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How to Supplement Breastfeeding with Formula
Read time: 6 minutes
As a breastfeeding consultant, I know that even though moms do their best to breastfeed exclusively, sometimes it’s just not enough. There is no right or wrong way to feed your little one; and as long as they are happy, thriving, and developing well, using baby formula to supplement can be a safe and supportive addition to breastfeeding.
Know that if you supplement breastfeeding with formula, it doesn't have to be the end of your breastfeeding journey. Your little one will benefit from breast milk in whatever amount you’re able to provide it.
In this article we’ll talk not only how to supplement breastfeeding with baby formula, but how to help protect your breast milk supply should you want to keep breastfeeding.
Can you supplement breastfeeding with formula?
Absolutely. Your feeding journey doesn’t have to be either breastfeeding or formula; you can use both to best meet your and your baby’s needs. As long as your baby is growing well, combination feeding can be safe and effective.
Some parents mostly breastfeed and supplement a few ounces here and there with formula. Others may have transitioned to mostly formula but are still breastfeeding a couple of times per day.
Whatever works well for your family is the best scenario to follow.
When and why doctors recommend supplementing
There are many reasons someone may choose to supplement with formula, including:
Baby’s growth is faltering. Sometimes baby is either not able to take as much milk from the breast as is available, or mom is not producing enough breast milk, causing poor weight gain.
Maternal illness or medications. Sometimes mom has an illness that makes it unsafe to breastfeed. Other times she may need to take medication that isn’t safe for baby.1
Being away from baby, such as at work or school. Even though there are laws protecting a woman’s right to pump at work, there are still workplaces and situations that make it more difficult to do so.23
Mom has a delayed milk production or a low milk supply. There are certain factors that may delay your milk from coming in, such as premature birth or preeclampsia.23
Mom had breast surgery. Certain types of breast surgery may cause issues with milk production.4
Breastfeeding is too painful. There are many reasons why breastfeeding may be too painful, such as engorgement, tongue-tie, inverted nipples, and a poor latch.5While it’s important to chat with a lactation consultant to see if there is anything you can do to help reduce the pain, supplementing may be needed in the meantime.
Read about:
What to do About Sore Nipples While Breastfeeding
Breastfeeding and Pumping Tips for Going Back to Work
Breastfeeding: How to Support a Good Milk Supply
Signs your baby may need extra formula
Other than the obvious reasons why your little one may not be able to breastfeed, such as mom having to take specific medications or going back to work, there are a few signs that can help you know if your little one is not getting enough breast milk.
Signs your baby is not getting enough breast milk include:
Poor weight gain
Not making enough diapers. After day 7, look for at least six wet diapers and three poopy ones as a sign of getting enough breast milk.7
Breastfeeding for too short or too long. If breastfeeding sessions are shorter than 10 minutes or longer than 50 during the first few months, it could be a sign that your baby is not transferring milk well.6
Baby still seems hungry after feedings. If your little one is not relaxed (hands open, “milk drunk”, or asleep) after feeds, it could mean they’re not getting enough. Fists clenched and fussy may mean they’re not satisfied.8
You don’t hear baby swallowing often enough. At first your baby will suck a lot without swallowing to help your milk let-down, but then you want to hear and see a rhythmic pattern similar to “suck, suck, swallow, breathe”.9
Read about:
Choosing a Baby Formula for Supplementation
There are many baby formulas to choose from, but all must meet clear-cut regulations and contain specific nutrients to ensure they are safe and will meet your baby’s needs.
Cow milk-based formula. This is the most common formula in the United States. While it is based on cow milk, it is altered significantly to meet baby’s needs: There is more lactose added to be similar to the amount in breast milk, and the butterfat is mostly replaced with oils which better reflect the fatty acid in breast milk.24
Goat milk-based formula. Like cow milk-based formula, goat milk-based formula has been dramatically changed to meet baby’s macro- and micro-nutrient needs. While some people believe this type of formula is easier for baby to digest and may be better tolerated, this is not certain. Note that infants who are allergic to cow milk protein likely will not tolerate goat milk-based formulas as the proteins are very similar.24
Soy formula. Soy formula uses glucose or sucrose for its carbohydrate source instead of lactose. It is sometimes used for babies who cannot tolerate lactose.24
Extensively hydrolyzed formula. Also called ‘pre-digested’ formula, these include proteins that have been broken down into smaller, digestible proteins and are often used for babies with protein allergies.24
Read more: How to Choose a Baby Formula
Common Combo Feeding Problems and Solutions
Sometimes introducing formula to a breastfed baby goes without a hitch! But more often than not your little one may experience a few changes, and it’s helpful to know what might be coming your way.
Some babies become a little gassier
This may be from the foam that is created when you shake powdered formula with water, or from baby drinking too quickly, both of which may cause baby to swallow more air.25
Solution: Let the bottle sit in the fridge until the bubbles have dispersed. Know that formula can be prepared up to 24 hours ahead of time! Use a slow-flow nipple and paced bottle feeding to help slow baby’s drinking down.
