Combination feeding: breast and expressed breast milk bottle feeds

How to make the best of breast and bottle feeding.

In Baby

At a glance

Your partner can get involved – bonding time for them and break time for you

Combination feeding can start once breastfeeding is in full swing

 

Give baby a bottle of expressed breast milk first

Baby might insist on breast milk if they can smell mum nearby

Combination feeding means both breastfeeding and bottle-feeding your baby. The bottle could be full of expressed breast milk or formula milk. Combination feeding lets you feed your baby in a way that suits you and baby’s needs. It’s up to you (well, your baby really) whether you bottle feed with expressed breast milk or formula.

Some parents choose combination feeding when:

  • Returning to work
  • Concerned about baby’s weight and they prefer to see how much expressed milk baby is getting
  • Their partner wants to feed baby or they need a babysitter

When’s the best time to start?

It’s best to wait until breastfeeding is nicely established to make sure you’ve got a good supply and baby is latching on correctly, before gradually introducing a bottle. Around four to six weeks is ideal before you introduce a bottle of expressed milk. Any messing around with the breastfeeding routine can affect mum’s supply. So if you start using formula milk for combination feeding then it’s worth knowing the amount of breastmilk produced will reduce.

How to introduce a bottle

Here are some starters on how to combination feed:

  • Start with just one bottle a day. Routine is comforting for babies so try the same time every day. Perhaps when you’ve got someone else there to do the feeding. The one bottle a day thing will also help mum’s breasts adjust gradually.
  • If your baby is only used to breast milk, first try and set aside some time to express breast milk as this will help them accept the bottle.
  • Try and express when nice and relaxed. Oxytocin helps release your milk and you produce more oxytocin when you’re happy or relaxed.
  • Letting your partner do the bottle feeds is a good idea. It means they get some bonding time that doesn’t involve changing nappies. It also gives you a few moments to yourself. You’ll just need to set aside some time for expressing.
  • Many people like to give one of the evening feeds by bottle. One benefit is mum can get a head start on sleep if someone else is doing the feeding.
  • Babies sometimes refuse a bottle if they smell you and think breast is on the menu. So it’s a good opportunity for a walk or a bath while your partner gives a bottle of expressed milk.
  • If you’re returning to work soon try and get them used to expressed milk in bottles or mixed feeding, a few weeks before you go back, so you can relax knowing they’re happily getting fed without the breast.
  • You can get freezer bags for your milk, so if you’re having a productive pumping day then you can save some of your milk in a freezer for up to six months (smaller freezer compartments in fridges give the milk a shorter life).
  • Your breasts are usually fullest in the morning so this might be a good time for an expressing session.

If in the very early days your baby you were unable to breastfed, for whatever reason, but now you want to try combination feeding, it might still be possible. It just takes time and a lot of pumping. You will need to get your supply up by focusing on breastfeeding for a while wherever you can. It’s all about supply and demand. The more you breastfeed baby, or the more you pump, the more milk you’ll eventually make. While your supply is still low you might have to give your baby formula while you focus on getting your supply up by pumping. Once you have a steady supply you can combi-feed from there if you want to. Speak to your midwife, health visitor or a public health nurse for more advice and guidance on how to safely go about this.

Combination feeding breast milk and formula

Woman bottle feeding her baby in her arms

If you want to start mixed feeding with breast milk and formula your baby will still get some of the antibodies from breast milk some of the time. Before you introduce formula you should speak to a health visitor, public health nurse or GP for advice on what’s best for your baby.

Good to know when combining breast and formula milk:

  • Formula milk might flow out of the teat differently from breast milk so try different teats. Start with a slow flow but work your way up if baby doesn’t seem happy.
  • You can find teats that are designed for babies who have been breastfed previously.
  • Formula takes slightly longer to digest than breast milk so your baby may need to be fed less frequently.
  • Especially in the early days of bottle feeding it’s important that you express milk to keep your supply up. This might sound time-consuming, and you may wonder about this if you’re trying to make time for yourself, but the effort is worth putting in at an early stage as it will make it easier for you to be flexible later on. It will also help your breasts, they can get a bit painful and full as you decrease breastfeeds.
  • If increasing formula feeds, then try to do it gradually, rather than suddenly. That way your supply isn’t thrown off and you won’t end up with sore, leaky breasts.
  • If you decide to give a bottle of formula at one of the night feeds try and make sure the other night feed is a breastfeed or that you express at this time so you don’t wake up with sore breasts and soaked sheets.
  • Just a heads up that the contents of baby’s nappy might change slightly when you start combination feeding. Poos may be less frequent, less runny and pong a bit more. The colour may also change a little.

IMPORTANT NOTICE: The best way to feed a baby is to breastfeed, as breast milk provides the ideal balanced diet and protection against illness for your baby and also many non-nutritional benefits for both baby and mother. We recommend that you speak to your healthcare professional when deciding on your choice of feeding your baby. Professional guidance should also be sought on the preparation for and maintenance of breastfeeding. If you do choose to breastfeed, it's important to eat a healthy, balanced diet. Infant formula is intended to replace breast milk when mothers choose not to breastfeed or if for some reason they are unable to do so. A decision not to breastfeed, or to introduce partial bottle-feeding, will reduce the supply of breast milk. If for any reason you choose not to breastfeed, do remember that such a decision can be difficult to reverse. Using infant formula also has social and financial implications which must be considered. Infant formula should always be prepared, used and stored as instructed on the label, in order to avoid risks to a baby’s health.

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How to bottle feed a baby - everything you need to know

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Important advice to mothers

The World Health Organisation (WHO) recommends exclusive breastfeeding for the first 6 months of life. SMA® Nutrition fully supports this and continued breastfeeding, along with the introduction of complementary foods as advised by your healthcare professional.

 

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