Mixed (combination) feeding

Mixed feeding recommendations

The health advantages for you and baby are higher if you exclusively breast feed, however any breastfeeding is beneficial to both you and your baby.

If you choose to mix feed, ideally breast feed initially in the first few days or weeks to stimulate your milk production before introducing formula. This gives your body the greatest opportunity to initiate your milk supply and helps ensure milk supply in the longer term.

Use first stage formula for the first year of your baby’s life if you are mixed (combination) feeding.

Introducing formula

Introducing formula may impact your breast milk supply. Ways to try to minimise this include:

• Try to maintain night feeds. These are important for maintaining milk supply, as there is an increase in the hormone prolactin during night feeds.
• Try to limit the total amount of formula given, if possible.
• Try to separate formula feeds from breastfeeds, if possible.
• You can use expressed breastmilk instead of formula to maximise health benefits.
• See more information on responsive bottle feeding (pdf, November 2024, from First Steps Nutrition Trust) and which formula milk to choose.

How to introduce a bottle feed

Try to do this as a gradual process, especially if you are going to use formula. This will support the transition for your breasts and prevent sore, uncomfortable breasts or developing mastitis.

If you are going back to work or planning being away for a period of time from your baby, start a few weeks before the intended date.

Remember if your baby is over 6 months old they may not need a bottle, and using a free flow cup could be more beneficial for your baby than introducing a bottle. If you are using formula milk in a cup, then please remember that this needs sterilised the same way as you would a bottle and teat. See more information on cups at NHS.uk

Try to introduce a bottle when your baby is relaxed, as this is a new skill for both them and you, so try to make this a nice relaxing experience.

Don’t worry if baby does not take from the bottle the first time. Keep trying, and it might be useful to ask someone else to try a bottle feed when your baby is not near you.

Try to make small feeds up, so as not to waste any formula milk or expressed breast milk when you are first attempting your baby at the bottle.

See more information and some mother stories on combination feeding, from NHS.uk

Vitamin D when mixed feeding

If you are mixed feeding you are entitled to free vitamin D tablets for you, and your baby will be given free vitamin D drops until their 1st birthday when they are getting less than 500mls of formula per day.

Please ask your health visitor or family nurse for free vitamin D for you or your baby. If you have any problems sourcing vitamin D:

• email hirs.mailbox@nhs.scot