Mixed feeding: how to start and combine breast and bottle

There are as many ways to breastfeed as there are mothers, so what matters is finding the best solution for each mum and her baby. If you have decided on mixed feeding, we at Happymami have put together this guide so you know when to start, how many bottles to give and how to combine breast and bottle without losing your breastfeeding.

In short:

• When to start: if there is no medical reason, wait until breastfeeding is well established, often at around 3–4 weeks. If you are going back to work, start about 2–3 weeks beforehand.
• How many bottles: start with one a day and add the next when the first is going well and your breasts have adjusted. You will find the table by age further down.
• How to keep breastfeeding: replace one feed at a time, keep the morning, evening and night-time breastfeeds, and express if you skip feeds.
• How to give the bottle: at a gentle pace (paced bottle feeding), with your baby almost upright, the bottle almost horizontal and with pauses, just like at the breast.

The best food for your baby is breast milk, but there are many situations in which a mum needs or wants to combine breastfeeding with bottle feeding. Have a look at our bottle for mixed feeding too.

What happens if I combine breastfeeding with formula?

Mixed feeding can be done with expressed breast milk or with formula milk. Both are compatible with carrying on breastfeeding. What matters is following a few sensible guidelines to protect your breastfeeding, above all avoiding generic bottles and using a Happymami mixed feeding bottle.

That way, on the one hand you stop your body from producing less breast milk, and with the made-to-measure Happymami bottle you help prevent nipple confusion in your baby, protecting your breastfeeding.

Read our Breastfeeding Guide to answer all your questions about mixed feeding.

When should you start mixed feeding?

Mixed feeding from birth

Your body starts preparing to breastfeed during pregnancy. After the birth, when you put your baby to the breast, the engine of breastfeeding starts up, and its biggest trigger is suckling: the more the breast is suckled, the more milk is made, whether by your baby or by a breast pump. So if your baby needs a top-up from the very first days (for example, because they have been in hospital or are gaining little weight), your midwife or paediatrician will tell you how much to give and how. Keeping your baby at the breast and expressing will help your milk supply get going. Besides the bottle, there are other methods for the first days, such as a small cup, a spoon, finger feeding with a syringe or a supplemental nursing system.

🍼 Our personalised bottles are designed to be combined with breastfeeding from day one. 🍼

Once breastfeeding is well established: at around 3–4 weeks

If there is no medical reason, it is best to breastfeed only for the first few weeks and wait until breastfeeding is well established, often at around 3–4 weeks: feeds no longer hurt, the latch is good and your baby is gaining weight steadily. These weeks are crucial: your baby learns what your breast is like and your body adjusts its supply to what your baby needs. In the first days and weeks, a newborn usually feeds 8 to 12 times in 24 hours, and it is that frequency that regulates your supply.

Before going back to work

If you are starting mixed feeding because you are going back to work, begin offering the bottle about 2–3 weeks beforehand. That gives your baby time to get used to it and gives you time to find your expressing rhythm. We explain it in our guide to going back to work and breastfeeding.

How many bottles and feeds a day with mixed feeding?

There is no ideal number: it depends on your baby's age, your milk supply and how you organise things. What we do know is that the more breastfeeds you keep, the more stable your supply will be. Start with one bottle a day, always at the same feed, for a few days, and add the second when the first is accepted well and your breasts have adjusted (without painful fullness). And, of course, don't forget to use a made-to-measure Happymami bottle so as not to confuse your baby.

Baby's age	Feeds in 24 h (breast + bottle)	Bottles a day	Amount per bottle (guide)
First 3–4 weeks	8–12, on demand	None, unless your midwife or paediatrician recommends a top-up	The amount you are told
From 3–4 weeks to 2 months	8 or more, on demand	Start with 1; add the 2nd when the first is going well	Breast milk: 60–120 ml. Formula: start with a small amount; if it replaces a whole feed, up to 90–150 ml
From 2 to 4 months	On demand	As many as you need, replacing one feed at a time	Breast milk: 60–120 ml. Formula, if it replaces a whole feed: 120–180 ml
From 4 to 6 months	On demand	As many as you need, replacing one feed at a time	Breast milk: 60–120 ml. Formula, if it replaces a whole feed: 180–210 ml
From 6 to 12 months (with solid foods)	Breastfeeding on demand, alongside meals	Depending on how you organise things	Formula, if it replaces a whole feed: 180–240 ml

These are guide values for a healthy baby born at term. A top-up bottle doesn't need to be as big as the bottle of a baby who is only bottle-fed, because your baby is also breastfeeding: offer it when you see hunger cues and let them stop when they are full. If the top-up has been prescribed by your paediatrician, follow their amount. There is more detail in our article on how much milk in a bottle by age.

The good signs are the usual ones: around 6 heavy, wet nappies a day, regular poos and weight gain that your paediatrician or midwife keeps an eye on.

Mixed feeding schedule: an example day

This is only a rough guide. Every baby is different and may need more or fewer feeds through the day, depending on their age, growth and appetite.

