Combination feeding, also called mixed feeding, is the practice of nourishing an infant using both breast milk and infant formula. This flexible approach allows parents to provide the nutritional benefits of breast milk while using formula to manage common challenges, such as returning to work or concerns about milk supply. This method also allows partners and other caregivers to share feeding responsibilities, providing the breastfeeding parent with greater flexibility and rest.
Establishing the Combination Feeding Schedule
Logistical planning is necessary to create a sustainable combination feeding routine. Parents typically choose between two main scheduling approaches: supplementing or alternating. The best method depends on the family’s lifestyle and their goal for milk supply maintenance.
Supplementing involves offering formula only after a breastfeed, often referred to as a “top-up” feed. This strategy is frequently used when a parent is concerned about the baby’s intake or when the breast milk supply is naturally lower, such as in the evening. The baby receives the maximum breast milk volume first, and the formula ensures they are satiated, supporting overall growth.
Alternating, in contrast, replaces entire breastfeeds with a formula bottle at designated times. A parent might, for example, breastfeed in the morning and at night, but use formula during the workday or for the overnight feed. This method requires consistency in the timing and volume of the formula feed to help both the baby and the parent’s body adjust.
Introducing formula gradually, perhaps starting with a single bottle every 24 to 48 hours, allows the baby’s digestive system to adapt. This also gives the parent’s body time to regulate milk production. Tracking the baby’s natural hunger cues can help align the formula feeds with times when the parent needs the most flexibility.
Strategies for Protecting Breast Milk Supply
Lactation operates on a principle of supply and demand, meaning the body produces milk based on how much is removed from the breast. When a formula feed replaces a nursing session, the breast misses the signal to produce milk, which can lead to a gradual reduction in supply over time. A primary strategy for maintaining milk volume is to avoid skipping consecutive breastfeeds.
If a formula bottle is given, the parent must pump or hand-express milk around the same time to mimic the baby’s demand. This action ensures the body continues to receive the necessary hormonal signal to maintain its current level of production. For parents returning to work, pumping every three to four hours during the workday can help keep the supply robust.
Timing is also an important consideration for supply protection. Prolactin, the hormone responsible for milk production, often peaks overnight, making night feeds particularly influential in maintaining overall output. If a parent chooses to replace a night feed with formula for rest, they may need to pump once overnight or first thing in the morning to fully empty the breasts. Prioritizing breastfeeding during peak supply times, such as the morning, also supports supply maintenance.
Safe Preparation and Storage Guidelines
Maintaining strict hygiene is necessary when handling and preparing both breast milk and formula to ensure infant safety. Hands should be washed thoroughly with soap and water before expression, preparation, or handling of feeding equipment. All bottles, nipples, and pump parts must be cleaned after each use; this often involves washing with hot, soapy water, rinsing, and air-drying.
Prepared infant formula can spoil more quickly than breast milk and must be used within two hours of preparation. If formula is prepared ahead of time, it can be stored in the refrigerator for up to 24 hours. Any prepared formula that is leftover in the bottle after a feeding must be discarded within one hour, as the bacteria from the baby’s saliva can cause rapid spoilage.
Expressed breast milk has different storage guidelines based on temperature. Milk should be stored in the back of the refrigerator or freezer, not in the door, to protect it from frequent temperature fluctuations.
- Freshly expressed milk can remain at room temperature, 77°F (25°C) or colder, for up to four hours.
- It can be stored in the refrigerator for up to four days.
- It can be stored in a standard freezer for about six months.
- Storage up to 12 months is acceptable.
If formula and breast milk are mixed in the same bottle, the mixture must be treated with the shorter time limit of formula once the baby begins feeding. It is recommended to store them separately to avoid wasting breast milk if the baby does not finish the bottle. When preparing powdered formula, parents must follow the manufacturer’s instructions exactly, including using the correct water temperature and measurement, to ensure the baby receives adequate nutrition.
Navigating Infant Acceptance and Digestive Issues
Introducing a bottle alongside nursing requires attention to the baby’s acceptance and digestive changes. Some babies may struggle to switch between the breast and the bottle due to the difference in how they must suckle, a phenomenon sometimes referred to as “nipple confusion.” Using a slow-flow nipple on the bottle can help mimic the slower, more controlled flow of breast milk, making the transition smoother.
Paced bottle feeding is a technique that helps avoid the baby developing a preference for the faster flow of a bottle, which can lead to breast refusal. This method involves holding the baby upright, keeping the bottle horizontal, and allowing the baby to draw the milk rather than letting gravity force the flow. Taking breaks during the feed also helps the baby regulate intake, more closely resembling the natural pauses during a breastfeed.
Formula is not as easily digestible as breast milk, and its introduction can cause notable digestive changes in the infant. Parents may observe a change in the baby’s stool consistency, which can become firmer, or a different odor and color compared to exclusively breastfed stools. Formula may also cause increased gas, which is often related to the baby swallowing air from the bottle. Burping the baby frequently during and after a bottle feed can help relieve any discomfort from gas.