Bottle & Combination Feeding

Feeding your baby does not always look as simple as breastfeeding or bottle feeding. In this section we will look at

• Protecting breastfeeds when also supplementing
• Common reasons parents introduce extra milk
• “Topping up”
• Combination feeding
• Paced bottle feeding
• Donor breastmilk
• Choosing an infant formula milk
• Making up bottles safely
• Choosing bottles & teats
• Dummies/Pacifiers

Protecting breastfeeds when also supplementing or combination feeding

There are lots of reasons why parents decide to offer their baby more than breastfeeds alone. You may like to read the breastfeeding section for more information on support & common challenges if your aim is to exclusively breastfeed your baby. If you feel that your baby needs more milk than they are able to take at the breast the following can help to protect breastfeeds & milk supply.

• Making sure that baby is latching well at the breast
• Feeding baby frequently & offering the breast first
• Using breast compressions when breastfeeding
• Offering expressed milk if possible rather than formula
• Cup feeding
• Using a spoon to feed baby milk
• Using an at breast supplementer (pictured)
• Trying to keep additional feeds to the minimum amount needed
• Continuing skin to skin with baby
• Expressing milk if you miss a breastfeed

Common reasons parents introduce extra milk

There are lots of reasons why a parent may feel they need to introduce extra milk. Common reasons include

• Baby will not latch yet
• Baby has lost more than 12% of original birth weight
• Baby is not having enough wet and/or dirty nappies
• Breastfeeding is too painful
• Concerns that milk supply is low
• The mum feels like she needs a break

However, this does not always mean extra milk is needed. It can be difficult and take time to get baby to go back to exclusive breastfeeding if deciding to give extra milk, so chatting things through with a breastfeeding counsellor can be helpful.

“Topping up”

Parents are sometimes recommended to ‘top up’ their baby with additional milk after weight loss or static/low weight gain in their baby. It can be helpful to know what normal weight gain looks like and other signs that baby is getting enough milk before deciding to do this. Some parents find these alternatives to topping-up helpful

• Breast compressions
• Skin to skin
• Offering baby more feeds

If you do decide to top up, trying to do small amounts can help to protect breastfeeding. You can discuss your options with the infant feeding teams in midwifery or health visiting; or come along to one of our Nourished Feeding Drop-ins

Combination feeding

Combination or mixed feeding are terms often used to describe a combination of breast and bottle feeding. This article from the NCT has lots of information for parents who decide to start combination feeding.

Paced bottle feeding

Paced bottle feeding is where you feed your baby at their pace, keeping baby upright and the bottle horizontal, taking regular breaks to allow baby to pause. This helps baby to have control over the amount of milk they are taking & prevents over feeding. This is helpful for all babies and helps to foster responsive feeding.

Donor breastmilk

Some hospitals will offer donor breastmilk if your baby is in NICU and you are struggling to express enough milk. Donor breastmilk is breastmilk another mother has donated, the milk then undergoes a pasteurisation process before being offered. This is not offered at all hospitals.

There are other ways to use donor milk such as Human MIlk for Human Babies UK however, these are informal milk sharing methods where mothers are not normally tested and the milk is not pasteurised. Some parents may not feel comfortable with this as this relies on trust and there are risks to sharing milk informally. You can read more about this here.

Would you like to donate your breastmilk? You can do this via Healthy Babies UK, click on the logo to take you to this information.

Choosing an infant formula milk

It can be a difficult decision knowing which formula milk to buy for your baby. Lots of supermarkets have a large selection of formula, multiple brands and lots of ‘stages’. Some claim to be better for hungry babies or babies with reflux or colic. The good news is that you only need to ever buy a stage 1 or first milk. There is no evidence to state that other milks are better or even needed at all for your baby. A stage 1 milk, regardless of brand will have the industry standards of what needs to be in the milk. Expensive marketing and brands do not mean they are better for your baby, they all have to have the same basic ingredients.

Your baby only needs the stage 1 milk from newborn to 12 months. Babies can then switch to cows milk. If you have any concerns about your baby’s milk, you can contact your health visitor or call the NCT Infant Feeding Line. You are also welcome to contact Early Nourishment or pop along to a drop-in.

Making up bottles safely

It is really important that parents know how to make a bottle of formula safely. This is because the powder is not sterile and babies’ immune systems are still developing. If formula is made incorrectly, the milk can be contaminated and this can put baby at risk of illness. It is important correct amounts are used as per the manufacturers guidance. It can be dangerous to water down or make formula more concentrated. You can read more from the NHS guidance on making formula.

Choosing bottles & teats

There is no unbiased evidence that certain bottles are better than others. Keeping baby on a slow flow teat can be helpful as this allows baby to have more control of the pace of the feed. As mentioned earlier, paced feeding helps to keep feeding responsive & protect breastfeeding.

Dummies & pacifiers

The NHS recommends waiting until 6-8 weeks before offering your baby a dummy/pacifier. This is to help ensure that all baby’s sucking needs are met at the breast during the early days where the foundations for the milk supply are being laid – the more suckling at the breast, the more feedback is given to mums body to make enough milk for her baby.

If you do decide to give baby a dummy/pacifier at any point it can be helpful to offer a feed first.

Some parents believe that dummies/pacifiers can help prevent SIDS. The evidence is limited with this but we do know that breastfeeding reduces the risk of SIDS. This article from BASIS can help parents to make an informed decision when trying to decide whether to introduce a dummy/pacifier.

If you are considering a dummy as you are struggling to meet baby’s suckling needs, you can contact us for support or come along to one of our Nourished feeding drop-ins.