then given via a bottle and formula milk given in a bottle or sometimes a sippy cup if the baby is older.
Can You Combination Feed with Just Breastmilk?
Yes! If you just want to give your baby breastmilk, but do so through a mixture of the breast and expressed breastmilk in a bottle, then that is a type of combination feeding. The baby would be fed exclusively on breastmilk but not exclusively fed by breast.
Reasons People Choose Mixed Feeding
- They want to allow a partner to help with the feeding
- They are going back to work and so are no longer able to exclusively breastfeed
- They want or need to be able to leave the baby in someone else’s care
- They want to gradually give up breastfeeding
- They aren’t producing enough breast milk and are looking to “top up” with formula
Whatever your reason for choosing combination feeding, it is totally your choice how you feed your baby and I strongly believe that “fed is best”. The advice in this post will be relevant to people with all of the reasons above apart from the last. If you are topping up breastfeeds and hoping to stop doing so in future then your focus will be on increasing your supply so your tactics will need to be different. You can find relevant advice in this post on topping up.
Benefits of Combination Feeding
We started combination feeding so that my mum could look after my son for a few hours when I was struggling with new motherhood but actually found that it had lots of benefits beyond that:
- It allows extended family and friends to offer support if you are struggling with mental health issues or exhaustion
- It allows a partner to help with night feeds, meaning just one person doesn’t take the brunt of the sleep deprivation
- It gives a partner the chance to be involved in feeding and develop a closer bond with the baby
- Combination feeding can reduce the negatives of breastfeeding, allowing it to continue for longer than it would if it was exclusive
- If you suddenly need to be away from your baby unexpectedly, it won’t be so difficult to deal with
- Your baby is still getting the benefits of some breastmilk
The Disadvantages of Combination Feeding
- If you are mixing breastmilk and formula, your baby will be getting less breastmilk
- You will lower your milk supply, which would be a problem if you changed your mind
- Babies have been known to decide they like bottles better
- Your baby might struggle with switching between breast and bottle
Is Combination feeding bad for Baby?
While mixed feeding can have some disadvantages, most of them can be managed. The best way to do this will be discussed in our section on “How to start combination feeding”. Combination feeding itself isn’t bad for your baby. While breastmilk is great stuff, having parents that are in a good place mentally is more important than the type of milk they drink and how they drink it.
Equipment for Combination Feeding
If you’ve been exclusively breastfeeding until now you may be shocked to discover how much stuff you need if you want to introduce bottles to your routine.
Which Formula Should I use for Combination Feeding?
If you plan to mix breastmilk and formula you’ll need to buy some formula. You can either buy cartons of ready mixed milk or tubs of formula to mix up yourself. The process of mixing formula can seem a bit daunting so you might want to start with cartons, although they are expensive. We always kept a few cartons in the house in case we had forgotten to get a bottle ready in time.
You should choose a formula that is labelled “first milk” and described as a breastmilk substitute. These are whey based formulas that are designed to mimic breastmilk as closely as possible. You don’t need to consider bedtime milk or follow on milk.
Bottles are tricky as every baby has a difference preference. My best advice is to not buy too many until you’ve found one that your baby likes. There are plenty that are designed to be close to the breastfeeding experience and that’s probably the type to start with. You should also choose one with a “low flow” which will only let the milk come out slowly. This will help minimise the chances of your baby deciding they prefer the bottle because the milk comes out faster!
A Breast Pump
If you plan to offer expressed breastmilk in a bottle then, unless you only plan to do it in the very short term, you’ll probably want a breast pump. You can get everything from a simple hand pump to expensive hospital grade pumps, with a range of prices to match. Unfortunately, a bit like babies with bottles, a lot comes down to personal preference. I had a medulla hand pump that worked well for me but had I been pumping more I’d have invested in an electric one.
If you’re going to give milk to a baby in a bottle any time before they’re 12 minutes you’ll need to sterilise them. There are a variety of methods you can use but most people buy a microwave or electric steriliser to make life easier.
When to Start Combination Feeding
This is actually a really tricky question. The advice is always that you shouldn’t introduce bottles until breastfeeding is well established, usually at around 6 weeks. Based on this advice, with our son we didn’t introduce a bottle until shortly after the 6 week mark but this turned out to be a mistake.
It took months of work to convince him to take a bottle. We had to use every trick in the book (I’ll describe them later) to convince him to drink from a bottle. Even when he eventually did take it, he was never very good at it, he usually ended up dribbling as much down his front as he swallowed.
When we had our daughter two years later I was determined that wasn’t happening again. I’d had postnatal depression previously and knew how much I needed to be able to allow someone else to help me with the feeds.
You can read about my experience with postnatal depression and how I recovered here.
I still didn’t want to offer a bottle too soon so decided to be led by her rather than her age. She took really well to breastfeeding and I felt it was well established by four and a half weeks so we introduced a bottle then. She took to it after a few tries and it was a so much easier.
My advice would be to be led by your baby. If you feel that breastfeeding is well established then try a offering bottle in preparation for starting combination feeding.
