Formula Combo Feeding: How to Safely Combine Breast Milk and Formula

A lot of mothers nursing their children exclusively on breast milk struggle with low milk supply and ultimately opt for infant formula. But do you know there's also a third approach, "formula combo" that you can adopt to ensure your child is well fed and nourished while getting all the essential nutrients he needs.

Formula combo feeding, also known as mixed feeding, is when you choose to give your baby an infant formula bottle to supplement breastfeeding. There might be many reasons, including that your baby is not getting enough milk, you need to get back to work, your supply can't keep up, and your baby keeps crying all the time.

This guide will help you make the transition easier and understand what formula combo feeding is, why you should choose it, when to start combo feeding a baby, how to successfully implement it, its pros and cons, and the best formula to supplement breastfeeding.

Table of Contents

What Is Formula Combo Feeding?

Formula combo feeding, or combination feeding, refers to offering infant formula alongside breast milk to feed your baby. Whether you're coping with low milk supply and your baby is not getting adequate nutrition, going back to work, or choosing mixed feeding for more flexibility, combination feeding can help. Remember, your kid will still be getting the antibodies from breast milk that can help to develop their immune system.

Why Parents Choose Combination Feeding

Combination feeding is when you consider giving your baby infant formula to supplement breastfeeding. There are various reasons to consider formula combo feeding, including low milk supply due to hormonal changes, any medical conditions, work obligations, or simply wanting to share feeding duties with your partner or other caregivers (grandparents).

Another reason might be that your baby is not gaining much weight, and your pediatrician recommends an infant formula to supplement breast milk. Some mothers prefer to offer breast milk in the morning, while a caregiver offers iron-fortified formula for lunch and the mummy nurses again at night. Some parents offer formula once or twice a day; others offer it only when they have commitments and not with the baby. Follow the routine that works for you and your baby.

When can I start combination feeding?

It totally depends on you. Some mothers prefer to wait until the baby establishes a breastfeeding habit and is confident with it after 6-8 weeks. Others prefer to give formula right after birth, so the baby doesn't deny the bottle later.

Formula Combo Feeding: Benefits and Risks

The key benefit of combination feeding is that it lets you extend your breastfeeding journey and allows your partner to support you in feeding the baby using infant formula, expressed breast milk, or by mixing both so that your baby's nutrient needs can be fulfilled.

How Combo Feeding Can Support Baby's Growth

Whether combo feeding supports your baby's growth doesn't depend on a single factor. Genetics, breast milk, and your baby's activity levels all contribute to your baby's overall growth. Formula milk contains vitamins and all essential nutrients; when supplemented with breastmilk, it may support your baby's weight gain.

How Formula May Affect Breast Milk Supply

Combining breast milk and formula-feeding affects the milk supply because your baby will breastfeed less, and your body will produce less milk as it works on demand and supply. To maintain a healthy milk supply, you should offer breast milk at least 8-12 times daily and express or pump your milk between formula feeds to avoid breast engorgement.

When to Talk to a Pediatrician or Lactation Consultant

Taking care of a little one on your own is a big deal. There can be many stages when parents have questions, especially related to feeding and nutrition. So, you can consult your pediatrician or lactation consultant whenever you feel confused. There is no need to wait for a serious issue to reach out to them.

Best Formula Types for Combo Feeding

Looking for the good formula to supplement with breastfeeding? Buying an infant formula for new parents can be a bit challenging. Below we have explained different formula types so you can choose the right formula for your baby's unique dietary needs.

Cow's-Milk-Based Formula

The most widely used and sold formula in supermarkets, cow milk-based formula, is considered good for infant growth as it is enriched with cow's milk protein and lactose. It is gentle for your baby's tummy because it undergoes a process that replaces butter fat with vegetable oils and makes it more digestible. Also, the process adds more lactose to make it more like breast milk.

Partially Hydrolyzed Formula

More expensive than traditional formulas, the protein in partially hydrolyzed formula undergoes a process that breaks it down into smaller proteins, making it easy to digest. If your baby has some allergic sensitivities, your pediatrician may recommend hypoallergenic formula.

Hypoallergenic formula

Also known as extensively hydrolyzed formula, cow's protein in this infant formula is broken down into very tiny peptides, so it won't react with the body's immune system. This is given to babies with cow's milk protein allergy that can cause digestive symptoms and respiratory issues. Avoid giving goat milk or any other mammal milk to babies with CMA (cow milk allergy).

