Mixed feeding

What is mixed feeding?

Mixed feeding is when you feed your baby formula as well as breast milk.

Mixed feeding can involve:

• breastfeeding and giving your baby formula
• breastfeeding and giving your baby a combination of expressed breast milk and formula
• bottle feeding your baby using expressed breast milk and formula

How you feed your baby is a personal choice. It’s important to know that mixed feeding with formula can make breastfeeding more challenging, as it can reduce your milk supply. If you prefer to feed your baby using a bottle, you might choose to feed your baby with expressed breast milk.

It’s a good idea to talk to a health professional if you are thinking about introducing formula so they can give you advice and support.

Why might I think about mixed feeding?

Exclusive breastfeeding for about the first 6 months is the ideal start for your baby. Many parents choose to combine breastfeeding and bottle feeds for a variety of reasons, including:

• issues with breastfeeding
• low breast milk supply
• a baby with slow weight gain
• returning to work

Issues with breastfeeding

Sometimes, breastfeeding can be challenging. It’s important to be patient and remember that both you and your baby are learning.

Some of the physical challenges with breastfeeding can include:

• sore, cracked or bleeding nipples
• painful, blocked ducts in your breasts
• mastitis — inflammation of your breast that can cause pain and flu-like symptoms
• oral thrush or breast and nipple thrush
• nipple vasospasm — where the blood vessels in your nipple tighten and go into spasm, preventing blood from flowing normally
• inverted or flat nipples — consider getting advice from a professional about trying a nipple shield

Some other challenges with breastfeeding can include:

• difficulty attaching your baby to your breast — seek advice on positioning and attachment and check for issues such as tongue-tie or cleft palate
• your baby becoming 'fussy' at the breast or refusing to feed
• discomfort breastfeeding in a public
• returning to work — while some people successfully combine breastfeeding with returning to work, others may prefer not to

You can get help for many of these issues. This might allow you to continue breastfeeding or return to exclusive breastfeeding if you choose.

Low breastmilk supply

You might worry that you don’t have enough breast milk for your baby. If you're not producing enough milk, there are things you can do to try and increase your breast milk supply.

The best way to establish a healthy supply of breast milk is to breastfeed often. Check that your baby is latching on well and emptying your breasts. If you are struggling, ask for help from your midwife, lactation consultant or doctor.

Signs that your baby is getting enough milk (after the first week of life) include:

• 6 to 8 wet nappies (4 to 5 heavy disposable nappies) in a 24-hour period
• having 8 to 12 breastfeeds in 24 hours
• passing soft yellow poo (3 to 4 times a day, if they are younger than 6 to 8 weeks old)
• settling and sleeping between most feeds
• returning to birth weight by about 2 weeks old
• gaining an average of 150g or more every week for their first 3 months

A small number of people may have low supply due to past breast surgery, insufficient breast tissue, or another medical reason. In these cases, you may be able to produce some breast milk and choose mixed feeding for your baby with donor milk or formula.

Baby with low weight

You may consider mixed feeding if you’re worried that your baby has lost or is not gaining enough weight. All babies grow differently, and their weight may change at different times.

Sometimes, slow weight gain is nothing to be concerned about and only lasts for a short time due to a temporary milk supply or feeding issue. At other times, your health professional may suggest that your baby may benefit from mixed feeding. Some examples include if they:

• were born very prematurely (earlier than 32 weeks)
• born at low birth weight
• are unwell or have a medical condition.

Depending on the situation, a health professional might suggest introducing extra feeds for your baby. You might choose to give your baby expressed breast milk for these feeds, or you may begin mixed feeding with formula.

How can I mix feed my baby effectively?

To mix feed your baby, it’s a good idea to aim for a balance that supports both breast milk production and the nutritional needs of your baby.

Here are some tips:

• Offer your baby frequent breastfeeds, especially in the first weeks, as you establish your milk supply.
• Continue to breastfeed often, even when you are supplementing with formula, to help keep up your milk supply.
• If you are using formula for top-ups and want to maintain your supply of breast milk — start with small amounts and gradually increase if needed, while continuing to breastfeed often.
• Seek advice from health professionals to manage mixed feeding.

Visit a child health nurse, breastfeeding counsellor or lactation consultant to help you manage mixed feeding. It’s important that your baby gets the nutrition they need from both breast milk and formula.

How do I move from mixed feeding to full breastfeeding?

If you are planning to fully breastfeed after mixed feeding, it’s important to increase your breast milk supply.

When you breastfeed, the more milk that is removed, the more milk your breasts will make. To increase your milk supply:

• Offer your baby breastfeeds more often, even if your baby won’t feed for long.
• Feed from both breasts at each feed.
• Ensure you and your baby are comfortable and your baby is well-attached during feeds.
• Help your milk flow by being relaxed when feeding, practicing deep breathing and applying warmth by stroking your breast inwards (towards the nipple).
• Gradually cut down on formula feeds, so your baby is hungrier for your breast milk.

Your healthcare professionals can help support you with this.

FIND A HEALTH SERVICE — The Service Finder can help you find doctors, pharmacies, hospitals and other health services.

What to expect when mixed feeding

If you try mixed feeding, it’s good to be aware of the following:

• If your baby is used to breastfeeding, they might resist the bottle at first. Try asking someone else, like your partner or a family member, to offer the bottle to your baby.
• Your baby might take milk from a bottle more quickly and start to prefer the bottle to the breast. This might cause your baby to refuse the breast.
• Your baby’s poos will change in colour, smell and consistency.
• Your breasts might get overfull, which can be painful. It can also cause your body to stop producing milk.
• If you started mixed feeding because you were concerned about your milk supply, this might be a sign to increase breastfeeding again and reduce mixed feeding.

Resources and support

For help introducing or managing mixed feeding contact:

• a registered lactation consultant
• your maternal child health nurse
• your midwife
• your doctor

The Australian Breastfeeding Association Breastfeeding Helpline has information and support from qualified breastfeeding counsellors — call 1800 686 268 (1800 mum 2 mum).

Looking for information for Aboriginal and/or Torres Strait Islander people?

The Australian Breastfeeding Association offers breastfeeding resources for Aboriginal and/or Torres Strait Islander families.

Check out the graphic guide to breastfeeding for Aboriginal and/or Torres Strait Islander parents.

Watch the video Just Let Them Feed — a health resource on breastfeeding.

Do you prefer to read in languages other than English?

Read the Australian Breastfeeding Association's Breastfeeding Confidence — a guide to breastfeeding in a range of community languages.