Combining Breastfeeding and Formula Feeding

Giving your baby infant formula in addition to breastfeeding is called supplementing. It's completely OK and perfectly safe to breastfeed and give your child formula. In fact, many families choose this type of combination feeding method. Here's what you need to know about combining breastfeeding and formula or bottle feeding, 

What Do Experts Recommend for Infant Feedings?

The American Academy of Pediatrics (AAP) and the World Health Organization (WHO) recommend breastfeeding exclusively for the first four to six months and then continuing to breastfeed up until one year or longer along with the introduction of solid food.

However, the decision to add infant formula to your child's diet is up to you.

Reasons for Formula Supplementation

Making the decision to supplement with formula may not be an easy one. It may be something that you want to do, or you may have no choice and have to supplement. It might be emotional, and it may even be a great source of stress or guilt. Here are some of the reasons you may need to or choose to supplement your child with formula.

Your Child has Medical Issues: If your baby is born premature or with certain medical conditions, she may need more than just your breast milk.

You Have a Low Breast Milk Supply: A previous breast surgery or certain medical conditions can interfere with the production of breast milk. If you or your doctor feel that your baby is not getting enough breast milk through breastfeeding alone, you may need to supplement with infant formula.

You're Going Back to Work: It may be too difficult or stressful to pump at work, or you may have a decrease in your breast milk supply once you return to work.

So, if you don't have a stockpile of breast milk stored in the freezer to use, you may have to supplement your baby's diet with formula.

Your Partner Wants to Participate: You may want your partner to take part in feedings and give an occasional bottle. You could pump and use your breast milk, or you can give your little one a bottle of formula once in a while.

You have Multiples: Exclusively breastfeeding twins or triplets can be a challenge. Not only do you have to build and maintain a large enough breast milk supply, but you'll be breastfeeding very often. You may just need a break a few times a day.

It's a Personal Choice: You may just have a personal preference to breastfeed some of the time and give your baby formula the rest of the time. That's OK, too.

When Would A Doctor Recommend Supplementation?

When possible, most doctors recommend exclusive breastfeeding. However, there are certain times when it's necessary for a physician to recommend supplementing a breastfed baby.

Your doctor may recommend formula supplementation if:

• Your newborn loses more than 10% of his or her body weight in the first few days of life.
• Your child loses weight or gains weight slowly after the first few days.
• Your baby is having less than six wet diapers in a 24 hour period.
• Your newborn is very fussy and does not seem satisfied after feeding.

How Should You Choose an Infant Formula for Your Baby?

Before choosing an infant formula for your child, talk to the pediatrician. Most doctors recommend an iron-fortified infant formula during the first year of life.

If your baby develops a rash, vomiting, diarrhea, excessive crying, fussiness, or gas after starting formula, it may be an allergy.

Stop using the formula and notify the baby's doctor to discuss other types of infant formula available.

When Should You Introduce Infant Formula to Your Baby

If you're not supplementing your child for medical reasons, experts recommend breastfeeding for at least one month before starting formula. Waiting at least four weeks gives you time to build up a healthy breast milk supply and ensure that your baby is breastfeeding well. At this point, you can slowly begin to add formula. 

How Adding Formula Affects Your Breast Milk Supply

Each day your body makes breast milk based on the concept of supply and demand.

What your baby demands, your body supplies. So, when you start to add formula, it can affect how much breast milk you make. If you plan on supplementing one or two bottles a week, it shouldn't affect your breastmilk supply. But, if you give your child one or two bottles of formula a day, your milk supply will begin to drop.

It's also important to remember to introduce formula supplements slowly. Going from not supplementing to giving a lot of bottles in a short period, could cause breast problems such as breast engorgement and blocked milk ducts.

To keep up your breast milk supply and prevent some of the common breastfeeding problems that can pop up when you skip breastfeeding to bottle feed, you can pump or use a hand expression technique. Removing your breast milk will help relieve the fullness that breast engorgement can cause. Plus, you can store your pumped breast milk to use at a later time. Depending on how you store it, breast milk can stay in the freezer for up to one year.

Can You Combine Breast Milk and Formula in the Same Bottle?

If you would like to give your baby breast milk and formula during the same feeding, you can. It's also OK to put breast milk and formula in the same bottle if you have already prepared the formula. But, even though you can, it's better if you don't mix breast milk and infant formula together in one bottle. It has nothing to do with safety, and everything to do with wasting your precious breast milk. You see, if your baby doesn't finish the bottle, you'll be throwing away some of your breast milk along with the rest of the formula. Since breast milk is so beneficial, you want your baby to get as much of the breast milk as possible. The recommendation is to give your breast milk first, then finish the feeding with the infant formula.

As mentioned above, it's OK to mix breast milk with the formula that is already prepared. However, you should never combine your breast milk with unmixed powdered or concentrated formula. Always follow the instructions to make the formula first, then add the prepared formula to the breast milk.

How Adding Infant Formula Affects Your Baby

If you've been breastfeeding your baby and begin to add formula to her daily diet, there are some things you may start to notice.

• She may Refuse to Take the Bottle: Your child may refuse to take the bottle especially if you're the one giving it to him or her. The transition may go more smoothly if you have your partner or another caregiver offer the bottle. If your little on is already using a bottle to drink your pumped breast milk, it may be easier to get her to take infant formula in a bottle. However, she still may not like the taste of the formula.
   
• She may Refuse to Take the Breast: Once you start to give your baby formula in a bottle, your baby may take the bottle without a problem. But, since it's more work to get your breast milk out of the breast than it is to get the formula out of a bottle, she may start to refuse to breastfeed.
   
• She May Wait for Longer Between Feedings: Since your baby can digest breast milk more easily than infant formula, the formula is more can your child feel full longer. You may notice that after formula feedings she doesn't seem as hungry as quickly as she does after breast milk.
   
• You may Notice Changes in his Bowel Movements: Adding formula to your baby's diet may change the pattern, color, and consistency of your baby's poop. Formula poop is usually firmer, tan or darker in color, and it has a stronger odor. Your child may also poop less often once you start giving him the formula.

Is Formula Feeding Along With Breastfeeding Safe for Your Child?

The ultimate goal of every parent is to have a happy, healthy baby who is growing and thriving. Infant formula is a completely safe choice when it comes to feeding your baby, so you should not feel guilty if you need to or decide to supplement. If you can breastfeed exclusively, that's great. But, it's not always possible for every mom. If you don't want to or can't breastfeed for every feeding, breastfeeding along with formula supplementation is a great option. Just remember, with breastfeeding it doesn't have to be all or nothing. Even a little breast milk is better than none. Every baby and situation are unique, and a combination of breastfeeding and formula may work well for your family.

Sources:

Academy of Breastfeeding Medicine Protocol Committee. ABM clinical protocol# 3: Hospital guidelines for the use of supplementary feedings in the healthy term breastfed neonate, revised 2009.

Auerbach, Kathleen, G. Ph.D., IBCLC, Montgomery, Anne, MD, IBCLC. Supplementing the Breastfeeding Baby.

Eidelman AI, Schanler RJ, Johnston M, Landers S, Noble L, Szucs K, Viehmann L. Breastfeeding and the use of human milk. Pediatrics. 2012 March 1;129(3):e827-41.

Lawrence, Ruth A., MD, Lawrence, Robert M., MD. Breastfeeding A Guide For The Medical Profession Eighth Edition. Elsevier Health Sciences. 2015.

World Health Organization. Infant and young child feeding: model chapter for textbooks for medical students and allied health professionals. 2009.