Combination Feeding Unveiled : Tips, Tricks and Best Practices for Parents

Combination Feeding Guide: Breastmilk and Formula

Combination feeding, is sometimes referred to as combi feeding or mixed feeding and it happens usually when a breastfeeding mother supplements their baby’s diet with infant formula (but can also happen when a formula feeding parent decides to introduce breastmilk/feeding). I see this in practice commonly when mothers return to work, if they are struggling with low milk supply or personal preference or when a baby is not gaining weight as expected. The first step in successfully combi feeding you baby is to understand and appreciate that although both breastmilk and formula provide nutrition, they are fundamentally different and so need to be treated that way.

Getting Started with Combination Feeding

1. Assess Your Needs and Goals: Focus on the why and that will tell you the how!

   - Determine the reason for combination feeding (returning to work, low supply, etc.) and whether supplementation with formula is necessary.

   - Think about how much breastmilk or formula you want your baby to receive and how you want your feeding journey to look like..what is the ultimate goal?

2. Consult with Healthcare Providers:

   - Speak with your Health Visitor/Midwife or doctor to ascertain whether there is a medical/ clinical need for combi feeding and to establish any potential risks to your baby's health that need to be considered. A lactation consultant/feeding specialist can help guide you through determining the best feeding approach for you and your baby.

   - Discuss any allergies or sensitivities that may influence your choice of formula- otherwise first stage formula is adequate.

3. Choose the Right Formula:

   - First stage formula is recommended until the age of 1. There is no real need to change to different formulas (hungry baby/reflux milk/comfort milk) but if you feel this is necessary- seek a review from a healthcare professional or feeding specialist.

   - If your baby has special dietary needs, consult with a healthcare professional for appropriate recommendations and seek referral to a dietician.

Introduction of formula for breastfed babies

1. Start Gradually:

   - Always introduce formula slowly unless medically/ clinically indicated otherwise. This will allow your baby to adjust to the changes

   - You can alternate between breastfeeding and formula feeding, ensuring your baby remains comfortable.

   - The introduction of formula can reduce milk supply and if you do not intend for this, you will need a carefully prepared feeding plan to ensure you continue to maintain supply. A lactation consultant is best placed to help you with this.

2. Timing:

   - If you would like to continue breastfeeding then introduce formula in the day- night time breastfeeds are important for long term milk production.

3. Responsive Feeding:

   - It can be difficult to recognise hunger cues if your baby has been breastfeeding (not always). Breastfed babies will suckle for comfort, pain relief, emotional regulation and sleep. So they may still want to suckle even after taking a bottle.

   - It’s common for babies to have different preferences—some may prefer one feeding method over another. This is okay and not all breastfed babies will take a bottle.

Introduction of breastmilk for formula fed babies

1. Donor milk

   - Donor breastmilk can be used if you are unable to produce any or enough breastmilk yourself. Speak to a healthcare professional and discuss your needs with a lactation consultant so that you understand risks/benefits and accessibility of donor milk.

2. Mixing and Matching:

   - Whilst you can combine breastmilk and formula, this is not usually recommended unless you have very small amounts of breastmilk and then you could add it in with a regular bottle of formula. breastmilk can be stored at room temperature for longer than formula and so if you combine it with formula, you have to discard sooner than you would if it was kept in a bottle on its own. Breastmilk can also be stored safely for much longer in the fridge and freezer so make use of this benefit.

3. Expressing/increasing milk production:

   - A double electric, plug in pump is ideal to help stimulate milk production. Regular expressing, 2-3 hourly, day and night on the highest setting that is comfortable will help get things moving quicker.

- a lactation consultant can help put in a tailored expressing plan that suits your needs and ensure that you have the correct flange size/equipment

Other important tips for success

1. Feeding Equipment:

   - Use bottles and teats that help you to pace feeds. A slow flow teat with good positioning can help reduce the risk of bottle preference in babies that also breastfeed. It can make feeding more comfortable for all bottle fed babies.

2. Keep Track:

   - It may be helpful to keep a log of when and what your baby eats, including the amounts for both breastmilk and formula as well as expressing sessions and growth. If you are struggling, this is the information that will help a lactation consultant/feeding specialist to understand what is happening.

3. Comfort and Bonding:

   - Hold your baby close during feedings, whether breastfeeding or bottle feeding. This promotes bonding and comfort.

Troubleshooting Common Issues

1. Nipple/teat Confusion:

   - If your baby struggles to switch between breast and bottle, try introducing the bottle when your baby is calm or sleepy.

   - Use a paced bottle-feeding method if they show resistance- remember that not all breastfed babies will take a bottle.

2. Stomach Upset:

   - Monitor for signs of allergies or intolerances to formula. Common signs include excessive fussiness, gas, or bowel changes and consult your healthcare provider.

- Breastmilk is a natural laxative so if introducing breastmilk, be prepared for more stools/ runnier stools. Again, seek support if you are concerned about stooling patterns.

3. Milk Supply Concerns:

   - If you notice a decrease in milk supply and this was unintended, increase skin-to-skin contact with your baby, increase expressing or breastfeeding and speak to a lactation consultant.

4. Physical Challenges:

   - For breastfeeding difficulties, seek assistance from a lactation consultant to address latching issues or pain.

Lets wrap this up!

Combination feeding can provide a flexible feeding option that meets the needs of both parent and baby. Be patient during the adjustment period and remain responsive to your baby’s needs. Seek support from healthcare professionals and connect with other parents for shared experiences. Ultimately, you will benefit from the input of a lactation consultant or feeding specialist to help you to navigate combination feeding successfully in a way that suits you. Your feeding journey is unique, and finding a balance that works for you and your baby is key. If you need further support- do not hesitate to get in touch!

Shami x