Combination Feeding: How to Breastfeed and Bottle Feed

Combination feeding, also called mixed feeding, means combining breastfeeding with bottle feeding. The bottle might contain expressed breast milk, infant formula, or you may use both at different times.

There is no single combination feeding routine that suits every family. You might want someone else to give an occasional bottle, need feeds covered while you are away from your baby, want to introduce formula while continuing to breastfeed, or be trying to move from bottle feeding towards more breastfeeding.

The main thing to know is that changes to breastfeeding can affect your milk supply, so it is helpful to introduce changes gradually where possible. Bottle feeds should also be responsive, with your baby’s hunger and fullness cues guiding the feed.

If maintaining breastfeeding is important to you, support from a midwife, health visitor or breastfeeding supporter can help you find an approach that fits your circumstances.

What is combination feeding?

Combination feeding simply means using more than one way to give your baby milk.

You might breastfeed and give bottles of expressed breast milk. You might breastfeed for some feeds and use first infant formula for others. Some families use expressed breast milk and formula in bottles alongside direct breastfeeding.

Your arrangement does not need to look like anyone else’s.

Some parents combination feed from necessity, while others choose it because it gives them more flexibility. Your feeding pattern can also change as your circumstances and your baby’s needs change.

If you are breastfeeding and thinking about introducing bottles, NHS guidance suggests allowing time for you and your baby to become comfortable with breastfeeding first where possible. There are situations where supplements or bottle feeds are needed earlier, so follow individual advice from your maternity or neonatal team if you have been given a feeding plan.

How introducing bottles can affect milk supply

Breast milk production responds to milk being removed from the breasts.

If a bottle of formula regularly replaces a breastfeed, your breasts receive less stimulation. Over time, this can reduce the amount of milk you produce.

That does not mean combination feeding and breastfeeding cannot work together. It simply means that your feeding pattern matters if maintaining your current milk supply is one of your goals.

The NHS recommends introducing formula feeds gradually where possible. This gives your body time to adjust and can reduce the chance of uncomfortable, overly full breasts and mastitis.

If you want to maintain milk production while someone gives your baby a bottle, expressing milk may help replace some of the stimulation that would otherwise have happened during a breastfeed.

Exactly how often you need to express depends on your situation. If milk supply is a concern, ask a midwife, health visitor or breastfeeding specialist for individual guidance rather than trying to follow a generic pumping schedule.

Introducing your baby to a bottle

A baby who is comfortable breastfeeding may not immediately understand what to do with a bottle. That can be frustrating, particularly if you need them to accept one by a particular date.

Give them time.

NHS guidance suggests offering early bottle feeds when your baby is calm and relaxed rather than waiting until they are extremely hungry.

Some babies may accept a bottle more readily from another caregiver, particularly if they associate you strongly with breastfeeding. Others are perfectly happy taking both breast and bottle from the same person.

There is no need to force the teat into your baby’s mouth. Hold them close in a semi-upright position, gently touch the teat to their top lip and allow them to draw it into their mouth.

Keep the bottle almost horizontal, with only a slight tilt. This helps your baby control the flow of milk rather than having milk pour quickly into their mouth.

Keep bottle feeds responsive

Being able to see exactly how much milk is in a bottle can make it tempting to focus on getting your baby to finish it.

Try to watch your baby instead.

Your baby may pause, stop sucking, turn their head away, spill milk from their mouth or push the bottle away when they need a break or have had enough.

Allow those pauses. Do not pressure them to finish the bottle.

Responsive bottle feeding is useful whether the bottle contains expressed breast milk or formula. It gives your baby more control over the pace and amount they drink.

Never leave a baby alone with a propped bottle, and take them out of a sling or carrier before breast or bottle feeding so they can be held in a safe feeding position.

Using expressed breast milk for bottle feeds

Expressing can be useful if you want another caregiver to offer breast milk while you are away or if you want to maintain breast stimulation when a direct breastfeed is missed.

You can express by hand or with a manual or electric breast pump.

Wash your hands before expressing and use clean equipment. Breast milk also needs to be stored and handled according to current NHS guidance.

Do not be discouraged if the amount you express seems smaller than expected. The amount collected by a pump is not necessarily a direct measure of your overall milk supply or the amount your baby can remove during breastfeeding.

If expressing is becoming painful, difficult or stressful, ask for help. A midwife, health visitor or breastfeeding supporter can advise on expressing technique and equipment.

Using formula alongside breastfeeding

If you are adding formula, first infant formula is the standard formula for most babies during their first year unless a healthcare professional recommends something different.

Powdered infant formula is not sterile, so it must be prepared carefully.

