Woman breastfeeding two babiesWoman breastfeeding two babies

What Is Combination Feeding?? 9 questions with Bobbie medical advisor, Dr. Amna Husain

We’re totally in favor of combination feeding—what that means is nourishing your little one with both breastmilk and formula. Think of it as the best of both worlds: a bit of breastmilk, a splash of formula. Maybe it’s a morning cuddle session while nursing, followed by a nighttime bottle for bedtime. It’s a setup that, in our opinion, makes everyone a winner! This approach alleviates the immense pressure often placed on mom to be the exclusive source of nourishment for the baby. Plus, it opens up feeding time as a shared experience, letting other important people in your life—like partners, grandparents, and other caregivers—step in and bond with the baby, without you having to be permanently attached to a breast pump.

At Babe, we support however you choose to feed, whether it’s 24/7 boobage, full-throttle formula, or a little of both. Aren’t options the best? So we sat down with Dr Amna Husain, board-certified pediatrician, AAP Spokesperson, International Board-Certified Lactation Consultant, Bobbie Medical Advisor, and mama to two little gals to talk the ins and outs of combo feeding, as her own personal experience feeding her babes both ways.

What is combo feeding? Is that the same as “supplementing?”

I typically use the phrases combo feeding and supplementing with formula interchangeably.  Once discussing feeding goals and subjective signs of satiety along with objective normal weight gain for the baby, I typically discuss ways to determine if supplementing is something that may work for a family or be helpful incorporated into a family’s feeding plan.

What are your general views on combo feeding? 

Combo feeding works for many families. It allows them to reach their breastfeeding goals (whatever they may be) without putting pressure on themselves to be the exclusive source of their child’s nutrition in the first six months of life before the introduction of complementary foods.

What are a few common reasons your patients would need to consider combo feeding for their baby? 

A mother’s milk supply can vary dramatically, from breast to breast, hour of day, and even pregnancy to pregnancy. A woman who produced enough for one child may need to supplement for another. If a mother chooses to return to work, she may notice her supply can dip as she is away from her baby and of course, a pump isn’t as effective as a baby. If a mother’s ill, her supply may dip as well and be unable to keep up with the baby’s demand temporarily. There are a number of reasons a parent may choose to supplement, which is why it’s important to discuss breastfeeding goals and feeding goals early on with a family and continue to re-visit.

How does one combo feed?

Sometimes it may be a few milliliters to an ounce of formula after a nursing session.  Sometimes it may be a larger volume in the evenings or just a bottle of formula during the day if the nursing parent is away from the baby and unable to nurse. It really depends on the family and the baby’s behaviors.

Many parents think breastfeeding is the only option.

What should first-time parents expect when it comes to a feeding journey to create reasonable expectations?

Feeding journeys can change over time and a baby’s nutritional needs will also change with time. I always review with families, especially first-time parents, that milk will likely take longer to come in (4-5 days typically) vs. subsequent pregnancies. Also, a mother’s medical history and the delivery experience, birth trauma, baby’s medical history, etc can make a difference in how feeding goes in the initial hours to days following delivery. 

I also usually review with parents that the first few days of life, stools can be dark and tarry (meconium) but should begin transitioning to yellow brown as more milk and/or formula is ingested by the baby. In the initial days, it is also normal to see a few wet diapers. Usually, on day one of life, we expect one wet diaper. 

When you first meet with parents, how do you discuss feeding goals? 

I’m used to fielding questions and troubleshooting breastfeeding concerns. However, I usually answer questions but follow up with one important question – what are your breastfeeding goals? I find that many parents haven’t considered this and once asked, may not be sure of the answer or even be on the same page. In that vein, I typically discuss if the goal is exclusive breastfeeding or is any introduction or use of formula acceptable. And if not, why?

When do you introduce formula or combo feeding into the conversation? How do you let people know that it may be a successful addition without making them feel defensive?

There’s no one way to discuss formula supplementation and/or combo feeding. Some families may never need to broach the topic if the mother has adequate supply. Some families may want to supplement from the get-go. There are other families who would like to learn options early on and put less pressure on themselves to exclusively breast-feed. I find it helpful to view each family in an individual manner and approach the topic as needed.

Read more: Combination Feeding: When to start combo feeding your baby

Are most patients excited about the idea of combo feeding? Do they see the value of how helpful it can be?

 It’s all about the way you introduce the topic. I find many parents are curious and generally want to know their options. For example, even if they never open a can of formula, they may have questions about which formula I recommend and which they should have in the house if needed.

Can you share your own breastfeeding journeys and experience with combo feeding?

My feeding journeys varied drastically with each of my girls. With my oldest, four-and-a-half years ago, I was not yet a lactation consultant. I was a pediatrician and didn’t understand very well the physiology behind breastfeeding and the nuances of normal newborn behavior.

I also wasn’t prepared for the toll it would take on my mental health and how breastfeeding really is a relationship between two people. Even though I wanted it to work, for various reasons, my oldest didn’t latch well. I switched to exclusive pumping and was taken aback by how I would equate my worth and really how my day went with how much I pumped.  

I had to introduce formula to meet her volume needs and initially it made me feel like I was doing something wrong. I eventually stopped exclusive pumping at six months when I felt it was really robbing me of the joy of feeding my baby and switched to formula feeding exclusively. I do not regret my decision for a second.

With my second baby, I approached breastfeeding with knowledge not only as an MD but also as an IBCLC  I set realistic goals for my breastfeeding journey and acknowledged that both baby and I were equal parties in this complicated breastfeeding relationship. I was able to nurse her for her first 11 months but still combo fed with formula. I wasn’t her exclusive source of nutrition but our nursing journey was much more memorable and joyful, for which I am truly grateful.

This article was written in partnership with Bobbie.