Feeding your baby with a bottle and directly from the breast is known as combination feeding. There are many reasons why moms and people who breastfeed choose to combo feed — here, Chaunie Brusie, a mother of five and lactation consultant, shares how combination feeding helped her
After successfully breastfeeding my first four children, my fifth baby threw a curveball my way by entering the world five weeks early. In the neonatal intensive, she struggled to breastfeed and while I spent hours trying to get her to nurse, it soon became apparent that she preferred the bottle.
I knew that giving her breast milk was important to me as a mom — and supply was not an issue for me — so I soon entered a world that I had really heard nothing about before: combination feeding. For around six months of my daughter’s life, I was able to exclusively pump milk for her (with a few nursing sessions sprinkled in).
Then, sometime after she turned six months, I used a combination of breast milk and formula. A combination of breast and bottle truly was the best of both worlds for me, and I’m so grateful that I was able to have access to both the convenience of formula and breast milk, even when she lacked the skills to physically nurse.
More and more parents are realizing that, like so many things in life, feeding their babies doesn’t have to be all or nothing. Combination feeding lets parents combine feeding types — formula in a bottle and either pumped milk in a bottle or directly from the breast — to find a flow that works best for them (pun intended!).
Read on to learn more about combination feeding, how mixing breast milk and formula can help, suggestions for making it work, and tips from real parents who have combo fed.
What is combination feeding?
Combination feeding (also known as mixed feeding) is when a parent combines breastfeeding and bottle feeds in order to feed their baby, explains Deedee Franke, a nurse and lactation consultant at Mercy Medical Center in Baltimore. This includes primarily feeding directly from the breast and supplementing with formula, or expressing breast milk and feeding your baby both pumped milk and formula — or any of these combined!
With more resources and technology to help parents feed their babies (for instance, I only made it through thanks to my Elvie pump), you might think that combi feeding is a relatively new phenomenon. But Franke says you’d be surprised — she’s actually witnessed it for as long as she’s been a nurse: 40+ years!
Why combine breastfeeding and bottle feeding?
There are many benefits to combining breastfeeding and bottle feeding, whether you suffer from a low supply or there are medical or mental health reasons that prevent exclusive breastfeeding. Some of the benefits of combi feeding include:
Allowing someone else other than the breastfeeding parent to feed the baby (for example, a partner or another family member).
Overcoming difficulties establishing breastfeeding.
Mitigating breast milk production or supply issues.
Enabling the mom to return to work, attend events, or travel for other reasons.
Helping the baby to gain weight if there are concerns about weight gain.
Easing strain on the mom’s mental health.
In my situation, for example, there were several factors that sparked my decision to combine breast and bottle. For starters, because my baby was born prematurely, she lacked the ability to breastfeed. As a result, we had to bottle feed her right from the start and she developed a preference for the bottle instead of nursing.
Secondly, I have had severe, recurrent mastitis through all of my breastfeeding journeys, which damaged my milk ducts — I also happen to have extremely thick breast milk (the hospital nurses passed bottles of my colostrum and milk around because they said they’d never even seen anything like it, which made me feel strangely proud but also very much like a dairy cow).
That means that cutting down how often I breastfed and pumped helped reduce my supply to a much more manageable amount so I didn’t continue to get mastitis. It allowed me to keep giving my baby breast milk without it physically harming myself. And I’m not alone — here are some other reasons parents decided to try mixed feeding.
Medical reasons for combination feeding
Mastitis was a catalyst into mixed feeding for mom of twin boys, Cheryl from Michigan. Her doctor prescribed a strong antibiotic to treat her breast infection, which has an unclear safety profile for breastfeeding. To stay on the safe side, Cheryl chose to split feeding her twins into a 3:1 ratio of three formula bottles for every one breast milk bottle.
She also chose to pump, since tandem feeding didn’t exactly work out, and introduced bottles when the twins were five days old. The way she works it out is simple: every time her boys take a bottle, she pumps. And when they’re done feeding, she also pumps.
“The natural letdown from their cries and the feeling of fullness are what have me pumping,” she says. She adds that she wasn’t given clear guidance on what kind of pumping/feeding schedule would be best, so she worked it out on her own and also joined a support group online. “I am part of a C-section and a breastfeeding group on Facebook that gave great tips/tricks and reassurance that I’m not failing my babies,” she notes.
Mental health reasons for combination feeding
Hannah, a stay at home mom of two boys from Jacksonville, chose to combo feed her second child for a variety of reasons, including to support her mental health. Having her husband be able to feed their baby was a huge factor. “I needed my husband to also feed him a bottle for my own mental health,” she explains.
