There are many ways to feed a baby and how they look differs from family to family. One popular method is combination feeding – sometimes called combination feeding or mixed feeding – which involves feeding your baby a combination of formula and breast milk. Large health organizations such as Centers for Disaster Control and Prevention (CDC) and American Academy of Pediatrics (AAP) recommend breastfeeding babies, especially in the first few months, but exclusive breastfeeding is not possible for all parents.
“Combination feeding ensures that a baby will be fed if and when breast milk is not available,” explains Dr. Jessica Madden, pediatrician and neonatologist, lactation consultant and medical director of Aeroflow breast pumps. “Bottle feeding also provides the flexibility for other caregivers to be able to feed a baby.”
Here, we’ll take a closer look at the benefits of combination feeding, how to do it successfully, and what caregivers need to know about this method.
What is combined feeding (combo)?
The combined power supply is defined like every time a baby is fed a combination of breast milk and formula. There are many reasons why a parent might choose this method. The most common, according to Madden, include:
- Prolonged separations from parents (e.g. during work).
- Supplementation during breastfeeding.
- To help with weaning.
Dr. Leah M. Alexander, a pediatrician and consultant for Mom Loves Best, says a parent may also choose combination feeding because they are dealing with a medical issue that makes breastfeeding difficult. “Some parents do not produce enough breast milk to meet their infant’s nutritional demand or needs for weight gain and growth,” she says. In these cases, offer formula after breastfeeding can be recommended to help improve baby’s weight gain.
Other parents may choose combination feeding 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 combination feeding simply because they are busy and don’t want to have to pump every time they have to be separated from their baby.
It’s the case for Siona Blaise, a mother of two, psychologist and blogger from Saint Lucia, Caribbean, who is currently feeding her 6-month-old baby combination. “I still breastfeed 95% of the time, but I barely pump,” says Blaise. “This means that when I am at work or elsewhere, his caregivers can give him formula.”
What are the advantages of combined feeding?
THE benefits of breastfeeding are well known, but breastfeeding doesn’t have to be all or nothing. Every drop counts. Many studies reveal that combination feeding has significant benefits for babies. For example, a 2017 study published in Pediatrics found that exclusive and partial breastfeeding for at least two months is associated with a halving of the risk of Sudden infant death syndrome (SIDS) in infants. Additionally, a 2016 study published in Medicine found that partial breastfeeding reduces the risk of babies developing cow’s milk sensitivities and eczema during early childhood.
“For parents who feel stressed and overwhelmed with breastfeeding, giving their 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 baby’s health: it can also provide much-needed support for parents and caregivers. “For parents who feel stressed and overwhelmed with breastfeeding, giving their formula for certain feedings can give them a break,” says Alexander. “Having the option to give formula can also allow other caregivers to participate in feeding and bonding with the baby.”
Blaise says she resisted giving her first child formula, but her new baby’s combination feeding is a relief. “I feel less pressure being solely responsible for his food,” she says. She likes knowing that other people can feed her baby and says it now seems more feasible to take longer trips away from home.
How to combine feeding a baby
There’s no one right way to combine foods, Alexander says. “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 stages of combination feeding include:
- Feed both breast milk and formula, in varying amounts.
- Breastfeed directly or express breast milk from bottles.
- Determine which feeding program is best for your family.
While there’s no one-size-fits-all combination feeding schedule, Alexander says how you feed your baby will likely depend on why you’re doing it. For example:
To supplement low milk production
For parents who are unable to produce a full supply of milk for their baby, offering additional formula after breastfeeding could be a feeding model that works. The amount of formula you give can depend, but your baby can take anywhere from one to two ounces per feeding, or up to four ounces of formula.
Adapting to parents’ work schedules
Parents who work outside the home can breastfeed their baby before and after work, at night and/or on weekends. Then the baby would get formula — or a combination of formula and pumped milk — at daycare or with a babysitter or nanny.
Give other caregivers a feeding option
Some parents may breastfeed when they can, but ask a spouse or other caregiver to offer them formula at night, when they are running errands or spending time with friends.
How to maintain milk production during combination feeding
One of the challenges parents may encounter when combination feeding is maintaining a milk supply. The path milk supply generally works on “supply and demand” – that is, the more you pump or breastfeed, the more milk you produce. Still, there are ways to maintain supply while also offering infant formula, Madden advises. His suggestions include:
Maintain your feeding and pumping schedule
“The key to maintaining breast milk production during combined breastfeeding is to continue to breastfeed directly or pump every 3 to 4 hours,” says Madden.
Maximize your pumping time
Consider adding some “power pumping” to your day, which involves setting aside about an hour each day and pumping several times during that hour.
Be Strategic About Breastfeeding
When and if possible, choose direct breastfeeding over expressing breast milk because the hormones in breast milk production (oxytocin and prolactin) are higher during direct breastfeeding. Also consider “reverse feeding,” meaning you breastfeed more frequently at night than during the day to maximize the amount of breastfeeding time you have.
Combined feeding strategies for parents and caregivers
Besides 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 knowing the best tips for success can make the process easier. Here, experts explain 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
Although there are exceptions, most babies are able to switching from breast milk to formula easily. You can expect that the ratio of breast milk to formula will differ from day to day, and that some babies will receive more breast milk than formula and vice versa, but this will not change their growth or development, she assures.
2. Don’t be afraid to mix things up
It’s OK to mix formula and expressed breast milk in a bottle, Madden confirms. “Just be sure to discard any milk left in the bottle after feeding,” she recommends. This is because breast milk and formula have different shelf lives, so throwing away 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 stools and the frequency of their bowel movements, Alexander says. Knowing what to look for can help parents and caregivers prepare and ensure the baby’s dietary needs are met.
Exclusively breastfed babies have yellow, grainy poop, but formula-fed poop is more greenish, gray or brown, Alexander says. “Breastfed babies also tend to have bowel movements several times a day, especially during the first few months of life,” Alexander noted. “Babies who take formula have bowel movements less frequently, sometimes as little as every one to four days.”
4. Keep the baby’s doctor informed
Sometimes babies fed a combination diet show signs of sensitivity or intolerance to the formula. If a baby seems to have an intolerance to a certain formula or is having difficulty feeding, be sure to discuss these issues with a doctor. “I encourage you to talk with your pediatrician before changing your formula,” advises Madden.
The essential
These days there is a lot of talk about breast milk versus formula and which is better. If you want to offer your baby the benefits of breast milk but exclusive breastfeeding is not an option for you, combined feeding is a good alternative. Madden says even one or two ounces of breast milk a day can boost your baby’s immunity and help prevent illness.
Above all, it is important to let go of any reservations or judgments about infant formula. “If you were planning to breastfeed exclusively and end up having to use a combination feed, you’re not a failure,” assures Madden. “Infant formula is a healthy and nutritious alternative to breast milk. »