• Morning (7:00 – 8:00): a breastfeed to start the day.
• Mid-morning (10:00 – 11:00): a bottle to complement feeding.
• Midday (13:00 – 14:00): a breastfeed to keep stimulating your supply.
• Afternoon (16:00 – 17:00): another bottle.
• Evening (19:00 – 20:00): a breastfeed before bed.
• Night (2:00 – 3:00): if your baby needs it, a breastfeed or a bottle that your partner can give.

It can be a good idea for your partner to give the bottle at night: some babies sleep a bit longer after that feed, and those hours can do wonders for your rest. If you skip a night feed and your breasts feel full, expressing for a short while will bring relief.

Mixed feeding without reducing your milk supply

After the birth or caesarean, and above all after skin-to-skin contact and the first breastfeed, your body understands that there is a baby and sets all the machinery in motion. In the first days your body says: “Right, there's a baby, let's start breastfeeding.” With feeds, or with the breast pump if your baby is in hospital, your milk comes in. Every mum is unique and it may happen sooner or later, but with the right stimulation it will come.

At first your body makes more than needed, just in case: “OK, there's a baby, or babies, I'm going all in.” As the days go by, your body adjusts its supply to what your baby takes, because it is perfectly designed to do so. That is why every feed you replace with a bottle is a signal to make a little less. To keep up your supply:

• Replace one feed at a time and give your body a few days to adjust before dropping another.
• Keep the morning, evening and night-time breastfeeds, which are the ones that stimulate supply the most.
• Express at bottle time if you skip feeds. If you give formula as a top-up, ideally express roughly the same amount your baby takes, especially in the first 2–3 months. Adapt it to your situation.
• Put your baby to the breast whenever you are together, in the afternoons and at weekends.

If you express, our guide to storing expressed breast milk tells you how long it keeps in the fridge and freezer, and expressing breast milk at work explains how to organise yourself.

How to bottle-feed without losing breastfeeding: paced bottle feeding

How you give the bottle matters as much as the bottle itself. Paced bottle feeding means letting your baby set the pace, just as at the breast:

• Baby almost upright, with their head in line with their body, rather than lying down.
• Let them take the teat: brush it against their lip and wait for them to open wide, instead of pushing the teat in.
• Bottle almost horizontal, just enough for the teat to be full of milk.
• Pause every few sucks by lowering the bottle slightly, so they can breathe and notice whether they are still hungry.
• Switch sides halfway through the bottle, as you would when changing breasts.
• Stop when they show they are full (turning their head, letting go of the teat, falling asleep): they don't have to finish it.

Show your partner or whoever will be looking after your baby how to do it. For more detail, read how to bottle-feed a baby.

Factors in mixed feeding

Your breastfeeding rests on two key pillars, your body and your baby, and making sure neither of them gets confused is the most important thing if you want to do mixed feeding without losing your breastfeeding.

What is nipple confusion in newborns during mixed feeding?

It is the confusion we create in your baby by using a teat that is different from your breast when doing mixed feeding, after which your baby may become confused and refuse the breast. That is why we need to avoid generic bottles and use a made-to-measure Happymami bottle, to help prevent nipple confusion in your baby and protect your breastfeeding when you combine breastfeeding and bottle feeding.

What can you do to avoid confusion with mixed feeding?

To avoid confusion when mixed feeding, you can use alternative feeding methods such as finger feeding with a syringe, a spoon or a supplemental nursing system. If you use a bottle, without a doubt choose one that is as similar to your breast as possible, and the most similar will be a made-to-measure Happymami bottle.

👶🏻 Use bottles adapted to your baby's needs to avoid confusion when combining breast and formula 👶🏻

Why is it important to use a bottle similar to your breast for mixed feeding?

When your baby is born, they have reflexes known as primitive reflexes. They are normal, disappear over time and help them “survive” this first stage. We will focus on two: the rooting reflex (when touched around the mouth, they turn their head towards the touch) and the sucking reflex (when something touches their palate, they suck).

But your baby doesn't know what a nipple is, or a dummy, or what mum's breast is like: they have to learn how much stimulation mum's breast will give their palate. For example, if mum has a large breast with a short nipple, over the days the baby will learn that they need to open their mouth wide and how much stimulation that nipple gives them, and will feel very comfortable with it. That is why every breast is perfect for breastfeeding: all we need is for the baby to learn what mum's breast is like, and that takes a few days or weeks to settle.

Benefits of using Happymami personalised bottles for mixed feeding

Happymami bottles are an excellent tool to support babies while they learn to feed, especially as they develop and refine their sucking reflex. Designed to mimic the texture and shape of the mother's breast, these bottles allow a natural transition between breast and bottle without confusion for the baby.

Happymami teats stimulate the baby's palate in a similar way to the mother's nipple, helping to reinforce the sucking reflex. They make it easier for the baby to associate similar feeding patterns between mum's breast and the bottle.

Mixed feeding with formula milk

When mixed feeding with formula, the most important thing is not to confuse your breasts. Just as we mentioned earlier not confusing your baby by using a made-to-measure mixed feeding bottle, now it is time to think about not confusing your body.

