Mixed feeding breast and formula: how to combine them without losing your supply, with a sample day

Mixed feeding breast and formula means giving your baby both, in whatever mix suits your family. It works best once breastfeeding is settled. HealthHub asks mums to aim for at least 8 breastfeeds in 24 hours for the first 4 to 8 weeks and to avoid formula top-ups then. KKH suggests starting a daily bottle at about one month, given by your husband or a family member. After that, swap one feed at a time and pump when your baby has formula if you want to keep your supply. When you pick a tin, price tells you little: MOH says every infant formula sold in Singapore meets the same food regulations. Here's how to do it step by step, with a sample day.

Why mums combine breast and formula

There are plenty of good reasons, and none of them needs defending:

• Going back to work and not wanting to pump at every feed.
• A low supply that hasn't picked up despite help.
• Sharing night feeds so you get a longer stretch of sleep.
• A baby who needs extra milk for weight gain, on a doctor's advice.
• Twins, a premature baby, or a mum who is unwell or taking medicines.

Any breast milk counts. Our guide to the benefits of breastfeeding sets out what the evidence shows for babies who get some breast milk as well as those who get only breast milk.

When to start mixed feeding

Early weeks are when your supply is set, so timing matters. HealthHub says milk production depends on frequent and effective milk removal, and asks you to avoid bottles and pacifiers in the first few weeks until breastfeeding is established. If your baby needs extra milk early on, HealthHub suggests giving expressed milk by cup, spoon or syringe.

KKH's advice for working mothers gives a clear timeline: breastfeed exclusively for the first four weeks, start expressing after that, and from about one month old, give one bottle of expressed milk a day. Let your husband or a family member give that bottle, so your baby doesn't look for your breast. Once your baby takes a bottle happily, one of those bottles can become formula. Our guide on when to introduce a bottle covers bottle refusal and moving to a cup.

If a doctor advises formula earlier, for example for low blood sugar or poor weight gain, follow that. You can still protect your supply by expressing.

How to combine them without hurting your supply

Your body makes milk to match what is taken out. HealthHub warns that interrupting the breastfeeding cycle interrupts milk production and reduces supply. These steps keep the drop small and on your terms:

1. Replace one feed at a time. Pick one feed to become a formula feed and keep the rest as breastfeeds. Give your body a few days to adjust before you change another.
2. Choose the feeds that help you most. A late-evening or night feed that a partner can give is a common first swap, and so are the feeds that fall during work hours once you are back at the office.
3. Pump if you want to keep your supply. If your baby has formula at a time you would normally breastfeed, express at that time. If you are happy for your supply to settle lower, skip the pump.
4. Keep the other feeds on demand. Breastfeed whenever your baby asks when you are together. Weekends are a good time to catch up on direct feeds.
5. Don't read growth spurts as low supply. HealthHub says babies feed more often during growth spurts at around 2 to 6 weeks, 3 months and 6 months. Feed more often for a few days before deciding you need more formula.
6. Bottle-feed gently. The NHS suggests keeping the bottle almost horizontal so the milk flows steadily, and never propping a bottle and leaving your baby alone with it.

Our milk supply guide covers what to do if your supply drops further than you want.

A sample day of mixed feeding

Here is one way a day can run for a baby of about three months whose mum has gone back to an office job. Nobody publishes an official mixed-feeding timetable, so follow your baby's hunger cues and move the times to fit.

How much milk goes in each bottle depends on age and weight. Our newborn feeding guide and milk feeding calculator give a guide by age.

Choosing formula in Singapore

You don't need the most expensive tin. In 2017, MOH, the Health Promotion Board and the food regulator said that all infant formula sold in Singapore, regardless of price, meets Singapore's Food Regulations and the nutritional needs of healthy infants. They added that the scientific evidence behind brands claiming to do more is weak.

Singapore also has a code on how formula is marketed. HPB runs the Sale of Infant Foods Ethics Committee Singapore (SIFECS) Code, whose 5th edition took effect on 1 January 2019; HPB says it isn't enforced by regulation but the industry has an ethical duty to follow it. MOH notes that Baby-Friendly hospitals, which include KKH, NUH and SGH, may not take sponsorship from formula companies.

To compare what a tin costs per month, use our formula cost calculator.

Making up formula safely

KKH's lactation clinic warns that formula prepared badly or with unclean water puts a baby at risk of infection, and that over-diluting it can cause malnutrition. Singapore's hospital pages we found don't give step-by-step preparation, so these steps follow the NHS:

1. Boil fresh tap water and let it cool for no more than 30 minutes, so it stays at least 70C.
2. Wash your hands and use a sterilised bottle.
3. Pour the water into the bottle first, then add the powder.
4. Level each scoop as the tin says. Never add extra powder or extra water.
5. Cool the bottle under cold running water with the lid on, then test a few drops on the inside of your wrist; body temperature feels warm on the skin.
6. Throw away any formula your baby leaves after the feed, as the NHS advises, rather than saving it for later.

If you warm bottles of expressed milk, our guide on whether you need a bottle warmer compares the options, and our breast milk storage chart shows how long pumped milk keeps.

Frequently asked questions

Does mixed feeding reduce breast milk supply?

It can, because your body makes milk to match what is removed. HealthHub says interrupting the breastfeeding cycle reduces supply. Replacing feeds one at a time, and pumping when your baby has formula, keeps the drop small.

When can I start mixed feeding?

HealthHub asks you to avoid formula top-ups and bottles in the first 4 to 8 weeks while breastfeeding is established, unless a doctor advises otherwise. KKH suggests one bottle of expressed milk a day from about one month old.

Is expensive formula better for my baby?

No. MOH said in 2017 that all infant formula sold in Singapore, whatever the price, meets the country's food regulations and a healthy baby's needs, and that evidence for extra brand claims is weak.

Who should give the bottle?

KKH suggests your husband or a family member, so your baby doesn't look for your breast. It also gives you a break.

Can I switch formula brands?

Yes. The Competition Commission found most parents stay with the brand their baby had in hospital, but every infant formula sold here meets the same rules. If your baby has allergies or a sensitive tummy, ask your paediatrician before you change.