By Alison Heyerdahl

Reviewed by Laura Silvas, RN IBCLC

While many of us understand the benefits of breastfeeding, for some moms, exclusive breastfeeding may not always be an option.  In this day and age, many moms have to return to work within a few months of their baby’s birth, adding pumping to their busy schedules. . 

Additionally, many moms struggle with issues such as getting their baby to latch, low milk supply, or poor transfer from breast to baby.  Sometimes, supplementing with formula is a must to ensure proper nutrition in case of breastfeeding difficulties. Some mothers simply make the decision to supplement with formula as a personal choice.  Regardless of the reason, we support you.

Many moms also feel like the only options for feeding are choosing between formula or breastfeeding, but they are not mutually exclusive.  It is possible to successfully breastfeed and supplement with formula simultaneously.  In fact, one out of three breastfeeding mothers in the United States supplement with formula by the time their babies reach the six-month mark. 

This article will outline ways to successfully combine feeds and manage any potential problems along the way. 

How do you introduce formula feeding?

• When to introduce your baby to a bottle:  If you plan to continue breastfeeding, it is essential to ensure that you have an established breastfeeding routine and milk supply.  Many pediatricians, therefore, recommend exclusive breastfeeding for the first month before starting with formula.  This gives moms time to build up a robust milk supply and ensure that their baby is feeding well. Once your baby is breastfeeding well and gaining weight, you can look at introducing her to a bottle. You can book a consult with our lactation consultants to discuss how to introduce the bottle, learn about paced bottle feeding, and pumping schedules to protect your supply. 

• Choose the right infant formula: There are so many different infant formulas on the market that making the right choice for your little one can be difficult.  We recommend talking to your pediatrician, who will likely suggest an iron-fortified formula for the first year of life.  Be aware that it is normal for your baby to have a change in stool patterns as they digest a new source of nutrition. If you are concerned with any of your infant’s reactions to the formula, ensure you are reaching out to your pediatrician. Additionally, be aware that infants younger than one year should never receive regular cow’s milk or any other milk as a replacement for formula or breast milk.    

• Choose the right nipple: Lactation Consultants suggest starting with a slow-flowing, wide nipple that mimics the shape and flow of your own nipples. This will reduce the chances of your baby developing a preference for the bottle over breastfeeding because it won’t be any easier to get milk out of the bottle. Paced bottle feeding ensures that your infant is taking the feeding similarly to breast as well, and at a slower pace. By holding your baby in a more upright position and holding the bottle in a horizontal position so that your baby has to suck a bit harder to get the milk out of the bottle, similarly to breastfeeding. Burp your baby after every ounce. 

• Do not force your baby to formula feed: Don’t force your baby to drink from a bottle if they refuse to do so.  Wait an hour or two, and then try again later.  The American Academy of Pediatrics suggests feeding on demand, as you would do with breastfeeding.  You will easily read the signs that your baby is hungry. 

• Start slowly: Breast milk supply is based on demand.  If you add formula to the mix, it will affect how much breast milk you produce. Going from exclusive breastfeeding to supplementing with too many bottles in a short space of time could also cause problems such as engorgement, blocked ducts, and even mastitis.   Experts suggest replacing one nursing session a week with a formula feeding session.  You can then gradually introduce an extra bottle a week at the same time each day.  This will train your breasts to stop producing milk at this time, however, if you’re wanting to keep your supply up make sure you’re pumping with each replacement of formula feeding. 

  How does formula feeding affect your baby

You may notice a few changes in your baby if you begin to add formula to their diet.  These changes are usually part of the transition and are nothing to be concerned about, but bottle feeding and formula feeding place different demands on your baby. Adding formula to your baby’s diet often changes the pattern, color, and consistency of your baby’s stool.  You may notice that it is darker in color, firmer, and stronger smelling than when they were exclusively breastfed.  They may also poop less frequently. 

Babies also feel fuller for longer when formula feeding, so they may have longer stretches between feeds as their body has to work harder to digest the formula. 

What problems may arise as a result of introducing formula?

• Engorgement: One of the biggest issues mothers complain about after introducing their babies to the bottle is engorgement.  You can relieve some of the pressure by hand expressing or pumping a little milk, but only until you feel relief.  If you empty your breast completely, it will signal to your body that it must continue producing more breast milk. 

• Drop in breast milk supply: Many moms notice that their milk supply begins to dwindle once they introduce their baby to the bottle.  If you wish to keep your supply up, you may need to breastfeed or pump frequently, everytime infant takes a bottle. Refusing the breast: Although you may have established a good breastfeeding routine with your baby, some babies prefer the faster, easier flow of a bottle nipple.  Babies who prefer a bottle may fuss, cry or push the breast away, essentially going on a nursing strike.  This can be very stressful, but it doesn’t mean that you can’t get your baby back onto the breast.  In this case, make sure you’re pace bottle feeding, increase skin to skin, and do more “dream feeds”. 

Conclusion

Overall the goal of all parents is to have a happy, healthy baby that is thriving and growing.  For some moms, it is not possible to breastfeed exclusively, whether they are returning to work or are having issues with breastfeeding.  However, the choice between formula feeding or breastfeeding is not mutually exclusive, and combination feeding can create a balanced and stress-free environment for both mother and baby.