Bear in mind that as your baby grows they will need more milk, so your breasts also need to make more: keep up good stimulation, with your baby or with the breast pump. Prepare formula exactly as the instructions on the pack say, and let your paediatrician guide your choice of milk.

How do you do mixed feeding?

To do mixed feeding without affecting your breastfeeding, we should follow a few guidelines. The first is to avoid using a generic bottle and use a made-to-measure Happymami bottle instead: that way you will help prevent nipple confusion in your baby and protect your breastfeeding.

There are two ways to do it:

• As a top-up: first you breastfeed until the breast is drained and then you give the top-up, in the amount set by your paediatrician, in your Happymami bottle. If you keep giving the bottles with your own milk, perfect; if you decide to introduce formula, that is fine too.
• With full bottle feeds: for example, when mum goes back to work and the bottle is given by her partner at home or at nursery.

If your baby won't take the bottle, don't worry: it is common in breastfed babies. We help you in my baby refuses the bottle and in how to move from breast to bottle.

Resources for mums who choose mixed feeding

Here you have practical information and key resources for mums who opt for mixed feeding: a detailed breastfeeding guide and basic tips on newborn care.

• Breastfeeding Guide 🍼
• Newborn Care Guide 👶

Risks of mixed feeding

If you do mixed feeding, the main risk is losing your breastfeeding, so it is important not to confuse your body or your baby. Your body needs ongoing stimulation to make everything your baby takes, and a made-to-measure Happymami bottle helps prevent nipple confusion in your baby, protecting your breastfeeding.

🍼Reduce the risks by choosing personalised bottles that respect your baby's natural sucking. 👶🏻

Design my bottle

What mums say about Happymami

Frequently asked questions about mixed feeding

When can you start mixed feeding?

If there is no medical reason, once breastfeeding is well established, often at around 3–4 weeks. If your paediatrician or midwife recommends a top-up earlier, you start when they say. If you are going back to work, start 2–3 weeks beforehand.

How many bottles do you give with mixed feeding?

Start with one a day and add one at a time, depending on your baby's age, your supply and how you organise things. The more breastfeeds you keep, the more stable your supply will be. You will find the table by age further up.

How do you combine breastfeeding and bottle feeding?

• Offer the breast first if the bottle is a top-up, to stimulate your supply.
• Use breast milk in the bottle whenever you can, especially at the beginning: its taste is familiar to your baby.
• Choose a suitable bottle, with a slow flow that mimics the nipple, and give it at a gentle pace.

Can you mix breast milk and formula in the same bottle?

Better not to: if your baby doesn't finish it, your milk is wasted, and formula must always be made up with the amount of water stated on the pack. Give your milk first and then the formula, in separate bottles.

Can you go back to exclusive breastfeeding after mixed feeding?

Often, yes: by increasing breastfeeds and expressing, your supply can go up again. Do it gradually, with your paediatrician or midwife keeping track of your baby's weight.

What if my baby prefers the bottle to the breast?

Sometimes milk flows more easily from the bottle. Use a slow-flow teat, give the bottle at a gentle pace and offer the breast at calm moments, skin to skin.

If you have questions about mixed feeding, you can ask Clara, our virtual midwife, at any time, or our Happymami WhatsApp community. And if something worries you about your baby's health or you notice a warning sign, see your doctor or go to A&E.

Conclusion

The foundation of mixed feeding is not confusing your body or your baby. That is why the first weeks of breastfeeding are so important: wait until it is well established, introduce the bottle gradually and keep as many breastfeeds as you can. These are ideal guidelines and you will need to adapt them to your situation.

Always use a made-to-measure Happymami bottle to help prevent nipple confusion in your baby, and keep stimulating your body so it carries on making the milk your baby needs. Be patient: there will be a learning stage, but afterwards it will be very easy.

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References

Materna L, Guillen AM, Dalmau Serra J, De Neonatología S, De Nutrición S, Fe L, et al. Alimentación del recien nacido sano. Aeped.es.

Fabm AKMI. Initiation of breastfeeding. Uptodate.com. 2022. Available at: https://www.uptodate.com/contents/initiation-of-breastfeeding

World Health Organization (WHO). Infant and young child feeding. Fact sheet.

Spanish Association of Paediatrics (AEP), Breastfeeding Committee, and AEP En Familia: mixed feeding, bottle feeding and hunger and fullness cues.

Academy of Breastfeeding Medicine (ABM). Clinical Protocol #3: Supplementary Feedings in the Healthy Term Breastfed Neonate, 2017.

Kassing D. Bottle-feeding as a tool to reinforce breastfeeding. Journal of Human Lactation, 2002.

Kent JC, et al. Volume and frequency of breastfeedings and fat content of breast milk throughout the day. Pediatrics, 2006.

Institut national de santé publique du Québec (INSPQ). Mieux vivre avec notre enfant de la grossesse à deux ans: milk amounts per bottle by age.

NHS. Combining breast and bottle feeding.