“Taking a bit of that load off my plate helped tremendously to take the pressure off of me. As the mom, the brunt of the work seems to always fall on us (hormones from giving birth, the pain from giving birth, the breastfeeding) so they did not help with my mental state at all and made it much worse when they were around.”
Fortunately, her husband was extremely supportive of her decision, another factor that supported her mental health. “My mental health was a little rocky already because of the loss of a family member less than a month before I had my son, so the stress of breastfeeding without his help would have been intense,” she says.
Lifestyle reasons for combination feeding
Lauren, a parent and consultant from Boise, explains that she chose to combine breast and formula milk when her baby was six weeks old, because she knew she would be heading back to work and so she could have a break from breastfeeding around the clock. She explains that she waited until her milk supply was firmly established before introducing formula feeds.
“I was told it would help prevent nipple confusion and then began [combo feeding] when I had some supply stored so that I could have a break from constantly being latched onto,” she explains. “Then it became necessary when I went back to work when my baby was 16 weeks old.”
Lauren notes that she had a lot of people who encouraged her to just pump, but she says, “They didn’t realize how much work goes into pumping.” So to make it work for her, she chose to feed from the breast for all feeds outside of her working hours, then bottle feed for the hours she’d be gone working so her baby would be on the same schedule. After her baby was 6 weeks old, she split feeds between 50% breastfeeding at the breast and 50% pumped breast milk in a bottle.
When to start combination feeding?
If you plan on feeding your baby from the breast, it is recommended that you establish a solid breastfeeding supply first, before introducing a bottle or formula. Franke cautions that if you plan on breastfeeding at all, it’s incredibly important to ensure you and your baby have that part down before you start bottle feeding.
“I want to stress how important the first two to three months are for a [parent] in establishing a good breastfeeding relationship with the baby and building a good breast milk supply before introducing any formula supplementation,” says Franke. “If started too early without prior guidance, it can quickly negatively affect mom’s ability to produce an adequate milk supply.”
That being said, the right time to start combination feeding also depends on your reason, she says. Always talk to your own baby’s doctor, but in general, you can use this as a timeline:
No medical reason: wait 2 to 4 weeks before introducing a bottle.
Medical reasons (such as the baby not gaining weight): introduce a bottle before 2 to 4 weeks as needed.
It’s also helpful to keep in mind that every baby and situation is different. For instance, due to her having preeclampsia and having to be readmitted to the hospital after her son was born, Hannah wasn’t even able to breastfeed for the first two weeks of her son’s life — and yet went on to successfully combo feed with 100% breast milk. “My son had zero issues adjusting and still doesn’t mind, either,” she notes. “That was a huge relief.”
Combination feeding with only breast milk
Hannah combo-fed with breast milk only, which meant she fed directly from the breast and also from the bottle with expressed breast milk. There is no one-size-fits-all with mixed feeding, which is part of the beauty, but it also means that as a parent doing it for the first time, it’s largely up to you to figure out a schedule that works best for you and your family.
How to combine breastfeeding and pumping
When combining breastfeeding with pumping, it’s best to breastfeed first, pump second. This ensures your baby gets all the milk they need during their first feed, and you’ll have plenty of time for your breasts to refill before the next feed. Your exact breastfeeding vs pumping schedule will depend on a number of factors — such as how much milk your baby needs — but it’s best to try to stick roughly to the same schedule each day.
For Hannah, she decided to only do bottles at night so she could get the maximum amount of rest and allow her husband to bottle feed the baby at night. Her rough schedule boiled down to:
Bottles at night using expressed breast milk.
Breastfeed in the morning while pumping the other breast — “I ended up with mastitis a few times, so I was super diligent about relief for both breasts,” she adds. “I did not mess around, that was so painful.”
Breastfeed and pump through the day.
All in all, her baby received two to three bottles of expressed milk a day, including night feeds, and was breastfed about four times.
Combination feeding with formula and breastfeeding
Emily, a mother of two and teacher from western Massachusetts, notes that she chose to combo feed because her newborns struggled to take adequate milk from the breast and weren’t gaining weight sufficiently. For each child, she ended up doing a combination of milk directly from the breast, expressed milk from the bottle, and formula milk.
Can you breastfeed and use formula?
Combining breastfeeding with infant formula can be beneficial for a number of reasons; for example, if your milk supply is low or your breastfed baby is not gaining enough weight. Your breastfeeding and formula feeding schedule will depend on your baby’s needs, but it’s best to introduce the first bottle feed when your baby isn’t feeling restless or hungry, and use a slow-flow teat to mimic the feel of breastfeeding.
