Mixed feeding 3 month old baby

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How to combine breast and bottle feeding

It can take several weeks for you and your baby to feel happy and confident with breastfeeding.

Once you've both got the hang of it, it's usually possible to offer your baby bottles of expressed milk or formula alongside breastfeeding.

This is sometimes called mixed or combination feeding.

Why combine breast and bottle?

You may want to combine breastfeeding with bottle feeding if you:

• are breastfeeding and want to use a bottle to offer your baby some expressed breast milk
• want to breastfeed for some of your baby's feeds, but give bottles of formula for 1 or more feeds
• are bottle feeding your baby and want to start breastfeeding
• need to leave your baby and want to make sure they have some milk while you're away

Introducing formula feeds can affect the amount of breast milk you produce. There is also a small amount of evidence to show babies may not breastfeed as well because they learn to use a different kind of sucking action at the bottle than at the breast.

These things can make breastfeeding more difficult, especially in the first few weeks when you and your baby are still getting comfortable with breastfeeding.

Your breastmilk supply will usually not be affected if you start bottle feeding your baby when they are a bit older, you are both comfortable with breastbeeding, and you breastfeed every day.

Introducing formula feeds

If you're combining breastfeeding with formula feeds both you and your baby can carry on enjoying the benefits of breastfeeding.

If you choose to introduce infant formula:

• it's best to do it gradually to give your body time to reduce the amount of milk it makes – this helps lower your chance of getting uncomfortable, swollen breasts, or mastitis
• if you're going back to work, start a few weeks beforehand to give both of you time to readjust
• if your baby is 6 months old or more and can drink milk from a cup, you may not need to introduce a bottle at all

For more information, see drinks and cups for babies.

Giving your baby their first bottle

It may take a while for a breastfed baby to get the hang of bottle feeding, because they need to use a different sucking action.

• it usually helps to give the first few bottles when your baby is happy and relaxed – not when they're very hungry
• it may help if someone else gives the first bottle feeds, so that your baby is not near you and smelling your breast milk
• you might want to try using a different position for bottle and breastfeeding

See more advice on how to bottle feed.

Restarting breastfeeding

If you want to start breastfeeding more and give your baby fewer bottles, it's a good idea to ask your midwife, health visitor or breastfeeding supporter for support.

These tips may help too:

• Hold and cuddle your baby as much as possible, ideally skin to skin. This will encourage your body to make milk and your baby to feed.
• Express your breast milk regularly. Expressing releases the hormone prolactin, which stimulates your breasts to make milk. About 8 times a day, including once at night is ideal. It may be easier to express by hand to begin with – your midwife, health visitor or breastfeeding supporter can show you how.
• Try bottlefeeding while holding your baby skin to skin and close to your breasts.
• If your baby is latching on, feed little and often. Do not worry if your baby does not feed for long to begin with. See tips on how to get your baby properly positioned and attached.
• Choose times when your baby is relaxed, alert and not too hungry, and do not force your baby to stay at the breast.
• Decrease the number of bottles gradually, as your milk supply increases.
• Consider using a lactation aid (supplementer). A tiny tube is taped next to your nipple and passes into your baby's mouth so your baby can get milk via the tube as well as from your breast. This helps to support your baby as they get used to attaching to the breast. Your midwife, health visitor or breastfeeding supporter can give you more information.

See more tips on boosting your milk supply.

Help and support with mixed feeding

If you have any questions or concerns about combining breast and bottle feeding:

• talk to your midwife, health visitor or breastfeeding supporter
• call the National Breastfeeding Helpline on 0300 100 0212 (9.30am to 9.30pm, every day)
• find breastfeeding support near you

Video: why combine breast and bottle feeding?

In this video, 3 mothers discuss ways to combine breast and bottle feeding.

Media last reviewed: 22 March 2020
Media review due: 22 March 2023

Page last reviewed: 8 October 2019
Next review due: 8 October 2022

Mixed infant feeding: how to start and introduce | Scheme and diet, menu for mixed feeding

Co-author, editor and medical expert - Klimovich Elina Valerievna.

Number of views: 62 694

Date last updated: 09/22/2022

Average read time: 4 minutes

, which means switching to mixed feeding. It is recommended to make a decision on the transfer of a newborn to mixed feeding together with a pediatrician who will help you choose the right mixture.

Contents:

When do mothers switch to mixed feeding?
How to organize mixed feeding?

When do mothers switch to mixed feeding?

1. Lack of own milk

In some cases, even if the mother puts the baby to the breast on demand, the child may still remain hungry and gain weight poorly. This is often evidenced by loud crying after eating. In this case, experts talk about hypolactia, when milk production is reduced due to hormonal disorders.

The “wet diaper” method will help to make sure that the baby really does not have enough milk. Do not put "diapers" on your baby and count the number of his urination in one day. From two weeks of age to six months, the result is evaluated as follows: if you counted 12 or more wet diapers, then you have nothing to worry about, 8–10 wet diapers indicate that lactation has decreased, 6 or less - the child does not have enough milk, and urgent action should be taken.

