Combine feeding

Combine feeding is when you offer your baby bottles of expressed breast milk or formula alongside breastfeeding. It’s sometimes called combination or mixed feeding, or partial breastfeeding.

Why do some women combine breast and bottle feeding?

There are lots of practical, physical or emotional reasons why women may choose to combine breast with bottle feeding. For example, you may be:

  • finding it difficult to breastfeed
  • going back to work and need your baby to take bottles while you’re away
  • thinking about sharing feeds with your partner
  • breastfeeding but want to use a bottle with expressed breast milk
  • bottle feeding your baby and want to start breastfeeding.

Whatever the reason, it’s important that you are happy about how you’re going to feed your baby. If you’re struggling and getting stressed or anxious about feeding your baby, talk to your midwife or health visitor. They can give you advice and support, as well as tell you about local breastfeeding drop-ins, cafes and centres. You can also find details of local support on the NHS website.

When can I start combine feeding?

It is generally a good idea to wait until breastfeeding is well established. This usually takes roughly 6–8 weeks after birth, but it can be different for everyone.

However, some woman will want to combine feed their baby from birth. This is safe to do but it may make breastfeeding more challenging in the early weeks if your baby is also bottle fed. You can speak to your midwife about good positioning and attachment of the baby onto your breast in order to prevent nipple/teat confusion.

If there are concerns about your baby’s weight and wellbeing, your midwife and health visitor will be able to guide you. They will help you make a feeding plan to support your breastfeeding and make sure your baby is getting enough milk.

“I wanted to breastfeed exclusively, but because my baby was being tube fed in intensive care this wasn’t possible. Once he was back on the ward with me, I started breastfeeding and used formula milk as a top up. I found it much easier to breastfeed during the night. It was more relaxed, there was no waiting around for the bottle to be warmed and my baby fed quicker, was much happier and went back to sleep a lot faster.”

Amy

Combining with expressed breast milk

You may decide that you would like to combine breastfeeding with expressed milk feeds.

The amount of milk you express is not always the same as the amount of milk that your baby gets when feeding from the breast at each feed.  You may need to give your baby a larger amount of expressed breast milk than you’ve expressed in 1 session for 1 full feed.

The time of day you express can also be important. Many women find that their supply is slightly greater in the mornings, which can make it easier and quicker to express. However, your breast milk has more melatonin content (a sleep-inducing hormone) in the evening and at night. Babies don’t produce their own melatonin yet, so giving them breast milk for their evening or night time feed helps them to go to sleep more quickly.

Babies also want to feed more at night time because your prolactin level (the milk-making hormone) is higher so more milk is produced by the breasts. Expressing or breastfeeding at night is also important for keeping your long-term milk supply at a good level. Keep in mind that it’s important to continue to feed or express regularly from each breast, otherwise there is a chance that your breast may become engorged, which can lead to further problems such as mastitis. Find out more about breastfeeding FAQS

How do I make sure I don’t produce too much milk if I’m expressing?

Your breast milk supply is very responsive to demand, so once your supply is established you only want to express as much as your baby needs. For example, if you plan to give your baby 2 bottles of expressed milk a day alongside breastfeeding, then you should only express twice.

Don’t worry if you find that your supply has increased too much. You can just gradually reduce the amount you express until your supply settles.

Introducing formula feeds

If you want to combine breastfeeding with bottle-fed infant formula, here are some tips:

  • it's best to do it gradually to give your body time to reduce the amount of milk it makes – this will also give your baby's body time to adjust from having breast milk to having formula milk
  • if you're going back to work, start combining a few weeks beforehand
  • if your baby is 6 months old or more and can drink milk from a cup, you may not need to introduce a bottle at all.

How do I keep my breast milk supply going if I’m combining with formula?

Introducing infant formula will probably reduce the amount of breast milk you produce. To keep your breast milk supply going, it is important to keep breastfeeding your baby regularly. If you are combining with formula milk, try to prioritise breastfeeding where possible. Your prolactin levels (the hormone that helps you produce breast milk) are much higher at night, so breastfeeding at night is best.