For Hannah, her first child was given 10% expressed breast milk in a bottle, 5% nursing at the breast, and 85% formula milk, while her second had 50% expressed breast milk in a bottle, 15% nursing at the breast, and 25% formula milk.
She explains that for her first child, she had limited information and high hopes for breastfeeding and when exclusive nursing didn’t work, she got the impression from others that she simply wasn’t “putting in enough effort” to make breastfeeding work. With her second child, however, her eyes had been opened to the benefits of mixed feeding.
“My first child taught me the benefits of using formula in addition to pumping, and therefore I was much more open to it for my second,” Emily says. “I also discovered that combo feeding is much more common than I had previously realized.”
Can you mix breast milk and formula?
Mixing formula and breastmilk in the same bottle is perfectly fine to do. Rather than adding formula to breast milk, however, you should prepare your formula first as per the instructions, ensuring you have the correct water-to-formula ratio. Once you’ve mixed the formula and water, you can add your breast milk to the bottle. It’s best to add equal amounts of each: half breastmilk, half formula.
Tips for combination feeding
Our combination feeding parents recommend a few key tips for making combo feeding work:
Wearable pumps are key. If your combination feeding schedule includes pumping, a wearable breast pump allows you to pump discreetly while you feed. For myself, the Elvie Pump was a game-changer.
Massage as needed. To ward off mastitis and plugged ducts, Hannah also found a breast massager helpful. Massaging the breasts before feeding or pumping also helps to improve let-down.
Get your partner on board. Lauren notes that a supportive partner that helps clean/organize pumping is crucial. And I’d have to agree — my husband helped me by devising a schedule, washing parts, and setting timers through the night when I needed to pump.
Stick to a schedule. “Getting on a schedule was vital, otherwise I would get a clogged duct or mastitis,” notes Lauren. Try to keep roughly to the same breastfeeding and bottle feeding schedule each day, as this will also ease your baby into a routine.
And perhaps most importantly:
Make combination feeding your own. The beauty of combo feeding is you get to choose. If pumping once a day works for you, do it. If you only want to nurse at bedtime, make it happen. Mixed feeding is whatever you want it to be.
Combination feeding schedule
Your baby’s exact combination feeding routine will depend on how you’re feeding and what your goals are. Ideally, you’ll adjust so you’re able to nurse, pump, or feed all around the same times every day — that’s because your body will get used to producing breast milk at the same time every day and if you miss a feeding or a pumping, you risk getting mastitis.
For Lauren, her goal was for her baby to have bottle feeds while she was at work, and nurse when she wasn’t, so her schedule was simple:
Bottles during work hours.
Nurse all other times.
She and her partner also found it helpful to label the bottles she pumped with the day and time and freeze anything unused — see Elvie’s guide to storing breast milk.
My feeding schedule looked different as my baby aged. In the beginning, to establish my supply and build up milk, I pumped every two hours. Over time, I adjusted my pumping sessions so I was pumping roughly five times a day.
Once I ran out of my breast milk supply surplus (around the time my daughter was six months old), I did a combination of breast milk and formula for every bottle until she turned 12 months. I mixed half the bottle with milk, then followed the instructions for formula for the rest. However, you could also choose the opposite: full formula bottles only and full breastmilk bottles only.
Restarting combination feeding
If you have stopped breastfeeding and hope to reintroduce the breast along with bottle feeding, or in some cases, if you want to introduce breastfeeding for the first time along bottle feeding (for instance, in cases of adoption), Franke says that it may be possible.
“It is possible to establish a milk supply but it will take some work,” she explains. “ A lot depends on how long it has been since the baby’s birth.”
She recommends working with a professional board-certified lactation consultant to ensure best practices for relactation initiation. Every situation will be different, and it’s best to work with a professional who can help guide you through your own.
Where to get help and support
If you’re interested in combination feeding or need support in your combination feeding journey, it may help to check out some resources such as:
Your delivery hospital. The hospital where you delivered your baby may be able to connect you to a lactation consultant that can help.
Your doctor or your baby’s doctor. “Combination feeding for a baby and new family is very personal, so I would stress getting some guidance from the baby’s health visitor and/or a lactation consultant,” says Franke.
The Office on Women’s Health. The National Women's Health and Breastfeeding Helpline may be able to help if you have a question or concern about combination feeding.
And last but not least, Lauren gives this advice: “Read all the instructions, label everything, and take a deep breath.” You’ve got this!