Last Updated on February 9, 2023

Combination feeding refers to the process of breastfeeding and bottle feeding your baby. The bottle feeds in question here can be expressed milk or formula milk. This practice of offering a breastfed baby both breast and bottle is also called mixed feeding.

An overview of breastfeeding

The World Health Organization (WHO) recommends that babies be breastfed exclusively for the first six months. After that period, liquids, usually in the form of water or water mixed with sugar, are introduced, and solid foods are introduced at 6 months of age. This is done to ensure proper brain development and to prevent allergies.

After six months of exclusive breastfeeding without introducing extra liquids or solids and when the baby has good weight gain, babies can be continued to breastfeed while being given their regular infant formula or solids regularly. Extra formula can be given when breastfeeding is not enough for the baby.

The WHO, the American Academy of Pediatrics (AAP), and the American Academy of Family Physicians recommend that babies only have breast milk from birth. Drinking other liquids, even water, before six months is not advisable because it undermines breastfeeding success. Other liquids and food may reduce a baby’s interest in eating (and therefore drinking) at the breast – which may lead to problems with mother-baby attachment.

The American Academy of Pediatrics (AAP) recommends that baby formula be discontinued when breastfeeding is well-established, and the infant has a good weight gain. Premature babies who are unable to breastfeed may need formula feedings in addition to, not instead of, their mothers’ milk. It is essential to recognize that premature infants have more difficulty accessing breast milk and may be more sensitive than full-term babies.

breastfeeding in the open

What are the benefits of combination feeding?

  • In a 2006 study published in the journal Pediatrics, 10 of 17 exclusively breastfed infants and 3 of 13 formula-fed infants had serious infections. In contrast, none of the combination-fed infants developed any infection.
  • Sanjay Gupta highlights that in addition to preventing infections and allergies with this method, combination feeding enables more varied opportunities for human contact with the baby, which is important for brain development.
  • In some cases, it can be very difficult to breastfeed so a woman may be required to formula-feed her baby. This would then become a combination feeding routine.
  • Combination feeding can be perfect when the mother has difficulty producing milk or breastfeeding her baby doesn’t go well and requires infant formula replacement.
  • Also, for a mother who can only nurse her baby for a certain amount of time or when she needs to be in public for long periods where breastfeeding can be challenging, combination feeding as a substitute or an alternative is perfect.
  • Savings in time and money is the most important reason for combining breastfeeding and bottle-feeding infant formula.
  • The additional cost of formula feeding may also be too high, which prevents the mother from continuing breastfeeding.

What are the drawbacks of combination feeding?

Although combination feeding from birth lets you be more flexible and allows for convenience, especially when it’s only expressed milk, there are some drawbacks:

  • If you combination feed and start bottle feeding your baby too soon, it can cause nipple confusion. This is when the baby cannot determine which to take, the bottle teat or the breast nipple.
  • Every time you bottle feed your baby, whether it’s expressed milk feeds or infant formula, it reduces skin-to-skin time and the chances of forming close and loving relationships.
  • Introducing formula feeds can sometimes cause dietary and stomach upsets. These should gradually reduce as the baby gets used to the balance of mixed feeding with breast milk and formula.
  • The breastfeeding mother’s breasts may become “tired” and produce less milk due to their lesser demand.
  • Some infants might refuse the bottle, which could lead them to reject the breast too.

Is expressed breast milk combination feeding?

Many people combine breastfeeding with exclusively pumping or “expressing” their breast milk as an alternative to combining breast and formula feeding. This still counts as a combination feeding baby, and allows mothers to continue offering their child breastmilk through a bottle.

Couple Bottle Feeding Their Son

Should you express breast milk and start combination feeding?

There are many benefits to expressing and combination feeding expressed breast milk:

  • Expressed breast milk can be stored for up to 10 days in a 1-2°C refrigerator.
  • Bottle feeding means you are more likely to pump before bed or during work hours when you need to express some milk for your baby. With a bottle, you will be able to feed your baby more easily (and conveniently) than if you were breastfeeding from the other breast at night or while on the go.
  • If a mother is going to return to work, bottle-feeding allows her to express milk during the morning and/or evening and freeze it so she can give it to her baby later.
  • If a mother’s partner is going to be caring for the baby, he can more easily prepare a bottle. For example, the partner can get the bottle out and defrost the milk, ready to give the baby at her convenience.
  • Bottle feeding allows you freedom of movement because you’re not tied down by your child holding onto your breast.
  • Breastfeeding mothers often worry that they are not producing enough milk. When you bottle feed, you will know exactly how much milk your baby takes by seeing the amount of expressed breast milk given in a day.
  • Your breast milk supply increases when you express using a breast pump and breastfeed too. The more milk that flows from your breasts, whether through a baby’s mouth or breast pump, the better the long-term milk supply.
Manual breast pump and milk


Many mothers choose not to exclusively breastfeed due to the lack of support, excessive pressure or other issues such as social or privacy problems. In addition, many mothers have insufficient milk production and rely on formula supplementation for their infants to gain weight and grow properly.

However, as you can see from the above, combining breast and bottle feeding can have many benefits, especially if you start combination feeding after six months of exclusively breastfeeding.

If combination feeding is something you’re considering but still unsure about, speak to your health visitor or lactation consultant for more advice.

Additional Resources

Sources and References

  1. How To Combine Breast And Bottle Feeding –
  2. Mixed Feeding: Supplementing Breastfeeding With Formula –

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