Combo Feeding

Abrie McCoy
December 29, 2022

As if evacuating another human from your body was not enough pressure and stress, let’s add the stress of baby feeding on top of it. Reflecting with a friend about the first hours, weeks, and months postpartum and baby feeding, we confided in each other about feeling guilty about using/supplementing with formula even though we had planned to breastfeed. Why should we feel guilty about feeding our babies? 

There is a common argument that breast is best or fed is best. However, that train of thought is pretty narrow minded, only considering the baby in the equation. What about the mom/parent? We know there is a SAFE replacement for feeding babies. Is there a replacement for moms/parents? We need to support parents in their journey of baby feeding. We can do this by taking a holistic approach to the pair. Our focus should be on ensuring that both mom/parent and baby are healthy, supported, and thriving. Parenting success shouldn’t be measured by the number of ounces of breastmilk a baby receives.

What is Combo/Combi or Mixed Feeding?

We know about 35% of babies are supplemented with formula while breastfeeding per the CDC. This type of feeding is typically referred to as “Combo Feeding”, “Combi Feeding”, or “Mixed Feeding” and defined as feeding a baby any amount of breastmilk and infant formula. However, this looks different for every family. Combo feeds may happen through the occasional bottle, top ups, or as the majority of infant nutrition. It is completely dependent on the needs of the family.

Do I have to Combo Feed?

Short answer: no. Families choose to combo feed for different reasons. Some of these reasons include:

  • Medical necessity
  • Concerns with milk production
  • Painful latching
  • Giving the parent(s) a break from feeding
  • Parental separation from baby
  • Relactation process
  • Because the parent chooses to

There is not one “right” way to feed your baby. It is whatever works for you and your family.

The Good & Bad

As with any choice, there are pros and cons.  If choosing to combo feed allows you to provide your baby breastmilk longer, then this can be a benefit! Regardless of amount, breast milk is beneficial! Breastmilk benefits both lactating parent and baby for as long as it is produced and/or given. 

Having an alternative can give parents peace of mind while navigating a variety of issues such as milk supply, weight concerns, as well as having time for damaged nipples to heal. 

However, supplementing can have an adverse effect on breast milk production. If you would like to sustain supply, you still need to express milk the same amount of times as you have been or to match supplemented feeds. If you go longer between emptying your breasts, this sends signals to your body to slow down milk production. As well as increase your risk for clogged ducts (ductal narrowing) or mastitis. Ensuring that you continue milk expression via nursing or pumping will match demand and support milk production.

Another thing to consider, your baby may not prefer eating from the bottle or dislike formula. It may be beneficial to start this transition slowly should you choose to supplement. As well as having continued support from a lactation professional to support you through your journey.

Things to Consider when Combo Feeding

If you are choosing to combo feed, make sure that you are still following and responding to your baby's hunger cues. This is sometimes referred to as responsive feeding. When you respond to your baby’s hunger cues with a bottle, always make sure to pace feed. This will help to avoid over feeding and flow preference. 

Using wide based bottle nipples can help with transitioning between breast and bottle. You may also choose a supplemental nursing system–a tube that can be taped to your breast so that you may supplement at the breast. This allows for the baby to get the supplement needed, and still stimulate supply. 

Try to be consistent with your routine of offering a supplement. For instance, if you are supplementing one feed, offer it at the same time each day. If it is a top up after feeds, always offer breast first. 

Please do not offer bottles with large amounts prior to bedtime in order to get your baby to sleep longer. Research actually shows that it does not help them sleep longer and could also be linked to increasing the risk of SIDS.

Final Thoughts

It is understandably difficult to have to change your feeding plans. You have to meet your child’s needs at the moment. If that includes supplementation, you are doing the best to care for your child. If supplementing with formula was not part of your long term plan, that is ok! Just because you use the supplementation now, does not mean that you will have to use it forever. Getting support from a lactation professional can help with overcoming obstacles and making a decision that is best for your family.