Amino Acid Based Formula

In this formula, the protein is in its tinniest form and is given when the baby doesn't even tolerate hypoallergenic formula. Also called elemental formula, this infant formula is generally expensive, given to babies with severe allergies, but can't be given without a doctor's guidance and is expensive. It is completely safe as a sole source of nutrition until 12 months of age.

Soy-Based Formula

A great alternative to milk-based formula, the soy-based formula is dairy-free and contains soy as a protein. It replaces lactose (the main sugar in cow's milk) with glucose or sucrose, making it a great choice for mothers with lactose-intolerant babies. However, soy-based formula should not be used as an alternative to cow's milk in children younger than 2 years old. This condition is rare in babies, so always consult a pediatrician before giving soy-based formula to your baby.

Specialty Formula for Preterm or Medical Needs

Premature babies are given specialty formulas designed for specific disorders or medical needs. Ask your consultant for ounces, schedules, and preparation methods if your baby is prescribed specialized formula.

How to Choose the Right Formula Combo

When formula combo feeding, it is crucial to choose the best formula to supplement breastfeeding that perfectly supports your milk supply and matches your kid's dietary needs. Find which formula is best if your baby is suffering from cow milk allergy, or if the baby is showing mild digestive symptoms, to make an informed decision.

Cow Milk Allergy

If your baby is diagnosed with cow milk allergy and has symptoms including vomiting, diarrhea, asthma-like symptoms, and rashes, the doctor may recommend hypoallergenic infant formula. However, if the formula fails to resolve the symptoms, the amino acid based formula might be the right choice for your baby.

Gas, Reflux, or Digestive Symptoms

For babies with gassy tummies and milk digestive symptoms, the partially hydrolyzed formula is considered best, as it is gentle for tummies. However, this formula doesn't work for babies with true lactose intolerance (a rare condition found in babies).

Dietary management of acute diarrhea

Lactose-Free Formula is considered effective to treat acute diarrhea more rapidly than lactose based formula. However, it must be given under strict medical supervision.

Iron-Fortified Formula and Nutrient Needs

The best formula that prevents your toddler from developing anemia is an iron-fortified formula designed to meet iron needs. It provides adequate nutrition and supports brain development and builds immunity. Almost all commercial formulas contain iron. An iron-fortified formula that contains 12mg/L of iron is perfect for your child's growth and development.

When your toddler turns 6 months, you can also feed them iron-rich foods including meat, iron-rich cereals, salmon, and egg yolks.

Also, it is not recommended to give your baby low-iron formula as it harms baby growth. The iron content in an infant formula doesn't cause constipation, which is a concern for most parents when considering a formula combo.

Recommendations for iron content00734-9/fulltext) in formula or iron supplementation of exclusively breastfed infants

How to Mix Formula and Breast Milk Safely

Many parents make mistakes when preparing formula milk by incorrectly measuring the amount of infant formula powder and water, especially when adding the powder by hand, which can result in a formula that is too thick (not safe for the kidneys and digestive tract) or too dilute, which can impact its nutritional value and make your baby dehydrated.

Follow the guidelines below to mix formula and breast milk safely.

1. Read the instructions listed on the label to prepare formula to ensure your baby gets adequate nutrients.

2. Add sterilized water first and then add powdered formula using the provided scoop and mix it with a spoon or a fork until combined well. Don't swap breast milk with water to prepare formula milk.

3. Avoid warming the prepared formula in a microwave.

4. Keep the can lid tight to avoid contamination, and do not transfer the powdered milk into another container.

5. Use the prepared milk as soon as possible to prevent bacterial growth.

You might be wondering: should I mix breast milk with formula?

The answer is yes. Once you have prepared the formula, you can mix it with breast milk.

Consult your healthcare provider for feeding guidelines and if your baby is premature or has a specific medical condition.

Safe Mixing Ratios for Combo Bottles

Prepare your formula without any guesswork using grownsy baby formula maker that can help you control the accuracy of the formula-to-water ratio. It is designed to quickly cool hot water to the exact feeding temperature that you can offer to your baby in less than 3 minutes. It helps to preserve the taste and nutritional value of formula.

Powdered Formula and Cronobacter Risk

According to FDA's guidelines, if your baby is born premature (born before 37 weeks), has weakened immunity, and is under 24 months of age, be extra cautious if you are giving them formula milk, as they are prone to getting infections from the Cronobacter that is naturally found in infant formula and starches.

