Combining Breastfeeding and Formula Feeding

Supplementing the Breastfed Baby With Infant Formula

Giving a baby a bottle
Is it OK to breastfeed and use formula?. Peter Cade/Photodisc/Getty Images

Can You Breastfeed and Give Your Baby Formula?

Giving your baby infant formula in addition to breastfeeding is called supplementing. It's certainly OK to breastfeed and give your baby formula, and many families choose this combination feeding method.

What Is the Recommended Way to Feed Your Baby?

The American Academy of Pediatrics (AAP) and the World Health Organization (WHO) recommend breastfeeding exclusively for the first four to six months and then continuing to breastfeed up until one year or longer along with the introduction of solid food.

However, the decision to supplement is up to you, and the main goal is that your child gets the nutrition he needs. 

Reasons Some Women Supplement With Formula

Making the decision to supplement with formula may not be an easy one. It may be something that you want to do, or you may have no choice and have to supplement. It might be emotional, and it may even be a great source of stress or guilt. Here are some of the reasons you may need to or choose to supplement your child with formula. 

Your Child has Medical Issues: If your baby is born premature or with certain medical conditions, she may need to get a supplement along with your breast milk. 

You Have a Low Breast Milk Supply: A previous breast surgery or certain medical conditions can interfere with the production of breast milk. If you or your doctor feel that your baby is not getting enough breast milk through breastfeeding alone, you may need to supplement.


You're Going Back to Work: It may be too difficult or stressful to pump at work, or you may have a decrease in your breast milk supply once you return to work. So, if you don't have a stockpile of breast milk stored in the freezer to use, you may have to supplement your baby's diet with formula. 

Your Partner Wants to Participate: You may want your partner to participate in feedings and give an occasional bottle.

You could pump and use your breast milk in a bottle, or you can give your baby a bottle of formula once in a while.

You have Multiples: It can be a challenge to breastfeed twins or triplets exclusively. Not only do you have to build and maintain a large enough breast milk supply, but you'll be breastfeeding very often. You may just need a breastfeeding break a few times a day.

It's a Personal Choice: You may just have a personal preference to breastfeed some of the time and give your baby formula the rest of the time. That's OK, too.


When Would A Doctor Recommend Supplementation?

When possible, most doctors recommend exclusive breastfeeding. However, there are certain times when it's necessary for a physician to recommend supplementing a breastfed baby.

Your doctor may recommend supplementation if:

  • Your newborn loses more than 10% of his or her body weight in the first few days of life.
  • Your child loses weight or gains weight slowly after the first few days.
  • Your baby is having less than six wet diapers in a 24 hour period.
  • Your newborn is very fussy and does not seem satisfied after feeding.

How Should You Choose an Infant Formula for Your Baby?

Before choosing an infant formula for your child, talk to your baby's doctor.

Most doctors recommend an iron-fortified infant formula during the first year of life. 

If your baby develops a rash, vomiting, diarrhea, excessive crying, fussiness, or gas after starting formula, it may be an allergy. Stop using the formula and notify the baby's doctor to discuss other types of infant formula available.

When to Introduce Infant Formula to Your Baby 

If you're not supplementing your child for medical reasons, experts recommend breastfeeding for at least one month before starting formula. Waiting at least four weeks gives you time to build up a healthy breast milk supply and ensure that your baby is breastfeeding well.

At this point, you can slowly begin to add formula. 

Supplementing and Your Breast Milk Supply

The amount of breast milk that your body makes each day is based on supply and demand. So, when you start to give your baby formula, it can affect how much breast milk you make. If you plan on supplementing one or two bottles a week, it should not affect your breast milk supply. But, if you give your child one or two bottles of formula a day, your will see a decline in the amount of breast milk that you're making unless you pump or hand express your breast milk to maintain your supply.

It's also important to remember to introduce formula supplements slowly. Going from not supplementing to supplementing a lot in a short period, could cause problems such as breast engorgement and blocked milk ducts

Can You Combine Breast Milk and Formula in the Same Feeding?

If you would like to give your baby breast milk and formula during the same feeding, it is not recommended to mix them together in one bottle. It is the most beneficial for your baby to get as much of the breast milk as possible. So, you should give the breast milk first, and then finish the feeding with the formula.

Changes In Your Baby With Formula Supplementation

If you've been breastfeeding your baby and begin to add formula to her daily diet, there are some things you may start to notice. 

Refusal to Take the Bottle: Your child may refuse to take the bottle especially if you're the one giving it to him or her. Try to have your partner or other caregiver give him a bottle.

Refusal to Take the Breast: Once you start to give your baby formula in a bottle, your baby may take the bottle without a problem. But, since it's more work to get your breast milk out of the breast than it is to get the formula out of a bottle, she may start to refuse the breast.

Longer Periods Between Feedings: Formula is not as easily digested as breast milk so your baby may feel fuller longer and not eat as often. 

Changes in Bowel Movements: Adding formula to your baby's diet may change the pattern, color, and consistency of your baby's poop. Formula poop is usually firmer, tan or darker in color, and it has a stronger odor.

Is Formula Feeding Along With Breastfeeding Safe for Your Child?

The ultimate goal of every parent is to have a happy, healthy baby who is growing and thriving. Infant formula is a safe alternative or additional choice when it comes to feeding your baby so you should not feel guilty if you need to or decide to supplement. If you can breastfeed exclusively, that's great. But, it's not always possible for every mom. Just remember, with breastfeeding it doesn't have to be all or nothing. Even a little breast milk is better than none. Every baby and situation are unique, and a combination of breastfeeding and formula may work well for your family.


Academy of Breastfeeding Medicine Protocol Committee. ABM clinical protocol# 3: hospital guidelines for the use of supplementary feedings in the healthy term breastfed neonate, revised 2009.

Auerbach, Kathleen, G. Ph.D., IBCLC, Montgomery, Anne, MD, IBCLC. (1999). Supplementing the Breastfeeding Baby. Accessed November 19, 2011

Eidelman, A. I., Schanler, R. J., Johnston, M., Landers, S., Noble, L., Szucs, K., & Viehmann, L. (2012). Policy Statement. Breastfeeding and the Use of Human Milk. Section on Breastfeeding. Pediatrics, 129(3), e827-e841.

Lawrence, Ruth A., MD, Lawrence, Robert M., MD. Breastfeeding A Guide For The Medical Profession Seventh Edition.  Mosby. 2011.

World Health Organization. Infant and young child feeding: model chapter for textbooks for medical students and allied health professionals. 2009.

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