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Combining Breastfeeding and Formula Feeding

Formula Supplementation

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Updated July 15, 2014

Written or reviewed by a board-certified physician. See About.com's Medical Review Board.

Bottle Feeding

Bottle Feeding

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Feeding your baby formula in addition to breastfeeding is called supplementing. There are many reasons women decide to give their children formula along with breastfeeding. The choice to supplement may be easy or emotional, it may be something you have to do or something you want to do. It can even be a great source of stress and guilt.

The American Academy of Pediatrics recommends breastfeeding exclusively for the first four to six months and then continuing to breastfeed up until one year along with the introduction of solid food. However, the decision to supplement is up to you and the primary goal is that your baby gets the proper nutrition.

Reasons to Supplement

Medical Issues: Babies born prematurely or with certain medical conditions may need supplementation.

Low Milk Supply/Not Enough Milk: If you or your doctor feel that the baby is not getting enough milk through breastfeeding alone, you may need to supplement.

Going Back to Work: Some moms decide to supplement when they go back to work. It may be too difficult or stressful to pump at work.

Partner Wants to Participate: You may want your partner to participate in feedings and give an occasional bottle.

Multiples: It could be a challenge to exclusively breastfeed twins or triplets.

Personal Choice: You may just have a personal preference to breastfeed some of the time and formula feed the rest.

Your Doctor May Recommend Supplementation If:
  • The baby loses more than 10% of his/her body weight in the first few days of life.
  • The baby loses weight or gains slowly after the first few days.
  • The baby is having less than 6 wet diapers in a 24 hour period.
  • The baby is very fussy and does not seem satisfied after feeding.

Choosing a Formula

Most doctors recommend an iron-fortified infant formula during the first year of life. Talk to your doctor about which formula to try. If the baby develops a rash, vomiting, diarrhea, excessive crying, fussiness or gas after starting formula, it may be an allergy . Stop using the formula and notify the baby's doctor to discuss other types of formula available.

Introduction of Supplementation

Experts recommend breastfeeding for at least one month before beginning to supplement in order to build up the milk supply and ensure the baby is breastfeeding well. Gradually introduce the supplementation to prevent problems with engorgement, and blocked milk ducts.

The amount of milk produced each day is based on supply and demand so supplementing can influence how much milk you make. If you plan on supplementing one or two bottles a week, it should not affect your milk supply. If you supplement one or two bottles a day, your milk supply will decrease unless you pump or express your breast milk.

If you would like to feed breast milk and formula during the same feeding, it is not recommended to mix them together in one bottle. It is the most beneficial for the baby to get as much of the breast milk as possible so you should give the breast milk first and then finish the feeding with the formula.

Changes In Your Baby With Supplementation

Refusal to Take the Bottle: The baby may refuse the bottle especially if you are the one giving it to him or her. Try to have your partner or other caregiver give the baby the bottle.

Refusal to Take the Breast: The baby may take the bottle easily. It is more work to get the milk out of the breast than out of the bottle so the baby may start to refuse the breast.

Longer Periods Between Feedings: Formula is not as easily digested as breast milk so the baby may feel fuller longer.

Stool Changes: Adding formula may change the pattern, color and consistency of your baby's poop. Formula stools are usually firmer and have a stronger odor.

The ultimate goal is to have a happy, healthy baby who is growing and thriving. Formula is a safe and effective means of feeding your baby so you should not feel guilty if you need to or decide to supplement. Breastfeeding is best, but it does not have to be all or nothing. Even a little breast milk is better than none. Every baby and situation is unique, a combination of breastfeeding and formula may work well for your family.

Sources:

Auerbach, Kathleen, G. PhD, IBCLC, Montgomery, Anne, MD, IBCLC. (1999). Supplementing the Breastfeeding Baby. Accessed November 19, 2011

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