Combo-feeding—a plan that involves feeding a baby a combination of breast milk and formula—is a choice that many families make for their infant. Parents can find much relief in knowing that formula can make up the difference for many reasons including, but not limited to:
Baby was born prematurely and needs formula to get a good start on ensured nutrition (pumping to help establish breast milk supply may be initiated here and moving to exclusive breastfeeding later on may be the goal)
A medical diagnosis of IGT, PCOS, or hypoplasia may be contributing to primary low milk supply, therefore the lactating parent needs formula to be used to ensure baby is getting adequate nutrition
The breastfeeding relationship proves either to be too demanding for the lactating parent who doesn’t make enough milk for their baby
Combo feeding may be more convenient and easier to manage for a lactating parent who has to be separated from their baby for scheduled or unpredictable amounts of time
A working parent who simply doesn’t have the mental or emotional capacity to pump or breastfeed all the breast milk needed to sustain baby’s appetite
A lactating parent who simply would like to free themselves of breastfeeding and let formula do a bit of the work!
Whatever the reason for parents to adopt a combo feeding plan, there should not be any judgment placed on the lactating parent since ANY breast milk given to your baby is better than none at all!
If baby has been prescribed formula for a medical reason that is temporary and the wish is to ultimately exclusively breastfeed or provide all breastmilk, parent must pump breast milk using either a medical grade pump or an electric pump that has been properly fitted with the help of a lactation professional each time formula is given. It is recommended that these pumping sessions be conducted unilaterally (both breasts) for 25 minutes. This pumping routine allows the lactating parent’s body to receive the signal to raise supply and “catch up” to the formula usage. Even if nothing comes out into those bottles the first few times you pump your breast milk - keep on pumping! It takes the body a few days to recognize the consistent demand, and then will slowly adjust to increase supply.
It is important to note that if formula supplementation is recommended during the first days postpartum, it is usually temporary. The feeding plan you come home from the hospital with may change once breast milk has fully transitioned from colostrum to more copious amounts of breast milk and a supply has been established. With the help of a lactation professional who can confirm that milk has transitioned and transfer is happening at the breast, or pumping amounts are sufficient, formula can start to be replaced with breast milk either at the breast or provided by bottle or other feeding mechanism.
If your plan is to combo-feed long term because it is working for your family and there is no need to try to increase milk production, there is no need to pump! Many choose to continue on with their combo-feeding plan - or must, due to diagnosed medical low milk supply- provide some breast milk and some formula daily. It is extremely important to work with a lactation consultant to ensure milk supply (in any amount is protected), there is consistency in adequate stimulation and demand to avoid clogged milk ducts and infection, and ensure that the baby is not being overfed.
Many ask how much formula they should supplement when combo-feeding. This can only be answered ethically after a full lactation consultation to assess how much breastmilk is being consumed, obtaining a current weight for the baby, and assessing the parents’ long term feeding goals.
Some important considerations are milk production and breastmilk/formula flow confusion. Each lactating parent's body is unique and sometimes, less stimulation (ex. Stimulating and feeding less than 60% breast milk due to formula supplementation), the body may gradually reduce supply more and more over time.
Formula is about five to six times thicker than breast milk and should always be pace-fed in a bottle, dropper, or other chosen feeding mechanism.
Combo-feeding can be done using a multitude of different feeding mechanisms and utilizing a plethora of different plans! Here are some examples of combo feeding plans:
Nursing only for comfort, providing formula to make up the difference
Hand expressing breast milk for top-off’s after providing formula bottles
Breastfeeding/chestfeeding during the day, formula at night
Formula while the breastfeeding parent is at work or separated from baby, breastfeeding/chestfeeding upon return
Breast/chest feed for one bottle, formula for the next
Pumped milk during the day, formula at night
Providing pumped breast milk with an SNS or other at-the-breast supplementer while providing a bottle of formula
Nursing a bit to calm the baby at the breast, bottle to provide fullness, nursing for comfort and additional stimulation to end the feeding
…among others! Combo-feeding, whether a diagnosis, medical need, or a conscious choice, should ALWAYS be done in a way that is most comfortable and stress-free for each individual family. Parents and caregivers alike need to be on the same page about what works best for them and lactation professionals should be available to assist as well as work in tandem with pediatricians to effectively make any necessary adjustments along the way. Please reach out to us at www.goldilacts.com
or find us on Instagram @goldilacts if a virtual support session is needed to explore the ways that you can implement a solid combo feeding routine for you and your baby!