Combining breast and bottle


It is possible to successfully combine breastfeeding and bottle-feeding expressed milk. But before making the decision to introduce a bottle to a breastfed baby, it is important to understand that any introduction of partial bottle-feeding can interfere with successful breastfeeding. Why?

  1. This happens because your breasts are designed to work on a supply and demand basis – the more your baby demands the more they will supply. When introducing partial bottle-feeding, make sure to keep up the demand for breastmilk by expressing.
  2. Secondly, because milk flows easier from a bottle than from the breast, babies can develop a preference for the bottle as it offers less resistance when sucking. Breast- and bottlefeeding require completely different sucking techniques and this is sometimes referred to as nipple confusion.

The number one rule to successful combining is to make sure that your breastmilk supply is properly established. Breastfeed as often as possible and delay introducing expressing and a regular bottle until at least 6 to 8 weeks. 

Use expressed breastmilk rather than formula, as breastmilk offers by far the best nutrition and immunity protection for your baby. It will also ensure continuation of your milk supply. Your baby will accept breastmilk more readily and it will prevent tummy upsets. 

How to introduce a bottle to a breastfed baby

  • When introducing a bottle to a breastfed baby, ask your partner, a caregiver or a friend to give your baby the first bottle. Babies are extremely sensitive to the smell of breastmilk. If she’s able to smell your milk, she may well refuse to take the bottle. 
  • Start off with just one feed every alternate day. Some moms express the late evening feed, leaving the bottle-feed for dad to attend to.
  • If your baby seems confused when holding her in the crook of the arm (because it’s associated with breastfeeding), lay her on the lap, facing the person who will be feeding her with her head resting on their knees. She may prefer to lie on her side as this is the position she is in while on the breast.
  • Never “prop” feed your baby (leaving your baby alone to suck on her bottle, or propping the bottle up with a towel or nappy). It can result in choking, and it also increases the rate of ear infections.
  • If your baby is very hungry, feed her for a few minutes on the breast to satisfy her initial hunger; hand her over and leave the room while she is offered the bottle.
  • Keep the teat in her mouth, even if she just chews on it. Once milk starts to come out she should start to suck.
  • If she is resisting, warm the teat slightly, as she will not be used to the coldness of the teat.
  • A little gripe water on the teat may encourage her to take it.
  • If your baby refuses to take a bottle, check that the bottle’s teat is small enough to fit into your baby’s mouth comfortably. You may have to try a few different shapes and sizes before you find one that suits her. 
  • If she rejects the bottle – persevere. It will get better.

Keys to success:

  • To avoid your baby developing a preference for the bottle when moving from exclusive breastfeeding to combination feeding (for instance when you go back to work), breastfeed her as often as possible and only use a bottle where necessary.
  • If your baby rejects the breast – crying when you bring her near the breast or pulling away with frustration because the milk is not flowing fast enough – cut out the bottle and breastfeed exclusively for a week or two if you’re able to.
  • If you are worried about nipple confusion, offer expressed milk in a cup with a spout from about 3 months as this will help prevent it.
  • If you are returning to work, start introducing the bottle a fair while before you do. It’s not always plain sailing and you may need a bit of time to get it right. Leaving it to the day before you return to work makes it even more stressful for you and your baby.
  • Once back at work, breastfeed your baby in the mornings, evenings and through the night if she is still demanding night feeds. To ensure that you have enough breastmilk for the early evenings be careful not to express milk later than 2pm.
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