Your baby’s stool color may turn green, brown, or a darker yellow
Solution: None needed! These poop changes are usually normal and nothing to be concerned about.26
Some babies refuse the bottle
The bottle is different than the breast, and that might take time to get used to!27
Solution: Offer the bottle when baby is alert, calm, and only a little hungry (not overly so!). Have someone else offer baby the bottle so that they aren’t expecting the breast. Use paced bottle feeding. Try feeding baby in a new spot, such as outside if the weather is right!
For more information on these challenges, check out these articles:
Introducing Infant Formula to a Breastfed Baby
What is Normal Breastfed and Formula-Fed Baby Poop?
How to Start Combo Feeding (Week-One Plan)
Remember that there is no single way to introduce formula to your little one, and everyone has a different schedule and different goals when it comes to combo feeding!
Some parents breastfeed during the day and formula feed at night, while others breastfeed when they are at home and their babies get formula while they are at work. Some babies who aren’t getting enough at the breast might be offered a little formula after each breastfeeding session.
No matter what schedule you end up following, starting a new way of feeding can feel overwhelming – so if you have the time and ability to ease into it, that may help you feel the most confident as you make this transition.
Before you get started:
Read the formula manufacturer’s instructions on how to prepare formula and try it out. Better to figure this out before a 1am feed when everyone is tired and cranky!
Figure out what water you'll be using to make the formula.
Learn about how to safely store infant formula.
Gather all the supplies you may need: Bottles, nipples, cleaning supplies, etc.
Think about your goals for combo feeding – how often, and when, will you be formula feeding?
Read more: Everything You Need to Know About How to Prepare and Store Baby Formula
Day 1 & 2: Introduce formula to your baby
The best time to do this is when your baby is calm and not too hungry. This way they will be more open to figuring out something new, like drinking formula from a bottle!
You can offer a bottle just one or two times on these first days, depending on how things go and how much your baby needs.
Tips on how to bottle feed
Hold baby semi-upright. Avoid bottle feeding your baby when they are lying down.
Tilt the bottle slightly so that the nipple is full of formula without air pockets.
Touch baby’s bottom lip with the nipple so they open their mouth and place the nipple inside their mouth slowly.
Remember that your baby takes in a mouthful of breast when they breastfeed, so they will likely also have the bottle nipple fully in their mouth, with their lips close to the base of the nipple.
Pause after ½ to 1 ounce by tilting the bottle nipple up in baby's mouth. Let baby suck the nipple back in if they are still hungry.
Don’t forget to listen to your baby and stop when they are full, even if the bottle isn’t finished. If baby turns their head away, closes their mouth, pushes the bottle away, or stop sucking, they’re probably done with the feed.28
Day 3 & 4: Build your routine
If your baby has gotten the hang of drinking from a bottle, it’s time to start building your combo feeding routine! Begin offering formula each time you want baby to take a bottle. You can try to offer a full feed if your little one will accept it, or you can start breastfeeding then end the feed early to offer formula for the remainder of the feed.
For example, if you want to offer bottles at night, breastfeed for half the feed then offer the rest of the feed from a bottle.
Remember that your little one might take the bottle better from someone else as you build this new routine.
This is also an important time to start watching for signs of intolerance. Know that it can be normal for babies to go through an adjustment period as they get used to a new formula, and that some symptoms are temporary, but if they persist, your baby may not be tolerating the new formula.
Signs that may mean your baby isn’t tolerating their formula well:
Extra gassiness
Excessive crying after a bottle feed
Dry, red, scaly skin
Extreme fatigue and weakness
Forceful vomiting25
If you have questions about any new signs that pop up after introducing formula, don’t hesitate to contact baby’s pediatrician. Know that some babies take longer than two days to get used to drinking from a bottle, but the key is to keep offering until your little one accepts it.
Days 5 through 7: Fully commit to the schedule!
This last part of the week, offer full bottles at each formula feeding session. Continue to listen to your baby’s hunger and fullness cues to understand how much formula they may need.
This article talks about how much formula a breastfed baby may need. Introducing Formula to a Breastfed Baby
You may experience some engorgement as you reduce breastfeeding at these sessions. To help, try hand expressing a small amount, as this will reduce the pressure and help avoid plugged milk ducts.
Know that if you do not pump at these times, your body will stop making milk at these times of day and your supply will reduce.
Will supplementing affect my milk supply?
To understand how to maintain or even increase milk supply while supplementing with formula, it’s important to know how our body makes milk.
When it comes to milk supply, what’s most important is how often you pump or feed, and if the breasts are being fully emptied.10 The more milk that is taken out of the breast, the more milk the body will make.1112
Should you like to continue breastfeeding while you supplement with formula, you may need to pump regularly. This will tell your body to keep up your milk supply.11
Learn more:
How to Choose the Right Breast Pump
Top Tips for Pumping Breast milk
How to maintain breast milk supply while supplementing formula
If you are giving formula during a time that you would normally be breastfeeding, such as while you are at work, pumping will help maintain your breast milk supply.13
The goal is to pump as many times as your baby takes a bottle.1415 If you do not pump, the body will think baby no longer needs that milk and your supply will decrease over time.
