Can You Breastfeed and Use Formula?
This post was written in partnership with Kabrita Goat Milk-Based Infant Formula. All opinions are my own. If you are a healthcare provider, join Kabrita’s Medical Herd to get access to new research, free continued education to share with your patients and peers, and invites to events.
Breast milk is a dynamic, special fluid that gives babies the best nutrition and protection against sickness. It also helps mothers stay healthy. However, there are instances when breast milk is not available, when breast milk alone cannot meet a baby’s needs, and when challenges can make exclusive breastfeeding and/or exclusive pumping difficult (which both require a great deal of time and effort).
Some mothers may struggle to produce enough breast milk, while others may encounter health issues or life circumstances that complicate their breastfeeding journey. Adoption, surrogacy, and the use of donor milk may also lead to circumstances under which breast milk is not available in adequate amounts for a growing baby.
Pediatricians may sometimes suggest incorporating infant formula to ensure adequate nutritional intake and growth, especially if a baby is experiencing severe jaundice. This leads many parents to wonder, “Is it okay to breastfeed and use formula?”
Rest assured, it's perfectly normal and acceptable to breastfeed and use formula. Your baby will still reap many of the benefits of breastfeeding, even when both are offered.
In this post, I’ll guide you through the process of supplementing infant formula for a breastfed baby. We'll discuss how to mix formula with expressed breast milk, feeding schedules, and finding the best formulas for supplementation while ensuring the mother's breast milk supply is maintained. Let's get started!
How to Introduce Infant Formula to a Breastfed Baby
When you start giving your baby formula in addition to breastfeeding, it's a good idea to have a plan. This plan should involve gradually introducing the formula to your baby.
If possible, it can be helpful to wait to introduce formula in a bottle until your breast milk supply is well-established and both you and your baby have gotten the hang of breastfeeding. Waiting until this point (usually around 5-6 weeks of age) can help protect the breastfeeding relationship and make it easier for your baby to go back and forth between the breast and bottle.
That being said, if you want or need to introduce formula earlier, you can absolutely continue to breastfeed too. Choosing a bottle nipple that allows your baby to latch in a way that most closely mimics your baby’s latch on the breast, and using a paced bottle-feeding technique to help approximate the flow of breast milk from the breast will help protect the breastfeeding relationship and facilitate combo-feeding as well.
Always keep in mind that every baby is different, so what works for one may not work for another. Try your best to be patient and flexible as you navigate this transition. Here's a general guide for how to introduce baby formula:
Start Slowly: Begin by replacing just one feeding per day with a bottle of formula. This gradual transition helps minimize potential digestive issues and allows the baby to adapt to the new feeding method. If you plan to continue breastfeeding or pumping, make sure to pump while baby drinks this bottle to prevent painful engorgement and clogged ducts.
Mixing Breast Milk and Formula: If your baby is hesitant about the taste of formula, you can try mixing breast milk and formula in one bottle. Begin with more breast milk than formula and slowly add more formula as tolerated.
Offering Formula in a Bottle: Some babies may initially resist the bottle if they are used to breastfeeding only. You can try different bottle nipples to find one that most closely mimics your baby’s latch on the breast. Most lactation specialists recommend a slow-flow nipple and paced bottle feeding to help mimic breastfeeding initially, especially for babies under 3 months of age. In general, paced bottle feeding involves positioning the baby more upright and holding the bottle in a more horizontal position so that the baby can control the milk flow. If your baby is 6 to 12 months old, you can offer formula or breast milk in a straw or open cup.
** TOP TIP ** Try having another caregiver other than mom introduce the bottle while baby is calm and not overly hungry, as some babies will prefer to nurse if near their moms.
Be Patient: Give your baby time to get used to formula in a bottle, especially if they are used to breastfeeding. Continue offering formula at regular intervals, but if your baby is resisting, do not force it. Try again at the next feeding.
Gradually Increase Formula: Pay attention to your baby's cues and reactions. If they seem to be accepting and tolerating the formula well and you’re not noticing issues like constipation, excessive spit-up, or gassiness, you can gradually increase the amount of formula offered.
Maintain Bonding: Continue to maintain skin-to-skin contact and bonding during feeding times, whether you are breastfeeding or bottle-feeding with formula. Regardless of the feeding method, this helps your baby feel secure and connected to you.
*** Keep in mind that while others may have strong opinions about your baby’s feeding journey, all reasons for wanting to introduce infant formula are valid. Whether you are experiencing challenges related to breast milk supply, or your baby has medical needs requiring increased calories or is unable to continue exclusive breastfeeding. Or if pumping on the go is just getting to be too much to manage in your busy schedule. Tune out any noise or judgment as best you can and do what’s best for your baby and you.