To prevent illnesses and kill Cronobacter, prepare the formula in very hot boiled water. Let it sit for 5 minutes before adding powdered milk. The prepared formula will still be hot. Wait until it feels warm to avoid burning your baby's mouth.

Formula Combo Storage and Warming Rules

When preparing a formula combo, it is important to learn how you can store it, as it spoils if left at room temperature for longer.

Room Temperature Storage Limits

Prepared infant formula spoils at room temperature, so it's recommended to use within 2 hours of preparation. Once your baby starts drinking, use it within one hour because your baby's saliva mixed with the feed results in bacterial growth. Use express pump milk within four hours if stored at room temperature.

Refrigerator Storage Limits

You can safely keep formula combo (infant formula mixed with breast milk) in the refrigerator for up to 24 hours.

Moreover, separately store breast milk for 4 days in the refrigerator or for up to 6 months in the freezer.

How to Warm a Mixed Bottle Safely

Looking for the safest and most convenient way to warm a mixed bottle safely while preventing hotspots? There are various ways to warm a combination feeding bottle, including holding a bottle under warm water to preserve its nutrients for 5-10 minutes or using a bottle warmer to warm formula milk mixed with breast milk.

For the most affordable bottle warmer that is also equipped with upgraded smart temperature sensor, consider Grownsy's 12-in-1 Fast Baby Bottle Warmer that is a perfect solution to your mixed feed warming needs.

Sample Combo Feeding Schedules by Age

Whether you are exclusively breastfeeding your child or opting for combo feeding (breast milk plus formula), the feeding schedule is best decided by your baby's demand and hunger-fullness cues.

However, all babies are different. Some want to be fed every hour, and some take a break of 3-4 hours. Some would have long sleeping intervals in between feeds. Naturally, parents get confused and worry if their baby is properly fed or not.

Here's a sample combo feeding schedule by age so you can feel at ease and feed your baby with confidence.

Let's discuss each one by one so you can specifically get details according to your baby's age.

Combo Feeding Newborn Schedule

The newborn stage is equally important for both mother and her baby. Breastfeeding alone is the most recommended in at least the first few days (unless there is an issue). Breastfeeding in these days helps to regulate and increase the mother's milk flow. According to the CDC, babies breastfeed 8-12 times a day on average.

At this stage, your baby has a really small tummy. They can get full very quickly with small quantities of milk. It is best to feed your newborn every 1-3 hours. If you are combo feeding, you may offer formula after breastfeeding if your baby's healthcare provider has recommended supplementation or your baby still shows hunger cues. Formula feed can be 1 to 2 ounces depending on the requirement.

While a 1- to 3-hour gap is okay between feeds, if your baby sleeps for longer, you must not wait for him to awake to feed him. Get him fed after waking him by gently stroking him or changing his clothes/diaper, etc.

Here is a sample newborn combo feeding schedule.

If your baby follows a different schedule due to his sleeping routine, that's fine as well. Just make sure he is getting fed every 1-3 hours until he is full.

1 to 2 Month Combo Feeding Schedule

By this age, babies have grown a little, and so has their appetite. By now, their schedules are usually predictable. At this time, you can either follow the previous schedule or replace 2 to 3 daytime breastfeeds with formula. A one-month-old baby can take 3 to 4 ounces per feeding session.

Here is a sample 1 to 2 month combo feeding schedule

3 to 6 Month Combo Feeding Schedule

As your baby experiences growth spurts, his appetite increases more than earlier. By this age, they still need to be fed at least 8 to 12 times in 24 hours. Parents can adopt one of these two approaches:

• Offer breastmilk on your free schedules and formula when you're away for work

• Offer breastmilk and formula alternatively

How to Adjust the Schedule Without Dropping Supply Too Fast

If you plan to increase formula feeds, be sure to keep a few points in mind. Our body is designed to adapt to gradual changes. Start by replacing one or two breastfeeds with formula, and drop only one pumping session at a time. This way, your body has time to adjust to the changes, and there is the least risk of a decrease in milk supply. Gradual dropping also helps to reduce discomfort and engorgement.

Whenever you make these transitions, have a close eye on your baby's adjustment to it too. Notice if the baby's diapers are getting wet more frequently than usual. Observe his weight gain. Check if your baby is getting satisfied with the feeds and transition or not.

If, at any point, you are concerned that your baby is not getting well-fed or you observe a decline in your milk supply, talk to your pediatrician for personalized guidance.

