Baby Care

Combinations feeding explained – Expert tips on combo feeding

There are many ways to feed a baby, and how that looks differs from one family to another. One popular method is combination feeding — sometimes referred to as combo feeding or mixed feeding — which is when you feed your baby a combination of formula and breastmilk. Major health organizations like the Centers for Disease Control and Prevention (CDC) and Academy of American Pediatrics (AAP) recommend that babies be breastfed, especially in the early months, but exclusive breastfeeding isn’t possible for every parent.

“Combo feeding ensures that a baby will be nourished if and when breastmilk isn’t available,” says Dr. Jessica Madden, a pediatrician and neonatologist, lactation consultant and medical director of Aeroflow Breastpumps. “Feeding by bottle also provides flexibility for other caregivers to be able to feed a baby.”

Here, we’ll take a closer look at the benefits of combo feeding, how to do it successfully and what caregivers need to know about this method.

What is combination feeding?

Combination feeding also called combo feeding is defined as anytime a baby is fed a combination of both breast milk and formula. There are many reasons why a parent might choose this method. The most common, according to Madden, include:

  • Extended separations from parents (such as while working).
  • Supplementation while breastfeeding.
  • To help with weaning.

Dr. Leah M. Alexander, a pediatrician and consultant for Mom Loves Best, says a parent might also choose combo feeding because they are dealing with a medical issue that makes it challenging to breastfeed. “Some parents do not produce enough breast milk to meet their infant’s demand or nutritional needs for weight gain and growth,” she says. In these cases, offering formula after breastfeeding may be recommended to help improve baby’s weight gain.

Other parents may choose to combo feed because they want the other parent or a caregiver to be able to participate more in the baby’s feedings, Alexander notes. Some parents may also choose to combo feed simply because they are busy and don’t want to have to pump every time they need to be separated from their baby.

This is the case for Siona Blaise, a mom of two, psychologist and blogger from St Lucia, Caribbean, who’s currently combo feeding her 6-month-old. “I still breastfeed 95% of the time, but I hardly pump,” Blaise says. “This means when I am at work or elsewhere, his caretakers can give him formula.”

What are the benefits of combo feeding?

The benefits of breastfeeding are well known, but breastfeeding doesn’t have to be all or nothing. Every drop counts. Multiple studies find that combination feeding has important benefits for babies. For example, a 2017 study published in Pediatrics found that both exclusive and partial breastfeeding for at least two months is associated with halving the risk of Sudden Infant Death Syndrome (SIDS) in infants. Additionally, a 2016 study published in Medicine found that partial breastfeeding lowers the risk of babies developing cow milk sensitivities and eczema in their early childhoods.

“For parents who are feeling stressed and overwhelmed about breastfeeding, giving their infant formula for some feedings can provide a break … [It] can also allow other caregivers to participate in feeding and bonding with the baby.”

— Dr. Leah M. Alexander, pediatrician

But the benefits of combination feeding aren’t just about the health of the baby: it can also provide much-needed support to parents and caregivers. “For parents who are feeling stressed and overwhelmed about breastfeeding, giving their infant formula for some feedings can provide a break,” says Alexander. “Having the option of giving formula can also allow other caregivers to participate in feeding and bonding with the baby.”

Blaise says that she resisted giving her first child formula, but combo feeding her new baby has come as a relief. “I feel less pressure to be solely responsible for his food,” she says. She likes knowing other people can feed her baby and says that taking longer trips away from home now feels more feasible.

How to combination feed a baby

There is no one right way to combination feed, says Alexander. “Parents should discuss what will work best for them and their baby with a pediatrician,” she says. “Among my patient families, I have seen a variety of strategies.” In general, the steps to combination feeding include:

  • Feeding both breastmilk and formula, in varied amounts.
  • Breastfeeding directly or pumping bottles of breastmilk.
  • Determining the feeding schedule that works best for your family.