How to Start Combination Feeding
Before you actually start combination feeding, it’s good to be clear about what your aims are. Do you want to replace one feed with a bottle? Two feeds? Half of the feeds? Are you planning to gradually give up breastfeeding? Do you want to get more sleep? Or be able to give your baby to someone else during the day? The answers to these questions will effect your strategy.
Start Mixed Feeding Gradually
However many feeds you want to switch to bottles in the long run, you’ll want to start with just one. This lowers the likelihood of your breasts becoming engorged and nasty things like blocked ducts or mastitis happening. By going with just one feed you also help your baby stay in the habit of feeding on the breast.
Have a Combination Feeding Schedule
A combination feeding schedule is really important for your milk supply. If you want to feed both breastmilk and formula, you’ll need to pick one feed that is going to be a formula feed and stick with it. By doing this, your body simply thinks that your baby doesn’t want milk at that time of day anymore and stops producing it. If you keep switching around when you breastfeed and when you bottle feed your body will become confused and your milk supply will be at risk.
Tips for Introducing a Bottle
Breastfed babies are often not that keen on taking a bottle so here are some tips and tricks to get you started.
- Experiment with temperature, most breastfed babies like it body temperature
- Warm the teat up so it’s body temperature
- Sit baby in an upright position rather than laying down as they would be when breastfeeding
- Have someone else feed them so they can’t smell your breastmilk, you might even ned to leave the house (I definitely did!)
- Try when they are peckish but not starving
- Try a variety of different teats until you find one they like
Frequently Asked Questions on How to Start Combination Feeding
Here are some of the questions you might have on combination feeding and their answers.
Will Combination Feeding Cause Nipple Confusion?
Feeding from the breast and feeding from the bottle require babies to use a different technique. Nipple confusion is where the baby forgets which technique to use for which thing. Combination feeding can in theory lead to this which is one of the reasons it’s advised not to start until breast feeding is well established.
Will Combination Feeding Effect Milk Supply?
If you are combination feeding by using a mix of breastmilk and formula then, yes. Breastmilk is produced on a supply and demand basis so the less of it your baby drinks, the less your body will produce. If you are combination feeding using a mixture of expressed breastmilk from bottles and breastmilk directly from the breast you can do so without reducing your milk supply but will have to be consistent with you pumping and stick to a clear schedule.
Can Combination Feeding Lead to Overfeeding?
Overfeeding babies is rare, generally babies won’t take more milk than they need and if you are just replacing breastfeeds with bottle feeds there is no reason this should lead to overfeeding.
Will Mixed Feeding Change My baby’s Bowel Habits?
Probably. Breastfed baby poo and formula fed baby poo is diferent so expect to see some changes to the contents of your babies nappies.
Will Combination Feeding Give My baby Wind?
It could. When babies drink from a bottle they swallow more air than when they drink from a breast and that can lead to more wind so it’s important to thoroughly burp a baby after feeding them a bottle.
Will Combination Feeding Give My Baby Colic?
Maybe. There is still no real answer as to what causes colic but some people think wind plays a part and as some babies get worse wind when they drink from a bottle it’s possible that it could have an impact. On the other hand, some of the medicines given for colic are easier to give in a bottle than to an exclusively breastfed baby.
If your baby suffers with colic you can read about our experience of having a breastfed baby with colic.
What Should I do about Combination Feeding and Cluster Feeding?
If your breastfed baby is cluster feeding I would avoid introducing a bottle at the times they cluster feed. Cluster feeding isn’t fully understood but may play a role in milk supply so it would be better not to stop it from happening.
Combination Feeding Schedule Examples
Your combination feeding schedule will depend on how strict you current routine is. If your baby doesn’t feed to a very predictable schedule, just do your best to stick to a rough combination feeding timetable by replacing the nearest feed to a particular time with a bottle.
We always had fairly strict routine so it was quite easy for us to stick to a routine.
With my oldest child, my aim was to allow make it so my mum could take him out every afternoon so my initial combination feeding schedule looked like this:
I was initially using exclusively breastmilk so when he was out in the afternoon with my mum and I was at home, I would pump a bottle of milk which she would then give him the next day. This also meant that at the weekends when he didn’t go to her, I could still breastfeed him at that time if I want to.
With my youngest, my aim was to get an uninterrupted stretch of sleep (I would go to bed exhausted at 8pm!) so my initial combination feeding schedule for her looked like this:
With my daughter, we only gave expressed breastmilk in bottles for a few days before changing to formula. As the plan was for me to get extra sleep, having to pump at that time would have defeated the object. Had I been really keen to give expressed breastmilk I could have probably have established a pumping session at a different time of the day but it may have taken some time.
Your combination feeding schedule will likely change over time. You may replace more breastfeeds with bottle feeds or indeed with cups of cows milk or formula as your baby gets older. The important thing to bear in mind is that your body will always respond to a drop in demand with a drop in supply and while that can be reversed, it will take hard work and dedication to do it.
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