Bottle Refusal and Nipple Confusion

Some babies may refuse to accept bottles at the start, as they don't know how to bottle-feed, which makes combo feeding a bit challenging, especially for new moms. Other reasons include that they might not like the taste of powdered formula, or they simply prefer to breastfeed.

Also, some babies link breastfeeding with a nap, and even if you feed them formula, they still look for breast milk to fall asleep. There are other reasons to refuse bottles too. If the baby is suffering from an infection, he will be frustrated if you want to feed him formula.

Choosing the Right Bottle Nipple Flow

Pick a bottle with a slow-flow nipple to avoid nipple confusion. Also, with a formula bottle, it's not only the flow that matters, but your baby is also struggling to adapt to different nipples and the taste of milk. Also, offer powdered formula while they're still sleepy in the morning, and don't wait until your baby starts crying from late feeding.

Paced Bottle Feeding

Paced bottle feeding mimics breastfeeding to prevent nipple confusion. It is a perfect way to help your little baby regulate their intake so they can suck to get milk, take breaks at their own pace (similar to breastfeeding), and stop when they are full for a more responsive feeding session. It helps to avoid the risk of overfeeding that may cause colic symptoms. This technique is perfect for babies who are on formula combo feeding.

When to Get Help From a Lactation Consultant

It is recommended to seek advice from your lactation consultant before deciding on a formula combo feeding plan that can guide your breastfeeding schedule, formula feed ounces, and formula feeding frequency, and give you a plan specifically designed for your baby's needs. Also, if your baby is spitting up a lot and has tummy discomfort after starting an infant formula, immediately seek advice from a lactation expert.

Troubleshooting Common Combo Feeding Problems

Like any milestone of your baby, combo feeding can also be confusing or challenging for some parents. But most issues can be solved with a few adjustments if dealt with patience.

Baby Seems Gassy or Fussy After Formula

Formula combo feeding may cause gas because babies may inhale more air while bottle feeding, or when the feeding routine changes, such as switching between breast milk and an infant formula. This can be resolved by paced feeding and using a slow-flow nipple. Also, follow the pattern: if it happens after a formula or breastfeeding session. It may help identify the actual cause (feeding method or volume).

Baby Refuses Breast After Bottles

You might be thinking that with mixed feeding, your baby might refuse breast milk later. Don't fret. Feeding from a bottle is very different from breastfeeding. To avoid nipple confusion, pick a slow-flow teat. As stated above, it is recommended to start formula combo feeding once your baby has established the breastfeeding habit. For more feeding support, seek your midwife's help to manage combination feeding.

Baby Still Seems Hungry After Feeds

If your baby is still crying and gives hunger cues even after a feed, it means they are not feeding well. Practice responsive feeding and follow their hunger cues if you are formula combo feeding to ensure they are getting adequate nutrition. However, don't force your baby to finish the bottle if they refuse to do.

Pumping Less and Milk Supply Dropping

With formula combo feeding, maintaining your milk supply can be quite challenging. Avoid consecutive bottle feeds, and express milk when skipping breastfeeding, as bottle feeding may affect your milk production due to less demand. Breastfeed your baby at least 8-12 times a day and follow the above feeding schedule to maintain your milk supply when formula combo feeding.

Formula Combo Safety Warning Signs

Almost all formulas that are sold in the USA market contain adequate protein and nutrients specified by the FDA and are designed to meet most requirements of your baby. Though really uncommon, some babies can show intolerance or allergic reactions to formulas based on cow milk. If during combo feeding, your baby shows signs of being unsettled after feeds and frequently vomiting the feeds, you should seek urgent medical care.\

Conclusion

Considering combo feeding for your little one? Most lactation experts recommend starting after a few weeks until they get comfortable with breastfeeding. However, if you find it difficult, it is Ok to start from Day 1. Also, start slow so your body understands that your baby needs less milk, and it gradually slows down milk production. This lowers the chances of breast engorgement and mastitis. Follow this routine for a few weeks so your baby adjusts to the bottle. Also, do not give your baby cow's milk until age 1 year. Babies until 12months of age face difficulty digesting cow's milk. Use either breast milk or formula fortified with iron.

References:

https://wicbreastfeeding.fns.usda.gov/making-milk-expression-work-you

https://www.fda.gov/food/resources-you-food/infant-formula-homepage

https://www.aptaclub.co.uk/feeding/combination-feeding/common-questions-and-concerns.html

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