How do I combine breast and bottle?

When you feed your baby from both your breast and a bottle, that is known as combination feeding. This is the case whether you choose to use infant formula milk or expressed breast milk for bottle feeding¹. 

Combination feeding offers a wonderful way to ensure your baby is still getting all the goodness of your breast milk, whilst at the same time being able to add a bottle into your baby's routine. There are several reasons why combination feeding might work for you and your family.

It might be that you are returning to work and will be away from your baby for longer periods of time. Or you would like to share your baby's feeding routine with your partner or other family members, allowing them to be more involved and you to get some rest if you need it.

If you need support with your breastfeeding journey, do not hesitate to speak to your midwife or health visitor, as they will be able to provide you with support you need.

If you have decided that combination feeding is right for you and your baby, the NHS recommends that you wait until at least 6-8 weeks after birth, until breastfeeding is fully established². However, everyone is different, and some parents might want to try combi-feeding from birth. Whatever you decide, there are a few things that you will want to consider when making your decision. We are exploring these below.

Your baby will use as different sucking action when drinking from a bottle than they do from the breast. Introducing combination feeding before breastfeeding is established could result in your baby experiencing nipple confusion and mean that they then struggle to latch onto your breast³.

Another consideration is you rmilk production. After your baby is born, your body will need to establish the amount of breast milk that your baby needs. Once you have introduced combination feeding with formula milk into your routine, this will start reducing your milk production, so you will need to do it gradually to give your body some time to adapt¹.

There are a few things that you can do to help the transition to your combination feeding routine.

The amount of breast milk that your body produces is based on a very clever system of supply and demand, designed to ensure that your body is making the right amount of breast milk for your baby. When combination feeding with expressed breastmilk, the amount of breast milk that you produce will decrease. Breastfeeding regularly and expressing can help to maintain your milk production and supply.

If you are combination feeding with formula milk, then your body will need to adapt to making less milk. Reducing the amount of breast feeds, you give gradually can really help here to prevent your breasts from becoming engorged, leaking, and the likelihood of mastitis¹.

To help you and your baby to get used to combination feeding, you could try giving a bottle feed instead of a breast feed at a time that works best for you and your baby - for example first thing in the morning or the last feed before bedtime.

Before you start combination feeding your baby, it is good to have a think about some of the things you will need. For example⁴:

• Feeding bottles with teats and caps.
• Bottle cleaing brush.
• Breast pump - you will need this if you are combination feeding using expressed breast milk.
• Steriliser.

If you are combination feeding with formula milk, then you will also need first infant formula. You can learn more about the equipment you will need to bottle feed your baby here.

Combination feeding is not solely a choice for those who wish to introduce their baby to bottle feeding. It might be that your baby was formula fed at birth, and now you would like to re-establish breastfeeding, or increase the number of breastfeeds you give.

Because your breast milk production will have decreased, it can be harder to increase your supply if regular breastfeeds have not been given in the first few weeks of life. This might be the case if your baby was premature or required special and additional care at birth, or because you needed some support to establish your milk production due to a low supply.

Whatever the reason, there are some things that you can do to reduce the number of formulae feeds your baby must increase breastfeeding. These include⁵:

• Expressing your milk regularly to stimulate your milk supply.
• Skin to skin contact - hold your baby close to you regularly.
• Offering your baby a breast feed as and when they are hungry.
• Encourage breastfeeding at night, as this is when your body produces more of the hormone prolactin. This is the hormone that supports milk production and helps to build your supply.
• Experiment with different breastfeeding positions to ensure that you and your baby feel relaxed, comfortable, and secure.

Introducing combi feeding can be a substantial change. Whilst some babies will adapt quickly, others may take a little longer to get the hang of their new feeding routine - especially if they have been exclusively breastfed. Be sure to give you and your baby the time you need to adjust.

It can take time for your baby to adjust to feeding from a bottle teat, and to help them along, you could try:

• Using a bottle teat that has a low flow. This will mimic the way your breast milk flows and help your baby to control the amount of milk they drink more effectively².
• Feeding your baby when they are content, happy, and relaxed. This way they will be able to take their time when feeding, and will not be too hungry, overtired, and resistant¹.
• Letting someone else give your baby those first early bottle feeds. If you are physically close to your baby as they feed, they may be able to smell your breast mulk and be less likely to take a bottle.

Read more on switching between breast and bottle feeding here.

If you are thinking about combination feeding or making any changes at all to your baby’s feeding routine, it is always best to have a chat with your midwife or health visitor. That way you can sure that you are getting all the support you need to keep your baby growing healthily and happily.