Rules for Mixing Breast Milk and Formula
When mixing breast milk and formula, it's important to follow specific guidelines for the safety and nutritional integrity of the feeding. Remember to always start by washing your hands and using properly cleaned feeding equipment.
First, follow the instructions on the formula packaging to prepare the desired amount of formula. You may want to keep it at room temperature or warm it slightly to help mimic the milk temperature while breastfeeding.
If you combine formula with expressed breast milk to help your baby adjust to the flavor of formula, make sure you’re using breast milk that is either fresh or that has been properly stored and reheated. Per the Centers for Disease Control and Prevention, freshly expressed breastmilk can be stored at room temperature for up to 4 hours, refrigerated breast milk is good for four days, and defrosted, previously frozen milk is safe in the fridge for up to 24 hours.
Combine the desired amount of prepared formula with the desired amount of pumped breast milk in a clean bottle. For example, if you want to make a 4-ounce bottle, you can start by adding the water first, then the formula powder needed to make 1 ounce of infant formula; then add 3 ounces of expressed breast milk.
Once your baby is tolerating this ratio well, increase to 2 ounces of infant formula and 2 ounces of pumped breast milk, adjusting the ratio further as tolerated until a bottle of 100% infant formula is accepted.
If there is any leftover mixed breast milk and formula after feeding, discard it within one hour.
Continuing to offer infant formula once you start
It is important to note that if your baby is introduced to and tolerates a cow’s milk-based type of formula at any point during infancy, keep offering it. Regular ingestion of cow’s milk infant formula, even as little as 10 mL, or about two teaspoons, daily, has been shown to help prevent loss of tolerance and may help prevent the development of cow’s milk allergy in infants.
To learn more about preventing food allergies, click here to preorder a copy of my new book, Safe and Simple Food Allergy Prevention. This accessible, practical guide to starting solids will empower you to safely introduce top allergens, navigate existing food allergies and intolerances, engage your baby in family meals, and build a balanced baby meal from recipes the whole family will enjoy.
Formula Closest to Breast Milk
While no formula can exactly replicate breast milk's composition, some formulas are designed to be closer to breast milk in terms of their nutritional content and composition. The best baby formulas for supplementing breastfeeding are options that closely resemble breast milk, are gentle on babies' stomachs, and adhere to all safety standards set by the Food and Drug Administration.
When choosing an infant formula to supplement breast milk, choose an iron-fortified infant formula that meets all of the FDA’s nutrient requirements for baby formula. Thankfully, all commercially prepared infant formula sold in the United States must follow strict safety regulations from the FDA and are required to include the essential nutrients necessary for infant growth and development. Be sure to check the expiration date, make sure the seal is not tampered with, follow the prep instructions on the can, and only use the provided scoop as those can vary from brand to brand.
The American Academy of Pediatrics (AAP) “recommends that iron-fortified infant formula be used for all infants who are not breastfed, or who are only partially breastfed, from birth to one year of age.” While most infant formulas sold in the US will be fortified with iron (between 4 to 8 mg/L), some may have lower than recommended amounts, so be sure to check the label.
Breast milk contains essential fatty acids like DHA (docosahexaenoic acid) and ARA (arachidonic acid), which are crucial for brain and nervous system development. Some studies suggest that some infants (such as premature infants, for example) may benefit from consuming DHA and ARA directly, so many formula companies have added these nutrients to their products.
Breast milk also contains human milk oligosaccharides (HMOs), which are special prebiotic carbohydrates that support the development of a baby's immune system and digestive health. Although current research on the lasting advantages of probiotics and prebiotics for babies is so far inconclusive, certain formulas now contain artificial HMOs and probiotics to replicate the benefits of breast milk.
Infant formulas that use goat milk as a base are a great choice if you’re looking for a product to supplement breast milk. The proteins in goat milk are naturally more similar to breast milk than cow milk, and goat milk naturally contains five times more oligosaccharides than cow milk. (Oligosaccharides are the third largest component of breast milk; they form prebiotic fibers, which help mature the gut microbiome and protect against pathogens and harmful bacteria.)
There is currently only one brand of European-produced goat milk-based infant formula (Kabrita Goat Milk Infant Formula) that meets all requirements set by the FDA and is here to stay in the U.S.
Kabrita's goat milk-based infant formula is easily tolerated and digested and tastes slightly sweet (I’ve tried it, it tastes good! There are no “goaty, off flavors”). By incorporating evidence-based ingredients including iron, folic acid, high sn-2 palmitic acid, DHA, ARA, and prebiotics, Kabrita’s goat milk-based formula closely resembles the nutrient profile of breast milk, which makes it ideal for families seeking to complement breastfeeding with a suitable formula alternative.
If you are looking for more guidance on formula supplementation options, check out my post on Best Formulas to Supplement Breastfed Babies. Do not use homemade infant formulas, which can cause food-borne illnesses, electrolyte imbalances, kidney damage, and poor growth.