Tip! Today there are many ways to increase lactation, but if they do not help, you should consult a pediatrician who will choose the right formula for supplementary feeding.

2. Lack of calories

Some mothers think that their milk is not nutritious enough. Most often, they come to such conclusions by expressing clear milk with a bluish tint. But it cannot be nonnutritive or nutritious. Milk is “rear”, saturated white, thicker and fatter (for a child, this is “food”), and “front”, liquid with a bluish tint (“drink”).

Tip! If the amount of urination is normal, but the baby is not gaining weight, then you need to think about whether your baby is getting "hind" milk. To do this, offer him only 1 breast during 1 feeding.

3. Coming to work

Some mothers have to reduce the number of feedings after going to work. And their first impulse is to switch to mixed feeding. But you should always remember that the best food for a child is mother's milk. If you want to go to work, try to prepare for this in advance. Make a "strategic stock" of breast milk in the freezer so your baby always has food, even when you're not around.

Tip! If you plan to go to work when your baby has started to receive complementary foods, then try to organize meals so that complementary foods are given to him in your absence. So you will have the opportunity to reduce the amount of formula or defrosted in his diet

Up to the content

How to organize mixed feeding?

Mixed nutrition has its own characteristics, which are very important for a nursing mother to know.

Basic rules for mixed feeding:

1. The timing of the introduction of complementary foods depends on the amount of breast milk the baby receives. If it is 50-70%, then it is administered as with breastfeeding (at 6 months). If less than 50% of breast milk is present in the baby's diet, then complementary foods can be introduced at the age of 5 months.
2. Always offer the breast first. Only if you see that the baby is not full, and the breasts are empty, then give him a mixture. It also helps increase lactation. The mixture should be introduced gradually. On the first day - 10 ml / 1 time, the second - 10 ml / 3 times, the third - 20 ml / 3 times. Increase the portion, bringing it to the norm.
3. Only the breast should be given at night and formula should be avoided. This is due to the fact that from 3 to 8 am, prolactin is actively produced, which is responsible for lactation.
4. Feed according to schedule (every 3-4 hours) and breastfeed on demand.
5. Keep water boiled and utensils and formula sterile. You need to cook right before eating.
6. Use a spoon instead of a bottle for complementary foods. Then you can avoid breast rejection.
7. Remember that mixed-fed babies should be given water, as dehydration can lead to poor digestion.

Follow these simple rules and try to keep your baby breastfed for as long as possible. Your milk, even though it's not your baby's only food, contains invaluable trace minerals that will keep your baby healthy and strong.

Back to Contents

The information in this article is for reference only and does not replace professional medical advice. For diagnosis and treatment, contact a qualified specialist.

Mixed feeding: when is it necessary and how to organize it

Formula supplementation should be introduced and discontinued gradually, focusing on the child's weight gain

How to understand that an infant needs to be supplemented? What to consider when choosing a mixture? How to maintain lactation and when to stop supplementary feeding? We answer common questions from parents about mixed feeding together with Olga Lukoyanova, MD, pediatrician, neonatologist, leading researcher at the Healthy and Sick Child Nutrition Laboratory of the National Medical Research Center for Children's Health.

When mixed feeding is recommended

The reasons for introducing supplementary foods may vary, but the main one is the lack of mother's milk. There are other situations where this is necessary, but they are much less common. Sometimes an allergy in an infant, frequent regurgitation, constipation is considered a sufficient reason for mixed feeding, but this is not the case. By themselves, these conditions are not yet a reason to introduce supplementary feeding - often these problems can be solved by changing the diet of the mother or prescribing medication to the mother or child.

Only in very rare cases (for example, a combination of constipation in a child and a lack of milk in a mother) do you have to introduce a medicinal mixture as a supplement. There are also very rare hereditary diseases (for example, phenylketonuria and other metabolic disorders) when it is really necessary to find the right combination of breast milk and a suitable therapeutic formula.

Not a single, even the most modern, adapted milk formula can be a complete replacement for mother's milk - it is, by and large, irreplaceable. Therefore, supplementary feeding is introduced only when all the ways to stimulate lactation have been exhausted and there are obvious signs of a lack of breast milk.

The main guideline is weight gain

How can you tell if a mother is really low on milk? This is a medical problem that should be addressed to a pediatrician or neonatologist. He will listen to the mother's complaints, weigh the child, evaluate his behavior and the dynamics of weight gain. By the way, in 2019, at the initiative of the Union of Pediatricians of Russia, a Program was created to optimize the feeding of children in the first year of life. A whole section of this document approved by the Ministry of Health is devoted to how to understand that a child is not getting enough mother's milk and when supplementary feeding is introduced.

The big problem is the too early and unreasonable introduction of supplementary feeding in the maternity hospital (on the first or third day after birth). However, it should not be administered when the child is crying and seems to be hungry.