The NHS recommends making powdered formula one feed at a time as it is needed. Use fresh tap water, boil it, then allow it to cool for no more than 30 minutes so it remains at least 70°C when mixed with the powder.

Follow the formula manufacturer’s instructions exactly. Use the scoop supplied, put the correct amount of water into the sterilised bottle first and then add the specified number of level scoops.

Do not make formula stronger by adding extra powder or dilute it with extra water.

Cool the prepared bottle before feeding and check the temperature on the inside of your wrist. Never use a microwave to heat formula because it can create hot spots.

Discard formula left in the bottle after a feed.

Cleaning and sterilising bottle-feeding equipment

If bottles are becoming part of your routine, cleaning and sterilising them properly is essential.

The NHS recommends washing and sterilising bottles, teats and other feeding equipment until your baby is at least 12 months old.

Wash equipment in hot, soapy water using brushes kept specifically for feeding equipment, then rinse in clean, cold running water before sterilising.

You can use cold-water sterilising solution, steam sterilising or boiling, depending on the equipment you have and the manufacturer’s instructions.

Even if you are only giving an occasional bottle, the same hygiene guidance applies.

Finding a combination feeding routine

One of the first questions many parents have is which feeds should be breastfeeds and which should be bottles.

There is no universal schedule.

Your routine may depend on why you are combination feeding. If you are returning to work, bottles may cover feeds while you are apart. If your partner wants to take part in feeding, you may choose a bottle at a time that works for your household. If formula has been introduced because of concerns about your baby’s intake or growth, you may have a specific feeding plan from a healthcare professional.

If maintaining your milk supply matters to you, regular breastfeeding remains important. Replacing breastfeeds with formula can gradually reduce production, so discuss your plans with a feeding professional if you are unsure how to balance the two.

It can also help to change one thing at a time. A gradual adjustment gives you and your baby a chance to get used to the new pattern.

Yes. One reason families choose combination feeding is so a partner or another caregiver can give some feeds.

That can be useful if you need to be away from your baby or simply want someone else to take responsibility for a feed.

It is worth remembering that sharing feeding does not require sharing every feed equally. If you want to protect breastfeeding and milk supply, there may be other ways a partner can make feeding easier too, such as bringing the baby to you, burping them afterwards, washing feeding equipment or settling them after a feed.

The right balance is the one that works for your family while meeting your baby’s feeding needs.

What if your baby prefers the breast or bottle?

Some babies move between breast and bottle fairly easily. Others take time to adjust or begin showing a strong preference.

If your baby refuses a bottle, try not to turn feeding into a battle. Offer it when they are calm, allow them to explore the teat and give them time to learn a different way of sucking.

If your baby becomes less interested in breastfeeding after bottles are introduced, check how bottle feeds are being given. Keeping the bottle relatively horizontal and allowing pauses can help your baby control the flow.

If you want to increase breastfeeding again, NHS guidance recommends seeking support. Frequent breastfeeding, skin-to-skin contact and expressing can all play a role in encouraging milk production, but your individual plan will depend on your baby’s feeding and your current supply.

A breastfeeding supporter, midwife or health visitor can watch both breast and bottle feeds and help you work out what may be happening.

Changing your combination feeding balance

Combination feeding does not have to stay the same.

You may decide to breastfeed more and reduce bottles, or gradually introduce more formula and reduce breastfeeding. Both changes are easier to manage with some thought about milk supply.

If you are reducing breastfeeding, doing so gradually gives your breasts time to adjust and can lower the risk of engorgement and mastitis.

If you want to increase breastfeeding, your breasts generally need more regular stimulation and milk removal. Your baby may also need help becoming comfortable at the breast again.

This is an area where personalised support is particularly useful. Feeding history, milk supply and your baby’s ability to breastfeed effectively all matter.

When to get professional advice

Speak to your midwife, health visitor, GP or breastfeeding supporter if you are unsure how to combine breast and bottle feeds, particularly if you want to maintain or increase your breast milk supply.

Ask for help if breastfeeding is painful, your nipples are damaged, your breasts become persistently painful, swollen, red or hot, or you develop symptoms that make you feel unwell.

You should also seek advice if your baby repeatedly refuses feeds, struggles to breastfeed or bottle feed, seems distressed during feeds, is unusually sleepy, has fewer wet nappies than expected or you are concerned about their weight or milk intake.

If formula has been recommended as a top-up because of concerns about your baby’s weight, health or milk intake, follow the feeding plan given by your healthcare team. Do not reduce prescribed top-ups without discussing it with them.

If your baby appears seriously unwell, has difficulty breathing, becomes unresponsive or is choking, seek urgent medical help.