“My baby was breastfed from birth but my nipples became really sore and I couldn’t bear to have him near them. I offered him a bottle and fully expected him to be bottle fed from then on. A few days later I just decided to try breastfeeding again, and he latched straight away. From then on, I would offer him breast first, then top him up with a bottle of formula. This lasted until he was around 16 weeks old when he just lost interest in the breast altogether and I couldn’t get him to latch. I’m glad we managed to get this far.”

Katie

How do I start giving my baby the bottle?

Babies use a different sucking action when drinking from a bottle and it may take a while for a breastfed baby to get used to it. Here are some tips:

  • It usually helps to give the first few bottles when your baby is happy and relaxed, not when they're very hungry.
  • It may help if someone else gives the first feeds, so that your baby is not near you and smelling your breast milk.
  • Keep trying but don't force your baby to feed. Your baby doesn't have to finish all the milk in the bottle. Let them tell you when they have had enough.

Responsive feeding

Some women may worry that they will lose their bond with their baby if they bottle feed. Try not to worry about this. Bottle feeding responsively will help you keep a strong emotional bond with your baby. This means focusing all your attention on your baby during feeds and nothing else.

If I’m also breastfeeding, how much formula milk should I be giving my baby?

The best guide is your baby and their feeding cues. Practising responsive feeding will help to prevent over feeding your baby. Your baby’s needs will change day to day and as they develop, so they will let you know how much they need.

Is it normal to have mixed feelings about combined feelings?

Some women may feel guilty or sad about combine feeding their baby, especially if they wanted to or expected to breastfeed exclusively.

It’s completely natural to have mixed feelings about this, but don’t be hard on yourself. Every mother and baby are different and there are many reasons why combine feeding may be the best thing to do for both of you.

If you still have any worries or concerns, talk to your midwife or health visitor. There is also more breastfeeding information and support services available.

I’ve started giving my baby the bottle and now they won’t take my breast. What can I do?

Combine feeding takes some practice and some babies will adapt more readily than others. Either way you decide to feed, having some skin-to-skin time during feeding can help. Practising responsive bottle feeding will also help to make sure that your baby is not taking a lot of milk quickly from the bottle. It can also help to avoid introducing a bottle or dummy until breastfeeding is well established, this can take at least 6–8 weeks, if not longer.

Can I stop combine feeding and go back to breastfeeding exclusively?

While you have a supply of breast milk, it is usually possible to return to breastfeeding exclusively. It’s best to do this gradually, by always offering the breast first for each feed and slowly reducing the amount of formula. It is also a good idea to have lots of skin-to-skin time and cuddles with your baby. This will help to increase your milk production as well as encourage your baby to feed from the breast.

It may also help to choose a time when you’re baby is relaxed, alert and not too hungry.

You may need to increase your breast milk supply by expressing after you have breastfed. The more you express, the more milk you will produce. This should ease the transition back to exclusive breastfeeding.

Some babies may find it difficult to go back to breastfeeding after they’ve got used to the bottle. Ask your midwife or health visitor or other local breastfeeding support network for help if you need it.

 
 

Read more about feeding your baby

  • A breast pump.

    Expressing

    Expressing milk means squeezing milk from your breast so you can store it and feed it to your baby later.

  • 'FAQ' written in pink chalk on black board.

    Formula feeding FAQs

    We’ve answered your questions about formula feeding.

  • Dad bottle-feeding baby formula.

    Formula feeding

    Formula is man-made milk that is designed for babies and can be used in combination with, or instead of, breastfeeding. Formula feeding is perfectly safe, just make sure you take care every time you make a bottle.

  • 'FAQ' written in pink chalk on black board.

    Breastfeeding FAQs

    Here are some answers to common questions about breastfeeding.

  • Mum breastfeeding baby.

    Breastfeeding information and support

    Breast milk is a fantastic first food for your baby because it protects them from illness. Breastfeeding has lots of benefits for you, too.

  • Mum breastfeeding baby.

    Feeding your baby

    Feeding can be a lovely time to get to know your baby and to bond. At the start you’re going to be doing a lot of feeding.

Sources

NHS Choices. How to combine breast and bottle feeding. https://www.nhs.uk/conditions/pregnancy-and-baby/combining-breast-and-bottle/ (Page last reviewed: 02/10/2016. Next review due: 02/10/2019)

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    Last reviewed on June 13th, 2019. Next review date June 13th, 2022.

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