Mixed feeding: combining breastfeeding and bottle 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, often called combination feeding, combined feeding, mixed feeding, or partial breastfeeding.
You may want to try mixed feeding because you want to breastfeed for some of your baby’s feeds, but give infant formula for one or more feeds, or because you’re bottle feeding your baby and want to start or resume breastfeeding.
It can be helpful to talk to your midwife, health visitor or breastfeeding counsellor about your options when it comes to combining breastfeeding and bottle feeding, as well as find out about the potential impact of mixed feeding.
What effect will combining breastfeeding and formula feeding have?
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. You can tell a feed is effective if your baby is well attached to the breast, you are both comfortable and your baby often starts with rapid sucks then slows to a more rhythmic suck, swallow pattern and comes off the breast looking full.
Giving your baby formula can affect the frequent feeds needed to ensure you're making the right amount of milk, especially when you first start breastfeeding. It usually means your baby breastfeeds less often, and therefore you make less milk.
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.
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.
There can be health implications of introducing formula as it changes babies’ gut bacteria so it’s therefore important to discuss this with a suitably qualified health professional or breastfeeding counsellor.
How can 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.
You can offer formula feeds before, during, after or instead of a breastfeed. Do talk to your midwife, health visitor or breastfeeding counsellor about this as different options will suit different circumstances. 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 separated from your baby and can’t be there to breastfeed. Sometimes, formula given in the middle of a breastfeed is an option, if the baby needs the comfort and closeness of a breastfeed to settle.
If you substitute a breastfeed with a formula feed, it will take around three to seven days for your breasts to adjust to missing that one feed.
If you ‘top up’ with formula at one or more feeding sessions, rather than replacing an entire feed, this is likely to extend the gap between breastfeeds, which will signal to your breasts to make less milk. You can then drop the breastfeeds you want to drop, replacing them with formula. On the other hand, if you are 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.
Introducing a bottle to a breastfeed baby
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.
To begin with, maybe ask someone else to offer a bottle and you could also try softening the teat with warm, boiled water. Another tip is to 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. If this doesn't work, there are a variety of bottle teats which may make a difference. For more suggestions, read our article about introducing bottles.
You could also ask your midwife, health visitor or breastfeeding counsellor about using a nursing supplementer, as an alternative to bottles. This is a gadget which you use at the same time as your baby is at the breast – the supplementer delivers formula, through a tube attached at one end to the teat on a bottle, and at the other end, it’s taped to your nipple. The baby gets formula (or expressed breastmilk) through the supplementer, at the same time as breastfeeding.
Last updated: January 2016
NCT supports all parents, however they feed their baby. If you have questions, concerns or need support, you can speak to a breastfeeding counsellor by calling our helpline 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. You can also find more useful articles here.
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.