Bottle of baby milk

Combined Feeding – Combining Breast Feeding with Bottle Feeding

Feeding your baby is not always simply a question of breast milk or formula milk – for some women the answer is both. But so-called “mixed feeding”, “combined feeding”, “combination feeding”, or “partial breastfeeding” brings with it a whole raft of questions and challenges.

In the article below, we look at what combining breastfeeding with bottle feeding means, what it involves and how you can overcome some of the challenges you might face along the way.

Why combine breastfeeding with bottle-feeding?

There are many reasons why parents might decide to combine breastfeeding with bottle-feeding. The most common include the following:

  • Difficulties breastfeeding
  • A desire to share feeding responsibilities among the family
  • The mother is returning to the workplace
  • You have been bottle-feeding but want to begin breastfeeding.

Who should you talk to about combined feeding?

Although there are plenty or resources available online, you may find it helpful to speak with your midwife, health visitor or breastfeeding counsellor about how to begin and how to manage combined feeding. The more information and advice you receive, the more likely it is that you’ll be able to successfully manage the transition.

Will bottle feeding interfere with breastfeeding?

The NHS reports that giving your baby formula milk will have an impact on your breast milk supply and it is generally not recommended. Unless advised otherwise, you should not attempt combined feeding until your baby is at least eight weeks old. There is also a small amount of evidence that indicates that once babies begin bottle-feeding they may develop a different kind of sucking action and find it harder to feed from the breast.

However, once your baby is older and your milk is established, combined feeding should not be too difficult to achieve.

How to introduce formula milk

Once you begin the process of combining breast and bottle feeds, it is important that you take a “gently, gently” approach. This means that you should slowly and gradually reduce your baby’s number of breastfeeds. You should also speak with your health visitor, breastfeeding counsellor or midwife about how and when to introduce bottle feeds. For some, the bottle may be introduced mid-breastfeed, for others it may be introduced before or at the end of a breastfeed and for others it will replace a breastfeed – what is right for one person may be unsuitable for another and vice-versa.

One thing is certain: by making a slow transition to combined feeding, you will reduce the likelihood of mastitis as well as breast engorgement and discomfort when you finally remove breast feeding from your routine – it can take as long as a week for your breasts and milk flow to adjust to missing just one feed a day.

You might find our articles on bottle feeding equipment, choosing formula and how to make up a formula bottle useful.

What if you are using combined feeding to “top up”

Sometimes breastfeeding mothers are advised to “top up” with formula in the short-term but with a view to returning to exclusive breastfeeding. If you are in this position but don’t want to lose any of your milk supply, you can express between feeds to ensure that you have plenty of supply when you return to exclusive breastfeeding.

‘Topping up’ with formula milk should really only be done if there is a genuine reason; perhaps your baby is not gaining enough nutrition from exclusive breastfeeding because of illness or an oral normality has caused a problem in suckling, but ‘top up feeds’ may lead to rejection of the breast, so approach this process with caution.

Tips for giving the first bottle

The first bottle feed can be a challenge for a breastfed baby as they will need to adapt their sucking action in order to successfully take on formula milk. However, you may be able to smooth the process if you follow the tips below:

  • Soften the bottle’s teat with warm, sterile water.
  • Try a feeding position that differs from your usual breastfeeding position.
  • Try different teats if baby is not comfortable; the one you are using may be giving too much or too little flow.
  • Have someone else offer the first bottle feeds – your baby may find it difficult to take the bottle if she can smell your breast milk.
  • If you’re returning to the workplace, start combined feeding a few weeks beforehand.
  • Only offer the bottle when your baby is content and not overly-hungry.

Responsive feeding

Some mothers may be anxious that by introducing bottle feeding alongside breastfeeding, they will lose out on bonding opportunities with their child. However, by bottle feeding responsively you can maintain this bond. Simply continue to watch and engage with your baby while feeding her and respond to her cues – being observant will also help to prevent you from ever overfeeding your baby.

Summary

There are many possible reasons why it might be right for you to combine bottle feeding with breastfeeding – what you decide to do will depend on your individual circumstances. The good news is that although it can sometimes be challenging, for the most part it is perfectly possible to make a successful adjustment to combined feeding that will be of benefit to you while also providing the benefits of breast milk for your baby.

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