In the first few days after birth, breast milk is often not enough. But if the mother is constantly next to the baby, often puts it to the breast and feeds on demand, then lactation is quickly getting better and supplementary feeding is usually not needed.

After discharge from the maternity hospital, the mother is left alone with her baby and, as a rule, is especially worried about his nutrition. But in the first days and weeks, the child naturally loses weight, and this does not mean at all that there is not enough milk. According to WHO experts, body weight can return to what it was at birth only by the end of the second week of life.

You can understand that there is not enough milk, for example, by the color of the baby's urine - normally it should be light, not concentrated. Another indicator is the number of bowel movements: they should be at least 4-6 per day. But the most reliable way to find out if the baby has enough mother's milk is regular weighing. Scales for newborns do not have to be bought, they can be rented - this will save money and reduce parental anxiety.

The baby should be weighed without clothes and a diaper at the same time of day. There is no need to do this before and after feeding - he can suck out different amounts of milk at a time. It is better to track the weight once a day, every 3 days, or even once a week.

For the first month, the minimum required is an increase of 25–30 g per day from the second week of life, or 400–600 g of birth weight. If during this time the child gained less than 400 g, then supplementary feeding should be introduced.

At the same time, it is necessary to continue to stimulate lactation, to put the baby to the breast as often as possible and try to keep mother's milk as the basis of the diet, and also to continue weighing the baby. If in the second month of life the increase is 180–200 g per week, then supplementary feeding is not needed.

At the age of 3-6 months, the rate of weight gain decreases to 120-130 g per week. In addition to weight dynamics, pay attention to other signs. If the child is often worried, rarely urinates, and at the same time the urine is concentrated, saturated in color, resume weighing once a day and share your concerns with the pediatrician.

How to choose the right milk formula

All formulas on the market are certified to be as close as possible to breast milk, adapted to the needs of babies, fortified with essential substances and similar in composition. To understand what kind of mixture a child needs for supplementary feeding, it is important to remember the features of his development. If there are no complaints, but the mother has little milk, then, in principle, the parents themselves can choose any milk formula for healthy children.

However, if there are complaints (regurgitation, constipation, allergies, colic), then a doctor will help you choose a special therapeutic mixture. After all, even ordinary, it would seem, infantile constipation can have different causes - for example, allergies. And in this case, even a therapeutic mixture for constipation will be useless. Therefore, first you need to find out the cause of the problem, and only then select a mixture that will help eliminate it.

Sometimes parents try to find the right formula for their baby by changing brands. However, firstly, the effect of introducing a new formula becomes noticeable no earlier than after 2 weeks. Secondly, mixtures of the same type (for example, for healthy children in the first six months of life or against colic and constipation) are almost identical in composition, regardless of the brand. Mixtures for different purposes from the same manufacturer differ much more from each other. Therefore, instead of changing brands, you need to look for a solution to the problem together with a specialist.

How to maintain lactation with mixed feeding

To prevent the milk from "leaking", formula should be given only after the baby is attached to the breast. To prevent a baby from switching to a pacifier, alternative methods of supplementary feeding are sometimes offered - for example, feeding from a spoon or through a drinking bowl. This approach can be applied to older children, especially if the proportion of complementary foods in the diet is small. But if the child is small, and the mixture is, for example, 50% of the daily ration or more, then it is still more convenient to supplement it from a bottle with a nipple. And so that the baby does not wean from the breast, it must be applied to it as often as possible - both day and night.

Of course, there is a risk of reduced lactation - studies show that the introduction of supplementary foods reduces the success of breastfeeding. But here it is important not to fall into another vicious circle: if a mother is very worried that she does not have enough milk, and the child is really screaming from hunger, then there will be even less milk. Therefore, it is better to introduce supplementary feeding for this period, calm down, continue to stimulate lactation, achieve stable weight gain in the baby, and then begin the gradual abolition of supplementary feeding.

How to correctly calculate the amount of formula

The amount of supplementary feeding depends on the mother's milk production, the age and weight of the baby, so there are no clear recommendations here. First of all, you need to focus on the condition and well-being of the child after feeding. For example, a 1-month-old baby may start with 10 ml (2 teaspoons) of supplementary feeding after breastfeeding, older children may need 30 ml.

After feeding, observe the condition of the baby: if he behaves calmly, then the mixture is enough and next time you can give the same amount. If the child is restless, you can gradually increase the amount of the mixture and control weight gain. It is not necessary to supplement the baby with each breastfeed - as a rule, it is enough to do this 2-3 times a day.

Supplementary feeding should be canceled in time

Supplementary feeding should remain a temporary phenomenon, therefore, against the background of its introduction, it is necessary to continue to stimulate lactation: often attach the baby to the breast, use special thermal pads on the breast before feeding, drink a hot drink before feeding, do contrast pouring over the breast area.

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