While there is no single combo feeding schedule, Alexander says that how you go about combo feeding your baby will likely depend on the reason you are doing it. For example:

To supplement low milk supply

For parents who aren’t able to produce a full milk supply for their baby, offering supplementary formula after breastfeeding might be a feeding pattern that works. How much formula you give might depend, but your baby might take between one or two ounces per feed, or up to four ounces of formula.

To fit within parents’ work schedules

Parents who work outside the home may breastfeed their babies before and after work, during the nighttime and/or on weekends. Then, the baby would take formula — or a combination of formula and pumped milk — while at daycare or with a babysitter or nanny.

To give other caregivers a feeding option

Some parents may breastfeed when they are able, but have a spouse or other caregiver offer formula during the overnight hours, when they’re out running errands or spending time with friends.

How to maintain milk supply while combo feeding

One challenge parents may encounter when combination feeding is maintaining a milk supply. The way milk supply typically works is by “supply and demand” – i.e., the more you pump or nurse, the more milk you produce. Still, there are ways to maintain supply while also offering formula, Madden advises. Her suggestions include:

Maintain your feeding and pumping schedule

“The key to maintaining one’s breast milk supply while combo feeding is to continue to either directly breastfeed or pump every 3 to 4 hours,” says Madden.

Maximize your pumping time

Consider adding some “power pumping” into your day, which involves setting aside an hour or so each day and pumping multiples times during that hour.

Be strategic about breastfeeding

When and if possible, choose direct breastfeeding over pumping, as the hormones of breastmilk production (oxytocin and prolactin) are higher during direct breastfeeding. Also, consider “reverse feeding,” which is where you’re breastfeeding more frequently at night than during the day to maximize the breastfeeding time you get.

Combination feeding strategies for parents and caregivers

In addition to parents, nannies, babysitters, grandparents and anyone else who cares for a baby have an important role to play when it comes to combination feeding. Knowing what to expect and the best tips for success can make the process easier. Here, experts share how parents and caregivers can make combination feeding work, and what they may need to know about the method:

1. Be flexible to meet the baby’s needs

While there are exceptions, most babies are able to switch between breast milk and formula easily. You can expect that the ratio of breast milk to formula may different from one day to another, and some babies will receive more breast milk than formula and vice versa, but this won’t change their growth or development, she assures.

2. Don’t be afraid to mix it up

It’s OK to mix formula and pumped breast milk in a bottle, Madden confirms. “Just be sure to toss out any remaining milk left in the bottle after the feed,” she recommends. This is because breastmilk and formula have different shelf lives, so tossing any leftovers will help prevent foodborne illness.

3. Prepare for stool changes

Adding formula to a breastfed baby’s diet can change the appearance of their poop and the frequency that they poop, Alexander says. Knowing what to look for can help parents and caregivers be prepared and ensure the baby’s food needs are being met.

Babies who are exclusively breastfed have yellow and seedy looking poop, but formula fed poops are more greenish, gray or brown, Alexander says. “Breastfed babies also tend to stool several times daily, especially during the first few months of life,” Alexander remarked. “Babies who take formula will pass a stool less frequently, sometimes no more than every one to four days.”

4. Keep the baby’s doctor in the loop

Sometimes babies who combination feed show signs of formula sensitivity or intolerance. If a baby seems to have an intolerance to a certain formula or is struggling to feed, make sure to discuss these issues with a physician. “I encourage you to discuss with your pediatrician before making a formula change,” Madden advises.

The bottom line

These days, there’s a lot of talk about breast milk vs. formula and which is better. If you want to offer your baby the benefits of breast milk but exclusive breastfeeding is not in the cards for you, combination feeding is a good alternative. Madden says that even one or two ounces of breastmilk per day can boost your baby’s immunity and help prevent illnesses.

Most of all, it’s important to drop any reservations or judgments about baby formula. “If you intended to exclusively breastfeed and end up having to combo feed, you are not a failure,” Madden assures. “Infant formula is a healthy and nutritious alternative to breastmilk.”

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