Be sure to consult with your pediatrician or registered dietitian before choosing a formula for your baby, especially if your baby has any specific nutritional needs or digestive issues.
Dangers of Mix Feeding a Baby
Feeding a baby both breast milk and infant formula is not inherently dangerous. However, there can be a few potential drawbacks.
One is the cost of formula, which can increase the financial burden on families, but the cost may be offset by the time saved and time made available for work due to formula feeding.
There is a potential for nipple confusion when first introducing a bottle to a breastfed baby. Nipple confusion is “an infant's difficulty with or preference for one feeding mechanism over another after exposure to artificial nipple(s),” and it can be alleviated by paced bottle feeding techniques that help mimic breastfeeding.
Some babies have no problem alternating between breastfeeding and bottles, while others have a more challenging time. According to La Leche League, one tip for reducing nipple confusion involves waiting until around four weeks of age before introducing a bottle. This is when breastfeeding is well-established.
If your baby refuses to breastfeed after starting with bottles, try using a skin-to-skin position while breastfeeding, feeding in a dimly lit, calm location, and expressing a little bit of milk onto the nipple to encourage your baby to latch.
Introducing formula to a breastfeeding routine can sometimes decrease breast milk supply. This is because breast milk production operates on a supply-and-demand basis, and if you don’t pump during a formula-feeding session, it can signal the body to produce less milk.
If you wish to continue breastfeeding, do your best to pump each time your baby takes a bottle to help maintain your milk supply.
Pros and Cons of Breastfeeding and Formula Feeding at the Same Time
As a pediatric dietitian and infant feeding expert, I find pros and cons lists helpful when making decisions! To sum up what we covered earlier, I wrote down some pros and cons of combination-feeding for you:
Pros:
- Flexibility for mothers who may face difficulties with breastfeeding or simply want to wean
- Shared feeding responsibilities, allowing partners and other caregivers to participate
- Assurance of adequate nutrition, particularly when breastfeeding alone may not suffice
Cons:
- Potential confusion for the baby (i.e., nipple confusion or preference for one feeding method over the other)
- Possible difficulty in maintaining milk supply if breastfeeding sessions are supplemented with formula too frequently without pumping
- Added cost of infant formula
Breastfeeding and Formula Feeding Schedule
Establishing a feeding schedule that incorporates both breastfeeding and formula feeding can be helpful.
When exclusively breastfeeding, most babies feed on demand according to their hunger and fullness cues. According to the American Academy of Pediatrics (AAP), exclusively breastfed babies feed about 8-12 times a day. In contrast, formula-fed babies usually feed about every 3 to 4 hours over a 24-hour period.
When feeding a combination of breast milk and formula, be sure to respond to your baby's signs of fullness. Pushing the bottle away, turning away their head, spitting out the milk, or chewing on the nipple often signals that the feeding is done.
Talk to your pediatrician if your baby consistently drinks more or less in their bottle than the AAP's general guidelines below:
Newborn (first week): 1-2 fluid ounces per feeding
1-month-old: Gradually increase formula until the baby is taking 3 to 4 fluid ounces per feeding (maximum of 32 fluid ounces per day)
2 months old: 3 to 4 fluid ounces per feeding (maximum of 32 fluid ounces per day)
6 months old: As babies get older and start eating solid food, they can drink more per feeding and usually start taking milk feeds less frequently throughout the day; babies drinking formula and breast milk from a bottle can drink about 6 to 8 fluid ounces about 4 to 5 times per day
Can You Breastfeed and Use Formula at Night?
Yes, it's fine to breastfeed during the day and use formula at night or vice versa. This approach allows caregivers to share the feeding responsibilities and ensure that the baby gets enough nourishment around the clock.
Keep in mind, however, that fewer breastfeeding sessions throughout the day or night without pumping while the baby takes a bottle may reduce breast milk supply.
Final Thoughts
Ultimately, the decision to breastfeed, formula feed, or offer both is deeply personal and influenced by various factors. While breastfeeding is considered the gold standard, incorporating formula into the feeding routine can provide flexibility for families while meeting the baby's nutritional needs. Ultimately, the key is finding a feeding approach that works best for your baby and for you.
* If you need additional support for specific nutritional concerns, reach out and schedule a virtual one-on-one consult in my pediatric nutrition practice.
* If you are a parent looking for high-quality feeding options for your baby that more closely resemble breast milk, learn more about Kabrita, the #1 goat milk infant formula brand worldwide.
* If you are a healthcare provider, join Kabrita’s Medical Herd to receive educational newsletters, research updates, and event invitations and stay up-to-date on the latest infant nutrition and product information.
Thanks for reading!
XO ~ Malina