What is mixed feeding?

Mixed feeding is when you feed your baby formula in addition to breast milk.

Mixed feeding can involve:

• breastfeeding and giving your baby formula
• breastfeeding and giving your baby a combination of expressed breast milk and formula
• bottle feeding your baby using expressed breast milk and formula

How you feed your baby is your choice. There are factors to consider, for example, it's important to know that mixed feeding with formula can make breastfeeding more challenging, as it can reduce your milk supply. If you prefer to feed your baby using a bottle, you might choose to express your breast milk by hand or using a breast pump.

If you are having trouble and want to exclusively breastfeed your baby, talk to a health professional for advice and support.

Why might I think about mixed feeding?

Exclusive breastfeeding for around the first 6 months is the ideal start for your baby.

You may also continue to breastfeed until 12 months or longer, while supplementing with a variety of solid foods that follow the Australian Dietary Guidelines. Many parents choose to combine breastfeeding and bottle feeds in the first 6 months for a variety of reasons, including:

• issues with breastfeeding
• low breast milk supply
• a baby with slow weight gain
• returning to work

Issues with breastfeeding

Sometimes, breastfeeding can be challenging. It's important to be patient and remember that both you and your baby are learning.

Some of the physical challenges that you may experience when breastfeeding can include:

• sore, cracked or bleeding nipples
• painful, blocked ducts in your breasts
• mastitis — inflammation of your breast that can cause pain and flu-like symptoms
• oral thrush or breast and nipple thrush
• nipple vasospasm — where the blood vessels in your nipple tighten and go into spasm, preventing blood from flowing normally
• inverted or flat nipples — consider getting advice from a professional about trying a nipple shield

Some other challenges with breastfeeding may include:

• difficulty attaching your baby to your breast — seek advice on positioning and attachment and check for issues such as tongue-tie or cleft palate
• your baby becoming 'fussy' at the breast or refusing to feed
• discomfort breastfeeding in public
• returning to work — while some people successfully combine breastfeeding with returning to work, others may prefer not to

Read more on common breastfeeding problems.

It's important to know that many breastfeeding issues can be solved with the help of someone skilled in breastfeeding support. For help with breastfeeding, you can talk with:

• your midwife or child health nurse
• a registered lactation consultant
• the Australian Breastfeeding Association Breastfeeding Helpline: 1800 686 268 (1800 mum 2 mum). They also have an app.

Low breast milk supply

You might worry that you don't have enough breast milk for your baby's growth and development. This is a common concern. Knowing what is 'normal' development can help you identify baby behaviours that may suggest your milk supply is low. If you're not producing enough milk, there are things you can do to try and increase your breast milk supply.

The best way to establish a healthy supply of breast milk is to breastfeed often. You can also increase supply by expressing breast milk. Check that your baby is latching on well and emptying your breasts. If you are concerned, ask for help from your midwife, lactation consultant or doctor.

Signs that your baby is getting enough milk (after their first week of life) include:

• having 6 to 8 wet nappies (4 to 5 heavy disposable nappies) in a 24-hour period
• having 8 to 12 breastfeeds in 24 hours
• passing soft yellow poo (around 3 to 4 times a day, if they are younger than 6 to 8 weeks old)
• settling and sleeping between most feeds
• returning to birth weight by about 2 weeks old
• gaining an average of 150 to 200 grams (g) or more every week for their first 3 months

A small number of people may have low supply due to:

• past breast surgery
• insufficient breast tissue
• medical reasons, including hormone disorders

In these cases, you may be able to produce some breast milk and choose mixed feeding for your baby with donor milk or formula.

Baby with low weight

You may consider mixed feeding if you're worried that your baby has lost or is not gaining enough weight. All babies grow differently, and their weight may change at different times, especially during their first 2 weeks of life.

