Mixed feeding: Everything you need to know

So you've decided to introduce a few formula feeds to your exclusively breastfed baby. Read this article first for information on mixed feeding

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Exclusive breastfeeding is recommended by health practitioners around the world as the best way to nourish a baby, especially for the first six months of life. However, sometimes, for a variety of reasons, a mother will choose to either exclusively bottle feed her child with milk formula, or offer a combination of formula and breast milk. The latter is known as mixed feeding.

Mixed feeding -- also known as combination feeding, combined feeding, or partial breastfeeding -- is quite common among mums, especially those who still want to give their babies the benefit of breast milk and breastfeeding.

Why mixed feeding?

A mother might choose mixed feeding for a variety of reasons, including:

  • illness or health conditions that prevent exclusive breastfeeding
  • postnatal depression
  • needing to take medication that is not good for the baby
  • a need for flexibility
  • return to paid work
  • concern about baby's weight gain
  • breast or nipple problems (e.g. low milk supply, inverted nipples)
  • personal choice

Whatever your reason for mixed feeding might be, if you are considering this method of feeding your little one, it can be helpful to first talk to a lactation consultant or health professional about your options, and the potential impact of mixed feeding, depending on the age of your baby.

What effect will mixed feeding have on baby (and mum)?

Newborn/infant (under 6 weeks old)

Virgin gut

There is no doubt that exclusive breastfeeding is the safest and best form of nourishment for a newborn baby.

Among the many benefits of breastmilk for a very young baby, one of them is that some antibodies in breast milk help prevent harmful pathogens being absorbed into baby's bloodstream through the creation of a "virgin gut".

This term is used to describe an exclusively breastfed baby's gut -- this unique environment is created by antibodies and other elements of breast milk. (Wade 2010Current Nutrition & Food Science 2012Molecular & Cellular Proteomics 2012).

However, the introduction of milk formula to a newborn, even in small amounts, can destroy this environment, "changing acidity and destroying the immunoglobulins that coat mucosal surfaces" (Mackie, Sghir, Gaskins. Bullen, Tearle, Stewart).

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This means that your baby is more likely to develop allergies later on as your baby's gut becomes 'sensitized' (Lim 2009).

The good news is that evidence suggests several weeks of exclusive breastfeeding can help restore the balance of good bacteria in a newborn's gut.

Supply and demand

If you are considering breastfeeding your baby for at least six months, introducing formula when he is still a newborn will have an impact on your breast milk supply.

This is because a good supply is driven by frequent, on- demand nursing. Once this is interrupted, it means that your newborn direct-latches less often, and therefore you make less milk.

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Nipple confusion

Krista Gray -- an IBCLC Lactation Consultant --  advises that if babies are introduced to an artificial teat before breastfeeding is well established, they might start to prefer the bottle rather than the breast.

This is because the bottle is basically easier to get milk from -- it releases formula in a steady stream. However, a baby has to work much harder to get milk from mummy's breast, and therefore, may start rejecting the breast.

Older baby

Once your baby is older and beyond the newborn stage, mixed feeding works well as you can usually maintain your breast milk supply along with formula feedings, as long as you nurse your baby every day.

In fact, mixed feeding an older baby can bring mum some much needed rest and also help a lot if she is looking to get back to paid work.

Getting started with mixed feeding

Keep these tips in mind if you're thinking about introducing mixed feeding to your baby.

  • Before introducing formula feeds, make sure that breastfeeding is well established with your baby -- generally around 6-8 weeks.
  • Reduce the number of nursing sessions gradually in order to introduce formula milk. While this makes the transition from breast to bottle easier on your baby, it also gives your breasts the chance to adjust to the change, reducing the probability of developing mastitis or becoming engorged.
  • You can offer formula feeds before, during, after or instead of a breastfeed. But do talk to a health professional or lactation consultant about this as different options will suit different situations. For example, formula might be given before a breastfeed to sick babies who are not breastfeeding well. If you are not physically with your baby, then the formula feed will replace the breastfeed. And sometimes, formula might be given in the middle of breastfeeding, if your baby needs the familiarity and comfort of your breasts to settle.
  • Keep in mind that it takes around 3-7 days for your breasts to adjust to missing one feed, if you substitute a breastfeed with a bottle of formula.
  • Try 'topping up' one or more nursing sessions with formula instead of replacing a whole feed. This will increase the gap between breastfeeds, signalling your breasts to make less milk. This will make it easier to replace the breastfeeds you want to drop, with formula.
  • On the other hand, if you are asked to ‘top up’ temporarily because you want to return to exclusive breastfeeding, express milk between feeds to increase the amount of breast milk you make and keep a steady supply.

Introducing a bottle to an exclusively breastfed baby

Getting an exclusively breastfed baby to take a bottle is often a difficult task. They may get confused by the different sucking actions and they may not take the bottle from you anyway.

But there are many different 'tricks' you can try out to help your baby get used to a bottle.

  • Ask someone else, like your partner or another caregiver, to offer the bottle. Your baby associates your breasts with you (and comfort) and may completely refuse to take a bottle from you for these reasons, at first.
  • Try softening the teat with warm, boiled water.
  • Hold your baby in a different position from your usual breastfeeding one. It may help your baby get used to the new way of feeding.
  • Ask your bottle-feeding mum friends for their recommendations on bottle teats. You may go through a few, before finding one your baby likes best.
  • If all fails, ask a lactation consultant or healthcare professional about using a nursing supplementer, as an alternative to bottles. This is a gadget which you use while your baby is at the breast. The supplementer delivers formula, through a tube attached at one end to the teat on a bottle, and at the other end, it’s taped to your nipple. The baby gets formula at the same time as breastfeeding.

The benefits of mixed feeding

For many moms, mixed feeding offers them the opportunity to continue breastfeeding, rather than give up on it altogether.

It's also beneficial to working mums, who, rather than coming home and struggling with a breast pump to express the milk needed for the next day, can direct latch, cuddle and enjoy that time with their baby instead.

Also, mixed feeding gives dad the opportunity to feed baby, bonding with him in the process.

Mums remember: you are not a bad mother for choosing to replace a few breastfeeding sessions with formula. Your baby is still getting your precious breast milk and the benefits it offers, even if you breastfeed just a few times a day.

Do you do mixed feeding? Share your most useful tips with other moms in a comment below. 

Republished with permission from: theAsianParent Singapore

READ: 7 Things that mothers miss after they’re done with breastfeeding