Mixed Feeding: 5 Tips for Success with Breast and Bottle

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At Family First Maternal Wellness we know it’s important for every family to have access to education that supports how they choose to parent.  In 2017, Statistics Canada surveyed families across Canada and found that at 6 months, 36.9% of babies were exclusively breastfed.

This means that over 60% of Canadian families are using infant formula, or doing some mixture of formula and breastfeeding.  In my experience, the majority of families I work with are doing some form of mixed feeding. And just like breastfeeding, the world of mixed feeding is full of myths, incorrect information, and just general confusion.

So let’s take the time to run over 5 tips for  success with mixed breast and bottle feeding!

1. Don’t mix unless you know they’ll munch

There’s a big myth out there that says you can’t mix formula and breast milk together.  If you’re pumping and feeding as well as topping up with formula you can absolutely mix the two together, but you may not want to.  

That’s because formula that has been mixed and warmed is good for approximately one to two hours, while breast milk that has been warmed is good at room temperature for approximately six hours.  So if your baby doesn’t take the entire bottle of mixed formula and breast milk, you may end up tossing some of the breast milk and see your hard pumping work literally go down the drain.  That can be hard to handle.

Also, powdered formula when prepared properly needs to be added to water that is no cooler than 70 degrees Celsius.  That temperature when mixed with breast milk can break down some of the antibodies that you’re pumping for in the first place. You also should not mix the two if they are different temperatures, as it can encourage bacteria to grow.  

So if you are not sure if your baby will take the entire bottle, or you’re planning to mix at two different temperatures of breast milk and formula together, it is likely best to keep the two in separate bottles. More dishes, but less hassle. If you’re partially breastfeeding at the breast and supplementing with formula don’t worry, that is perfectly fine

2. Babies don’t have nipple preference, they have flow preference

It’s true that some babies struggle to switch back and forth from breast to bottle. Usually when babies refuse to switch back from bottle to breast, it’s because they know they can get milk much faster and with less effort from the bottle.  Breastfeeding requires the baby to engage a lot of oral motor musculature, and while the flow can be strong, a tipped up bottle almost always provides a faster flow.

The baby also doesn’t have to engage their tongue, jaw, and oral muscles as much to use a bottle, and the flow is steady, where the breast flow waxes and wanes as letdowns come and go through the feed.  

Babies are very smart and adaptive little persons, and they will quickly come to prefer the flow from the bottle, especially if they’ve had some struggles with breastfeeding. There is a way to help prevent this flow preference however – which brings us to tip number three!

3. Pace it up (paced bottle feeding)

Typically we learn to bottle feed by what we see others doing, whether it be friends and relatives or on TV.  What we generally see is a baby that is laid back at an angle, eyes pointed towards the ceiling, and a bottle tilted up at a 45 to 60 degree angle to help the baby drink more formula or milk quickly and with less effort.  While you can certainly feed a baby this way, it doesn’t help them to continue to develop the oral musculature and patterning that they need for strong breastfeeding.

Instead, try paced bottle feeding. Start with a bottle that has a narrower tip. The wide tip bottles can sometimes further fatigue a baby that is dealing with feeding fatigue. They can also encourage the baby to slip to the end of the bottle nipple again and again, something that we don’t want them to do with either bottle feeding or breastfeeding.  

Sit your baby (yes even your newborn!) up in as close to a sitting position as possible, so that they are looking at the opposite wall instead of the ceiling. Prop them up in the crook of your arm, make sure they have a clear airway with head slightly tilted back, and with the opposite hand hold the bottle so that it is parallel to the ceiling.  

Next, tickle the baby’s top lip with the nipple and when baby opens wide, slip the bottle nipple in so that it points towards the top of baby’s mouth, and is pressing down slightly on the tongue. Let baby suck on the empty nipple for a minute or two, before tilting the bottle up slightly to bring milk/formula into the nipple.  

Let baby suckle away, watching to make sure his/her lips stay flanged. If baby starts to show signs of stress such as pushing the bottle out with their tongue, flailing, struggling, panting or gasping, pop the nipple out, give baby a break to start signaling he/she wants food again, and then repeat.  In this fashion, each ounce should take around 5 or so minutes.

This type of bottle feeding helps baby to maintain a similar flow to breastfeeding, as well as helps them develop and strengthen the same muscles that they need to latch and feed on a breast well.  It also will not cause colic, despite occasional sucking on an empty or half empty nipple. This is because baby maintains a sealed latch on the bottle nipple while feeding, the same as if they were breastfeeding, and there is no gasping from trying to suck/swallow/breathe pattern with too fast of a flow.

I like this video by Stacy Kucharkzk to show paced bottle feeding to my clients.

4. Pump for supply

One of the most important things to know about supplementing and mixed feeding is that without pumping regularly, your supply can slowly dwindle.  The breasts work on demand/supply, with a small protein called Feedback Inhibitor of Lactation (FIL) playing a big role in this.

The fuller the breast, the more FIL builds inside the glands. When FIL starts to build it signals the body to slow down milk production.  If the breasts aren’t emptied, the FIL continues to tell the body that too much milk is being made. By emptying the breasts regularly, FIL levels drop and the body knows more milk is needed and works to meet that need.

All of this means that regularly leaving breasts full will lower milk production. If the breasts don’t get emptied when we use other food sources like formula, the milk supply continues to drop until eventually your baby may go on what is called a nursing strike, where he/she refuses to nurse altogether. Nursing strikes are often (but not always) caused by a lowered milk supply.

If you want to maintain a comfortable milk supply, the breasts need to be emptied regularly even as your baby is getting his/her milk from other sources.  Pumping or hand expressing for every feed the baby doesn’t have at the breast is encouraged to keep a healthy supply.

Even if you’re just supplementing, a pumping or hand expressing is still a good idea. This is especially true if your long term goal is to go back to feeding just at the breast.  If your goal is to continue mixed feeding, then 3-5 pumping sessions a day of about 10-15 minutes each are needed to keep your milk supply high and your baby happy.

5. No shame in this game

Everyone’s goals for feeding their baby look different. Every breastfeeding parent needs support to meet their own unique goals, and that’s what I’m here to provide. At Family First we recognize the autonomy of every client and we encourage mothers to set their own goals, and then help them find a path to meet them. There’s no shame in whatever choice you make to feed your baby.

As you and your baby’s needs shift and fluctuate you may find your goals shift too, and that’s okay. I want to support you in the way that YOU need, and meet you wherever you’re at. Everyone needs strong support and good information during the postpartum period. So whether you’re breastfeeding, pumping, feeding formula or a mix of all three, I am here to support you in your journey and your goals, and so is our Centre!

If you’d like to book an appointment for either an in-home/in-centre breastfeeding support session or to attend one of our Nourish Your Newborn Prenatal Breastfeeding classes, click here.

Martha Neovard is the Breastfeeding Educator at Family First Maternal Wellness Centre and runs the infant feeding group every Thursday from 10:00-11:30 AM. This group is designed for all mothers who feed in all different ways, and is a warm and welcoming environment where you can ask questions, get answers, and find support for your unique journey.