Here we look at mixed feeding your baby, which is combining breastfeeding and formula feeding
"When it comes to feeding your baby, it’s not always a question of only breastfeeding or only formula feeding; many women do a combination of both. Watch our video to find out more about mixed/combination feeding.
What is mixed feeding?
Many women decide to combine breastfeeding and formula feeding; often called combination feeding, mixed feeding, or partial breastfeeding (NHS Choices, 2016).
Mixed feeding usually means mixing breast and bottle feeding. The content of the bottle can be either breastmilk or formula milk. In this article, we're talking about mixing formula milk feeds alongside breastfeeding.
Why do some women decide to try mixed feeding?
You might want to start mixed feeding for a variety of reasons. Your baby could be having some initial difficulties getting breastfeeding established and you want to give some formula feeds alongside breastfeeding. You might need to leave your baby for periods of time (for example if you are returning to work). Or you might be thinking about mixed feeding because you’re bottle feeding and want to start or resume breastfeeding (NHS Choices, 2016).
It can be helpful to talk to your midwife or health visitor about your options and the potential impact of mixed feeding (see below). You could also call our infant feeding line on 0300 330 0700 to talk to one of our breastfeeding counsellors.
How do I combine formula feeding and breastfeeding?
If you want to cut down on breastfeeds to introduce formula milk, you and your baby will adjust more easily if you reduce the number of feeds gradually (NHS Choices, 2016).
You can offer formula feeds before, during, after or instead of a breastfeed. Talk to your midwife, health visitor or breastfeeding counsellor about this, as different options will suit different circumstances. And will also depend on what you wish to ultimately achieve.
There are some cases when formula might be given before a breastfeed (for example, with sick or vulnerable babies who are not breastfeeding well). In other cases, the formula feed might be given instead of a breastfeed. This might happen if you’re not with your baby and can’t be there to breastfeed.
Gradually cutting down breastfeeding reduces the chance of your breasts becoming uncomfortably engorged and leaky. It will also reduce your risk of developing mastitis (NHS Choices, 2016). It helps to drop breastfeeds one at a time, whichever one is convenient for you (NHS, 2007). If you substitute a breastfeed with a formula feed, it may take around five to seven days for your breasts to adjust to missing that one feed (NHS, 2017).
If you ‘top up’ with formula during one or more feeds, rather than replacing an entire feed, this is likely to extend the gap between breastfeeds. It will also signal to your breasts to make less milk. You can then drop the breastfeeds you want to drop, replacing them with formula (NHS, 2016).
On the other hand, if you've been advised to ‘top up’ as a temporary measure and want to return to exclusive breastfeeding, you can express milk between feeds to increase the amount of milk you make (NICE, 2017). This way you can keep up your milk supply. Try and feed any available breast milk before each formula feed.
What effect will combining breastfeeding and formula feeding have?
Your baby will enjoy the benefits of breastmilk, even if you’re not exclusively breastfeeding. For instance, they will still gain some of the antibodies that will protect them against infection (NHS, 2016, WHO, 2009).
One thing to consider is that breastmilk supply is generally driven by frequent, effective breastfeeding. This means feeding your baby as often as they show they need to by responding to their feeding cues (Savage et al, 2018, WHO, 2009).
Giving your baby formula can affect your milk supply, especially when you first start breastfeeding. It means your baby breastfeeds less often so your body produces less milk (WHO, 2019).
The NHS suggest that it can take up to six weeks to successfully establish breastfeeding (NHS, 2016, NHS 2017). It's often recommended to wait until feeding is firmly established before introducing a bottle (NHS, 2016).
There is limited evidence that babies experience ‘nipple confusion’ from bottle use (Zimmerman & Thompson, 2015), as it requires a different type of sucking action from breastfeeding. However, if your baby is older, beyond the newborn stage, you can usually maintain your breastmilk supply alongside formula feeding, as long as you breastfeed every day. Much older babies – from eight or nine months – can breastfeed just a handful of times a day, and there is still a supply.
Very well-established breastfeeding, with a baby of a year or so or more, can continue with as few as one or two feeds in 24 hours (WHO, 2009).
If your baby is over six months they can use a beaker or cup rather than a bottle (NHS 2017).
Tips to introduce a bottle to a breastfeed baby
When introducing a bottle to a baby, it's best to:
- Hold your baby in a semi-upright position, close to your body.
- Offer the teat so that they can draw it into their mouth.
- Hold the bottle at an angle so that they can suck milk in avoiding air.
- Take the bottle out of your baby's mouth as soon as they begin to show signs that they've had enough.
This all helps to build a close loving relationship, responsive feeding, and avoid overfeeding (Unicef, 2016).
If you have breastfed your baby so far, they may be reluctant to take a bottle at first. The different sucking actions needed may confuse them and they may not take it from you. There are lots of different things you can try to help your baby:
- Try and offer a bottle when your baby is relaxed and happy, rather than very hungry.
- Maybe ask someone else to offer a bottle so they can't smell your milk.
- Try softening the teat with warm, boiled water.
- Hold your baby in a different position from your usual breastfeeding one. It may help your baby get used to the new way of feeding.
- Try a different bottle teat - this might make a difference.
(NHS Choices, 2016)
If you have questions, concerns or need support, you can speak to one of our breastfeeding counsellors by calling our infant feeding line on 0300 330 0700, whether you are exclusively breastfeeding or using formula milk. Breastfeeding counsellors have had extensive training, will listen without judging or criticising and will offer relevant information and suggestions.
Healthtalkonline.org has a comprehensive library of face-to-face interviews where parents share their experiences about breastfeeding, birth, parenting and many other issues.
Best Beginnings has video clips from the 'Bump to Breastfeeding' DVD.
Kramer MS, Kakuma R. (2012) Optimal duration of exclusive breastfeeding. Cochrane Database of Systematic Reviews, Issue 8. Art. No.: CD003517. DOI: 10.1002/14651858.CD003517.pub2
NHS. (2016a) How to combine breast and bottle feeding. Available at https://www.nhs.uk/conditions/pregnancy-and-baby/combining-breast-and-bottle/ [Last accessed March 2019]
NHS. (2017) Pregnancy and Baby Guide. How to stop breastfeeding. Available at https://www.nhs.uk/conditions/pregnancy-and-baby/stopping-breastfeeding/ [Last accessed March 2019]
NICE (2017) NICE Guideline NG75 Faltering growth: recognition and management of faltering growth in children. Available at https://www.nice.org.uk/guidance/ng75 [Last accessed March 2019]
Savage, J, Hohman, E, Marini, M, Shelly, A, Paul, & Birch, L. (2018) ‘INSIGHT responsive parenting intervention and infant feeding practices: randomized clinical trial’ International Journal of Behavioral Nutrition and Physical Activity 15:64 [Last accessed March 2019]
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Zimmerman, E & Thompson, K. (2015) Clarifying Nipple Confusion. Journal of Perinatology volume 35, pages 895–899