Sometimes, slow weight gain is nothing to be concerned about and only lasts for a short time due to a temporary milk supply or feeding issue. At other times, your health professional may suggest that your baby may benefit from supplementation by mixed feeding. Some examples include if they:

• were born very prematurely (earlier than 32 weeks)
• born at a low birth weight
• are unwell or have a medical condition

Depending on the situation, a health professional might suggest introducing extra feeds for your baby. You might choose to give your baby expressed breast milk for these feeds, or you may begin mixed feeding with formula.

How can I mix feed my baby effectively?

If you decide to mixed feed, it's a good idea to aim for a balance that supports breast milk production and your baby's nutritional needs.

Once you start to mixed feed your baby, it can be difficult to continue breastfeeding and maintain a strong supply of breast milk, especially in your baby's first 6 weeks.

Here are some tips:

• Offer your baby frequent breastfeeds, especially in the first weeks, as you establish your milk supply.
• Continue to breastfeed often, even when you are supplementing with formula, to help keep up your milk supply.
• If you are using formula to supplement and want to maintain your supply of breast milk, start with small amounts and gradually increase if you need to, while continuing to breastfeed often.
• Seek advice from health professionals to manage mixed feeding.

If you are beginning to mixed feed, you can express your breast milk to maintain your milk supply. Visit a child health nurse, breastfeeding counsellor or lactation consultant to help you manage mixed feeding.

How do I move from mixed feeding to full breastfeeding?

If you are planning to return to or begin fully breastfeeding after mixed feeding, it's important to increase your breast milk supply. To wean your baby off formula, you should gradually reduce the volume and frequency of formula feeding while increasing breastfeeding.

When you breastfeed, the more milk that is removed, the more milk your breasts will make.

To increase your milk supply:

• Offer your baby breastfeeds more often, even if your baby won't feed for long.
• Feed from both breasts at each feed — try to start with a different breast each time.
• Ensure you and your baby are comfortable and your baby attaches well during feeds.
• Help your milk flow by being relaxed when feeding — try deep breathing and applying warmth by stroking your breast inwards (towards the nipple).
• Gradually reduce formula feeds, so your baby is hungrier for your breast milk.

Your healthcare professionals can help support you with this.

What to expect when mixed feeding

If you are trying mixed feeding, it's good to be aware of the following:

• If your baby is used to breastfeeding, they might resist the bottle at first. Try asking someone else, like your partner or a family member, to offer the bottle to your baby.
• Your baby might take milk from a bottle more quickly and start to prefer the bottle to the breast. This might cause your baby to refuse the breast.
• Your baby's poos will change in colour, smell and consistency — they may become harder when you first introduce formula.
• Your breasts might get overfull, which can be painful. It can also cause your body to slow or stop producing milk.

If you started mixed feeding because you were concerned about your milk supply, this is not a solution. Its best to ask a lactation consultant or maternal child health nurse to help you to increase breastfeeding again and reduce mixed feeding.

Resources and support

For help introducing or managing mixed feeding contact:

• a registered lactation consultant
• your maternal child health nurse
• your midwife
• your doctor

The Australian Breastfeeding Association Breastfeeding Helpline has information and support from qualified breastfeeding counsellors — call 1800 686 268 (1800 mum 2 mum).

The Royal Women's Hospital has resources to help you learn more about breastfeeding.

King Edward Memorial Hospital has videos on common breastfeeding challenges.

Information for Aboriginal and/or Torres Strait Islander peoples

The Australian Breastfeeding Association offers breastfeeding resources for Aboriginal and/or Torres Strait Islander families.

Check out the graphic guide to breastfeeding for Aboriginal and/or Torres Strait Islander parents.

Watch the video Just Let Them Feed — a health resource on breastfeeding.

Languages other than English

Read the Australian Breastfeeding Association's Breastfeeding Confidence — a guide to breastfeeding in a range of community languages.

Queensland Health has breastfeeding fact sheets and booklets in many languages to support families from multicultural backgrounds.