If you’re combination feeding—also known as "combo feeding"—your baby, it’s natural to feel a bit uncertain about how to balance breastfeeding and formula feeding in a way that supports both your baby’s needs and your breastfeeding goals. Whether you’ve chosen to combo feed to bring more harmony to your feeding routine, because you’ve encountered challenges like low milk supply, or for personal reasons, you’re not alone. This guide is here to offer support, clear advice, and practical tips to help you meet your baby's nutritional needs and develop a new routine that works best for your family.

What is Combo Feeding?

Combo feeding simply means giving your baby both breast milk and infant formula. It can help ensure your baby gets enough nutrition when breastfeeding alone isn’t meeting their needs.

Why Might Combo Feeding Be Necessary?

Combination feeding may be necessary for a variety of reasons. While some mothers choose combo feeding for flexibility, for others it is a response to challenges with breastfeeding or circumstances beyond their control. Here are some common reasons why combo feeding might become needed:

  • Concerns about Weight Gain: If your baby isn't gaining enough weight or has lost too much, adding formula feeds can help them grow.

  • Breastfeeding Challenges: Difficulty latching, nipple damage, or tongue tie can make breastfeeding painful and difficult, leaving some moms to seek alternatives.

  • Medical Concerns: Some babies may need extra nourishment due to medical reasons. In these cases, formula may be needed alongside breast milk to help them thrive.

  • Low Supply: Sometimes a mother’s supply isn’t enough to meet her baby’s needs. Low milk production can happen for various reasons, including breast development or previous surgeries, hormonal issues, or other underlying medical conditions.

  • Return to Work: If you’re heading back to work or school and finding it difficult to pump enough breast milk for your baby, combo feeding can help ensure they’re well-nourished while you’re apart.

  • Personal Choice: Some mothers choose combination feeding because it offers flexibility and balance, allowing them to meet their baby’s needs without the pressure of pumping or exclusively breastfeeding.

Tips for a Smooth Combo Feeding Experience

If you’ve decided to get started combination feeding, here are some tips for making the transition smoother for you and your baby:

Breastfeed First

If possible, try breastfeeding before offering a bottle of formula or pumped milk. This can help maintain your supply and encourage your baby to continue breastfeeding frequently. Try to breastfeed as often as possible, especially in the first month when your full milk supply is being established. Avoid going long stretches without feeding or pumping if you want to protect your supply.

Watch Baby’s Cues

Pay attention to your baby's early hunger cues—such as rooting or sucking on their hands—to know when they need more. Be flexible and patient as you figure out the right amount of additional breast milk or formula to offer.

Formula Preparation

Follow the instructions carefully when preparing formula to ensure it’s safe and provides all the important nutrients your baby needs.

Expect Variation

Every baby is different. Some may only need supplementation after certain feedings, such as in the evening when there may be less milk. Many mothers find that breastfeeding overnight or in the early morning works well, as supply is often higher during those hours. You know your baby best. Adjust the number of feeds and amount of supplement over time.

Pump if Possible

If you’re not breastfeeding as much, consider pumping after some feedings or when your baby gets a bottle, to build a healthy supply of breast milk. Even a few extra pumps a day can protect or improve your supply.

Care for Yourself

Make sure you’re drinking plenty of water, eating balanced meals, and getting enough rest. 

Seek Help

If you’re unsure about how much and how often to offer formula, talk to your baby’s healthcare provider or consider working with a lactation consultant. They can provide personalized guidance as you find the right balance.

A Word on Mixing Milk

Some parents wonder if it’s safe to include a combination of breast milk and formula in the same bottle. While there is limited information about mixing human milk and formula, there may be some advantages to feeding them separately.

  • Practical Considerations: Although mixing breast milk and baby formula is generally considered safe, it can be wasteful. If your baby doesn’t finish the entire bottle, the mixed feeding must be discarded after one hour because formula milk spoils more quickly than expressed breast milk. If you aren't 100% sure that your baby is going to finish the full bottle feed, it's better to be safe and offer the feedings separately.

  • Potential Downsides: One study found that mixing formula with previously frozen breast milk reduced lysozyme activity—a key protein that fights infection—by 41% to 74%. NICU studies with premature babies linked decreased anti-infective activity to an increase in harmful bacteria like E. coli. If your baby is premature or has a compromised immune system, it may be safer to offer breast milk first and then top off with any formula that is needed.

What to Watch For

  • Diaper Changes: Adding formula may make stools firmer, darker, and more odorous. Frequency may decrease to once or twice per day.

  • Decreased Breast Milk Supply: Offering formula may reduce breastfeeding frequently. If you aren’t pumping to keep up your supply, you might notice a decrease in breast milk production over time.

  • Breast Refusal: Some babies may develop a preference for bottle feeding if they are given bottles too soon or too often. While some babies can go back-and-forth with ease, it’s harder for some babies. Breastfeeding frequently can help keep your baby comfortable with both methods. 

Every Drop of Breast Milk Counts!

Breastfeeding doesn’t have to be an all or nothing endeavor. Every drop of breast milk your baby receives is valuable, and combination feeding can be an empowering solution, especially when you experience breastfeeding challenges. Remember, you’re not alone in this journey—many mothers face similar struggles, and it’s okay to seek support when you need it. Trust your instincts, be gentle with yourself, and know that the choices you make are what’s best for both you and your baby. Your love, care, and dedication are what matter most, and you’re doing an incredible job, no matter how you choose to feed your baby.

Disclaimer: Our classes and accompanying materials are intended for general education purposes and should not replace medical advice. For personalized recommendations, please consult your healthcare provider and/or lactation consultant.