Should you end up pumping full bottles of breast milk, you can store these to use next time you are away. For example, if you are working, refrigerate the bottles to provide freshly pumped breast milk to your baby the next day.
Not all women enjoy pumping or are even able to pump while away. It’s okay to simply provide formula while you are out of the house and allow your supply to adjust down; making milk only for the times when you consistently breastfeed.
It is important to do what works best for you!
Read more: Safe Storage of Pumped Breast Milk
How to increase breast milk supply so you can stop supplementing with formula
If you are supplementing with formula because your breast milk supply is low, your goal may be to increase your supply and eventually stop providing formula. To do this, consider pumping after each time baby breastfeeds.16
Your goal would be to first breastfeed, then provide supplemental formula if needed, then pump. Other strategies include: pumping between feeding sessions rather than directly after one or breastfeeding on one side while pumping the other side.151718
This can be quite an intensive process for a mom of a newborn. While some moms may find this schedule worthwhile, you may reevaluate your feeding goals over time.
Read more: Dealing with a Low Breast milk Supply
Tips for pumping to increase supply
You may not get much breast milk when pumping directly after your baby feeds. This is because baby is taking most of the milk during their feed. The goal of this pumping session is to help fully empty the breast after each feeding to help stimulate the body to make more milk.19
Quick tips for pumping to help increase supply
Be consistent and pump every day
Always pump at the same time of day
Pump both breasts at the same time
Hand massage the breast while you pump (as well as while breastfeeding) to help empty the breast.
Pumping should not hurt. If it does, make sure the suction is not too high and that the flange is fitting correctly.121719
Remember that increasing supply may take anywhere from a few days to a few weeks depending on the mother and her situation. Continue to be consistent about pumping at the same times every day to help the body respond.12
If you want to learn more about increasing your milk supply, reach out to our team of registered dietitian nutritionists and lactation consultants for free! They’re here to help on our free live chat from Mon-Fri 8am-6pm (ET). Chat Now!
Tips for supplementing breastfeeding with formula
Ready to get started with supplementing your baby? Here are some tips to help you feel confident and prepared for this next step.
First: Know that it’s okay to combination feed!
If the goal is not to eventually exclusively breastfeed, or if mom plans to eventually wean to all formula, simply breastfeeding when you want (or are able), and providing formula when it works best for you and baby, is great strategy. No need to worry about extra pumping if maintaining your milk supply isn’t a top priority.
Remember that any amount of breast milk is beneficial for your little one.18
Your pediatrician and/or lactation consultant can help guide you as to how much and how often you should be giving your baby a bottle of supplemental formula.
Learn about: How Much Formula Does My Baby Need?
Use Paced Bottle Feeding
If your goal is to continue breastfeeding or even to eventually stop supplementing, paced bottle feeding can help.
Babies latch differently at the bottle than they do the breast, which may cause a shallow more painful latch when breastfeeding.20 It is also easier for babies to get milk from the bottle compared to the breast, sometimes creating a frustrated baby when trying to breastfeed.21
Paced bottle feeding slows down a bottle feeding to be a similar speed as breastfeeding and helps put baby in control.20 This may help to reduce any preference that may develop for the bottle.
For detailed steps on how to do Paced Bottle Feeding, read this article: What is Paced Bottle Feeding?
Hand massage or express before latching baby to breastfeed
Before putting baby to the breast, hand express or massage the breast until you feel milk is about to come out (this is your ‘let-down’ reflex). This way breast milk is ready to go, just like with a bottle, when baby latches. This can help reduce frustration.
Read more: How and When to Hand Express Breast Milk
How do I supplement with breast milk?
In many cases supplementing with breast milk instead of supplementing with formula is possible, so be sure to discuss this option with your pediatrician and/or lactation consultant.
Once you get into the routine of pumping, you may be able to increase milk supply. This stash of extra milk can be used to supplement when needed rather than supplementing with formula.
Remember that it takes time and consistency with pumping for your body to respond and increase supply.
Every infant feeding journey is different
While making the decision to supplement with formula is not taken lightly, you must do what is best for you and your baby. While breastfeeding in any amount will provide benefits for your little one, if it is causing anxiety and stress for you or your baby, then it may be doing more harm than good.
Reach out to a lactation consultant for an in-person assessment. They will be able to observe baby’s latch and asses your milk supply to give you individualized support.
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Our Happy Experts are a team of lactation consultants and registered dietitian nutritionists certified in infant and maternal nutrition – and they’re all moms, too! They’re here to offer personalized support on our free, one-on-one, live chat platform Monday - Friday 8am-6pm (ET). No appointment needed, no email or sign-up required. Chat Now!
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For more on this topic check out the following articles:
Dealing with a Low Breastmilk Supply
Breastfeeding: Supporting a Good Milk Supply
Formula Preparation: What Type of Water Should I Use?
Everything You Need to Know About How to Prepare and Store Formula
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