How to combination feed

When it comes to combi feeding, you can choose to⁽¹⁾:

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

It’s entirely up to you which one you choose, and it’s important that you do what feels right for you and your baby. If you decide that formula feeding as part of of your combi feeding routine is the right thing for you, here are some of the things you’ll need:

• Baby feeding bottles.
  
• A steriliser.
• A breast pump (if you’re combi feeding with expressed breast milk).
• Infant formula (if you’re combi feeding with baby formula).

You can read more about the things you’ll need here.

Before making any changes to your baby’s feeding routine, it’s always worthwhile having a chat with your midwife, health visitor or other healthcare professional, to ensure that your mixed feeding journey is a success, and that you’re getting the breastfeeding support that you might need. Remember that both you and your baby will need time to adapt to combi feeding, particularly if you have an exclusively breastfed baby. However, with time and patience, your baby will soon get the hang of it.

If you feel it’s the right thing for you and your family, you can start combi feeding from birth. However, health professionals advise that it’s usually best to wait until your exclusive breastfeeding routine is fully established before you introduce a combination feeding schedule⁽²⁾. This will allow your baby to get used to latching onto your breast before introducing a bottle, and go some way to avoiding any nipple confusion.

Both breast and bottle feeding are new skills that you and your baby are learning together, so remember to give yourself the time and space you need to get things started and established.

You could start your combination feeding schedule by swapping one breastfeed for a bottle feed at a time of day that works well for you and your baby. For example, if you’d like to get more rest, perhaps introduce a bottle for your baby’s last feed, or first thing in the morning. Do this for a few days before replacing a further breastfeed with a bottle feed if you wish. 

It’s important to remember that breastfeeding works on a supply and demand basis. In order to produce the right amount of breast milk for your baby, it’s important that you continue to breastfeed or express your breast milk regularly when combi feeding in order to maintain your supply.

In the early days and weeks after the birth of your baby, your body is establishing its milk supply, and introducing bottles too early may interfere with this⁽²⁾ . 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.

All babies are different, and whilst one baby may take instantly to a new mixed feeding routine, for others it can take a little time to get used to. This is because the teat of a feeding bottle will feel different to your nipple, so it’s important to give your baby the time they need to adapt.

One of the reasons the NHS advises making sure that exclusive breastfeeding is fully established before you start combi feeding, is to avoid your baby experiencing what’s known as nipple confusion. Sucking from a breast requires a different skill to sucking from a bottle, and your baby will need to learn both in order for combi feeding to be a success.

To help your baby adapt, you could try:

• Experimenting with different positions when feeding to ensure that both you and your baby are comfortable. You’ll find lots of helpful information on breastfeeding positions here.
• When bottle feeding, use a teat with a low flow. This will mimic the flow of your breast milk and help to overcome any nipple confusion ⁽²⁾.

Feeding your baby when they’re content and relaxed, and giving them plenty of time to enjoy their feed.

Overfeeding means your baby receives more milk than their stomach and intestinal tract can digest.

Whilst it’s not possible to overfeed a breastfed baby⁽⁴⁾, this is something that can happen when bottle feeding. 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. It can also be harder for you to recognise when your baby has had enough, and it may be that you encourage them to take more when they don’t really need it.  

Recognising your baby’s hunger cues, and only offering a bottle feed when you see them, can help to avoid overfeeding. When bottle feeding your baby, be patient and feed them slowly. Look out for signs that they may want a break in their feed and allow them to do so. Practicing responsive bottle feeding and not forcing your baby to finish a bottle will help to prevent overfeeding⁽⁵⁾.

If you’ve got any concerns at all about how much milk your baby is drinking, or your baby’s weight, don’t hesitate to speak to your midwife or health visitor.

Baby feeding can be quite the balancing act. It’s important to find a combination feeding schedule that not only works for you and your family, but that also ensures that your breast milk supply is maintained and 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.

Before you start, think about what you’d like your combination feeding schedule to look like, what is it that you’d like to achieve? If you’re combi feeding to help you get more rest, introducing a bottle at night or first thing in the morning might be a good option. If you’re returning to work, you may wish to breastfeed at night or in the morning, and leave bottle feeding for during the day.

Combination feeding at night can provide a valuable opportunity for parents to gain some extra sleep, so exploring this routine may be helpful.

Whatever your combination feeding schedule looks like, your breasts will require regular stimulation both during the day and the night, in order for your body to produce the amount of milk your baby needs. With this in mind, it’s important to not switch all your night time feeds to infant formula, and to continue feeding your baby at the breast or expressing milk overnight⁽⁶⁾ .

If you miss a breastfeed overnight, you may wake up with very full or engorged breasts. If this is something you experience, try feeding your baby from the breast, as this will help to ease any pain or discomfort, and reduce your risk of complications such as mastitis.

This is a combination feeding schedule that many parents wish to 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 night, 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. 

Contrary to what you might have heard, there’s no guarantee that feeding with a bottle of formula during the night will help your baby to sleep better or for longer. In general, baby’s 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 production ⁽⁷⁾.
  
• Melatonin - the hormone that promotes sleep ^(8).

As such, 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.