What is mixed feeding?

Mixed feeding is when your baby is fed formula as well as breastmilk.

Some parents decide to start mixed feeding and combine breastfeeding and bottle feeds. This can be for a range of reasons.

Mixed feeding can involve:

• breastfeeding and giving your baby formula
• breastfeeding and giving your baby a combination of expressed breast milk and formula
• breastfeeding and giving your baby donor breastmilk
• bottle feeding expressed breast milk, formula, and/or donor milk

Regular mixed feeding with formula can make breastfeeding more challenging as it can interfere with your milk supply. Some babies may start to prefer drinking from a bottle.

The way you feed your baby is a personal choice. You may choose to feed your baby just expressed breastmilk as you prefer to feed using a bottle.

It’s a good idea to talk to a health professional if you are thinking about introducing formula.

From birth your baby needs to be fed regularly to have good weight gains. Newborns need to feed about every 2 to 3 hours (8 to 12 times in a 24-hour period).

Why might I think about mixed feeding?

Although exclusive breastfeeding for the first 6 months is the ideal start for your baby, there are reasons why you may consider mixed feeding. These may include:

• issues with breastfeeding
• low breastmilk supply
• baby with a low weight

Issues with breastfeeding

Sometimes breastfeeding can be challenging (it’s important to remember that you and your baby are learning). Some of the challenges can include:

• having sore, cracked or bleeding nipples
• painful, blocked ducts in your breasts
• mastitis — an inflammation of your breast that can cause pain and flu-like symptoms
• oral thrush and/or breast and nipple thrush
• nipple vasospasm — where the blood vessels in your nipple tighten and go into a spasm, preventing blood from flowing normally
• inverted or flat nipples — consider getting advice from a professional about trying a nipple shield
• difficulty with baby attaching to your breast — this can often be resolved with positioning and attachment advice or it could be due to issues such as tongue-tie, or a cleft palate
• your baby becoming 'fussy' at the breast or refusing to feed
• being uncomfortable about breastfeeding in a public
• returning to work — while some people successfully combine breastfeeding with returning to work, others may prefer not to

You can get help for many of these issues. This might allow you to continue breastfeeding or return to exclusive breastfeeding.

If you are having troubles breastfeeding, get support early. Talk to your midwife, child health nurse or organise a visit with a lactation consultant.

If you decide to move to mixed feeding, getting support can help you to continue with some breastfeeding as well.

Low breastmilk supply

You might worry that you don’t have enough breastmilk for your baby. Low milk supply may be temporary. Many people can build up their milk supply with the right help and support.

There are different things you can do to increase the amount of breastmilk you are producing. The best way to establish a healthy supply of breast milk is to start breastfeeding frequently. Make sure your baby is latching on correctly and emptying your breasts. Make sure you ask for help from a health professional.

Your baby’s weight and other measurements are recorded in your baby’s health record book. This helps check your baby’s health, growth and development against what is expected.

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

• 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 (3 to 4 times a day if younger than 6 to 8 weeks)
• settling and sleeping between most feeds
• is back to birth weight in about 2 weeks
• gaining on average 150g or more every week for their first 3 months

A small number of people may have low supply due to: previous breast surgery, not having enough breast tissue or another medical reason. You may be able to produce some breastmilk and choose mixed feeding for your baby with donor milk or formula.

Baby with low weight

A parent who is considering mixed feeding may be worried that their baby is losing or not gaining enough weight. All babies grow differently, and their weight may change at different times.

Depending on the situation, a health professional might suggest that you need to introduce supplementary feeds for your baby. You can often give your baby expressed breastmilk or you may begin mixed feeding with formula.

Sometimes a lower baby weight is nothing to be concerned about and only lasts for a short period of time due to a temporary milk supply or feeding issue.

Your health professional may say that your baby will benefit from mixed feeding if they were: born very prematurely (earlier than 32 weeks), had a very low birth weight (less than 1,500g), is unwell or has a medical condition.

How do I move from mixed feeding to breastfeeding?

If you are planning to increase breastfeeding again after mixed feeding, it’s important to keep up your breastmilk supply. Your healthcare professionals or one of the organisations listed below can help support you to do this.

Where can I get more help?

It's important to know that many breastfeeding and baby weight gain issues can be solved with the help of someone skilled in breastfeeding support.

You can call Pregnancy, Birth and Baby on 1800 882 436 to speak to a maternal child health nurse. Alternatively, you can contact:

• a registered lactation consultant
• your maternal child health nurse
• your midwife
• your doctor
• the Australian Breastfeeding Association Breastfeeding Helpline: 1800 686 268 (1800 mum 2 mum)

Depending on your circumstances and your baby's age, they can advise you on:

• how much formula to give your baby
• how many times a day to give formula
• when to move back to exclusive breastfeeding, if relevant