Combination Feeding: Breast Milk and Formula Together

For many families, feeding isn't either/or—it's both. Combination feeding, or mixed feeding, means giving your baby both breast milk and formula. This approach offers flexibility while still providing the benefits of breast milk, and it's more common than you might think.

Whether you're combo feeding by choice or necessity, you can make it work. Here's how.

Why Families Choose Combination Feeding AAP

There are many valid reasons to combine breast and formula.

Common reasons:

• Difficulty establishing full breastfeeding
• Returning to work
• Medical conditions affecting supply
• Partner involvement in feeding
• Personal preference or convenience
• Supplementing during growth spurts
• Giving breastfeeding parent a break

All reasons are valid:

• Any amount of breast milk benefits baby
• Formula is a safe, healthy supplement
• What matters is that baby is fed and thriving
• Your feeding journey is yours to design

When to Start Combination Feeding AAP

Timing affects success differently depending on your goals.

If protecting breastfeeding supply:

• Ideally wait until breastfeeding is established (4-6 weeks)
• This allows supply to regulate
• Reduces risk of nipple confusion
• Gives you time to learn breastfeeding

If supplementation is needed immediately:

• Sometimes medical necessity requires early formula
• This is okay—supplementation is better than baby not getting enough
• You can still work toward breastfeeding goals
• Early supplementation doesn't mean breastfeeding has to end

If combination feeding is the plan from the start:

• You can begin whenever you're ready
• Consider waiting a few weeks if possible
• Pump if baby is getting formula to maintain supply
• There's no wrong answer

How to Maintain Milk Supply While Supplementing AAP

The key principle: milk removal drives milk production.

To protect supply:

• Pump when baby gets a formula bottle
• Or nurse frequently at other times
• Don't skip too many breastfeeding sessions
• Night feeds are especially important for supply

Understanding supply-demand:

• Less nursing = less milk production
• Formula replaces nursing = supply decreases
• Pumping when supplementing helps maintain supply
• You can adjust the balance over time

If you want to maximize breast milk:

• Nurse first, then offer formula "top-up" if needed
• Pump after nursing sessions
• Nurse frequently when you're with baby
• Use formula only when necessary

If you're okay with supply decreasing:

• You can shift the balance toward more formula over time
• Some breast milk continues to provide benefits
• Weaning gradually is more comfortable
• There's no wrong amount of breast milk

Practical Approaches to Combination Feeding AAP

Different methods work for different families.

Method 1: Top-up feeding

• Breastfeed first, then offer formula after
• Baby gets breast milk first
• Formula fills any remaining hunger
• Works well when supply is limited

Method 2: Replacement feeding

• Replace specific feedings with formula
• Common: nighttime bottle from partner, or daycare bottles
• Keeps other feedings as breastfeeding sessions
• Pump if replacing daytime feeds

Method 3: Scheduled split

• Certain times are always breast, others always formula
• Example: breastfeed morning and evening, formula during work hours
• Predictable routine
• Pump during work hours if maintaining supply

Method 4: Flexible combination

• Mix based on circumstances
• Breastfeed when convenient, formula when not
• Less rigid, more adaptable
• Requires paying attention to supply

Avoiding Common Pitfalls AAP

Tips for success with combination feeding.

Nipple confusion:

• Some babies go back and forth easily; others struggle
• If concerned, wait until breastfeeding is well-established
• Try paced bottle feeding
• Use slow-flow nipples
• If issues arise, work with a lactation consultant

Supply dropping faster than intended:

• Pump when formula is given
• Don't replace too many feeds at once
• Maintain night feeds if possible
• Add pumping sessions if supply drops

Guilt and judgment:

• You're feeding your baby—that's what matters
• Any breast milk is beneficial
• Combination feeding is a valid choice
• Ignore unhelpful opinions

Bottle Feeding Techniques for Combo Fed Babies AAP

Paced feeding helps baby transition between breast and bottle.

Paced bottle feeding:

• Hold baby semi-upright
• Keep bottle horizontal
• Let baby pull milk in (don't tip bottle up)
• Pause frequently
• Watch for fullness cues
• Stop when baby signals they're done

Why pacing matters:

• Makes bottle more similar to breast effort
• Prevents preference for "easy" bottle flow
• Reduces overfeeding
• Helps maintain breastfeeding

Nipple selection:

• Use slow-flow nipples, especially at first
• Baby should work a bit for milk
• Increase flow only as needed
• Match bottle feeding time to breastfeeding time

Combination Feeding When Returning to Work AAP

This is one of the most common times to start combo feeding.

Options:

• Pump at work, baby gets breast milk at daycare
• Pump at work, baby gets formula at daycare (pump goes in freezer stash)
• Don't pump, baby gets formula at daycare, breastfeed when home
• Combination of above

If pumping at work:

• Match pump sessions to baby's feeding times
• Pump enough to maintain supply
• This can be challenging—formula supplementation can ease pressure

If not pumping at work:

• Expect supply to decrease
• Can maintain morning and evening breastfeeding
• Breasts will adjust
• This is a valid choice if pumping isn't feasible

Making the transition:

• Start bottles before returning to work
• Have caregiver give bottles to practice
• Start work transition gradually if possible
• Be gentle with yourself during adjustment

The Emotional Side AAP

Feelings about combination feeding are real and valid.

Relief:

• Pressure of exclusive breastfeeding is reduced
• Partner can help with feeding
• More flexibility in your life
• Baby is well-fed—that's what matters

Guilt:

• Common but unnecessary
• Any breast milk benefits baby
• Formula is a healthy choice
• Combination feeding IS a valid feeding method

Grief:

• If combo feeding wasn't your original plan
• Mourning what you envisioned
• These feelings can coexist with doing what's best
• Seeking support helps

Working through feelings:

• Talk to supportive people
• Remember why you made this choice
• Focus on baby's thriving
• Celebrate what you ARE doing

Special Situations AAP

Some circumstances have specific considerations.

Low milk supply:

• Combo feeding ensures baby gets enough
• Continue nursing/pumping to maintain what you have
• Any breast milk is valuable
• Work with lactation consultant if wanting to increase supply

Twins or multiples:

• Combination feeding is very common
• May be necessary to meet caloric needs
• Rotating who breastfeeds can maintain supply
• Finding a sustainable routine is key

Returning to exclusive breastfeeding:

• Possible with dedication
• Work with lactation consultant
• Gradually reduce formula while increasing nursing/pumping
• Not always achievable—and that's okay

The Bottom Line

Combination feeding offers the benefits of breast milk along with the flexibility of formula. Whether you're supplementing to ensure adequate intake, preparing for work, or simply choosing the balance that works for your family, you can successfully feed your baby with both. AAP

Remember:

• Any breast milk is beneficial
• Timing and method can be adjusted to your needs
• Pump when supplementing to protect supply
• Paced bottle feeding helps baby transition
• This is a valid, healthy feeding choice

Clara is here when you have questions about combination feeding your baby.