Combining Breast and Bottle
I work with many families balancing breast and bottle feeding. When breastfeeding is going well, this can be straightforward - babies get bottles as desired. This works well if the baby is nursing effectively, milk supply is healthy, and the parent pumps when bottles are used (to maintain supply and get milk for the next bottle).
However, if a baby is not nursing well, this balance can be more complicated.
Parents are often told that their milk supply is low, and that is the cause of feeding issues. But, more frequently, the problem is an ineffective latch - reducing stimulation to the breasts, and lowering supply.
This can create a negative cycle where parents feel trapped in a pattern of nursing, pumping, and bottle feeding at every feeding sessions - what we call “Triple Feeding”. And most families find triple feeding very stressful and time-consuming (I agree!).
If a baby is not nursing well (pain, low intake, etc) - I recommend to rely more (or exclusively) on bottle feeding and pumping. We want to feed the baby and protect the milk supply - keeping both baby and parent healthy while we determine why the baby is having difficulty with latch (and help them improve their skills). If the family’s goal is to breastfeed, ideally increasing pumping/bottle feeding is a short-term strategy. Then they can use the “extra time” (I know that’s kind of silly of me to say when you have a newborn!) - that’s not being spent on triple feeding to practice new latching ideas (thinking of nursing as practice and snacks, rather than full meals), and aid baby’s oral/body range of motion and suckling skills.
The plan needs to be efficient, manageable and work toward long-term goals. So figuring out the right balance of breast, bottle and pumping is essential for baby’s intake, milk supply, growing the baby’s suckling skills, and for the family’s sanity!
When combining breast/bottle - parents are often told to nurse first, then offer a bottle if the baby needs more. While this can work, it often leads to long, exhausting feedings, especially if the baby falls asleep, doesn’t get enough milk, or the nursing parent experiences nipple/breast pain. Adding to the fatigue is the time it takes to bottle feeding and pump to maintain baby’s intake and milk supply.
A more effective approach can be reversing the order of bottle/breast - also called:
Finish at the Breast
When nursing well, babies typically consume most of their milk at the start of a feeding and then shift to comfort sucking. However, when nursing is challenging, comfort sucking can become time-consuming and painful.
With the Finish at the Breast method, you offer a bottle first to satisfy the baby's hunger (or partially satisfy their hunger), then have them nurse to finish the feeding (and practice latching skills). This approach mimics their natural rhythm, often resulting in calmer nursing sessions where the baby can practice breastfeeding skills with less (or ideally no) frustration. It’s can also be emotionally rewarding for parents to see their baby satisfied at the breast at the end of the feeding.
As the baby’s nursing improves, you can gradually reduce the pre-bottle amount, transitioning to more breastfeeding.
Another helpful method for combo feeding is at-breast supplementing - doing the act of nursing and bottle feeding at the same time (see that post for more detail!)
But how do you know how much to give the baby by bottle
when they are also nursing part-time? We use….
“Breastfeeding Math”
Determining how much to give a baby by bottle while nursing part-time involves some simple calculations. For example, if a baby drinks a 1 oz bottle after every breastfeeding session and is gaining weight well, start with a 1 oz pre-bottle, then breastfeed after until the baby appears satisfied. If nursing sessions are comfortable and timely, and the baby is gaining weight, you’re on the right track! As the baby's latch improves, you can decrease the pre-bottle amount over time.
A typical breastfed baby from 1- 6 months drinks ~25-35 oz per day beginning around 10 lbs or at 1 month of age (whichever comes first). Keep in mind that this is an average; individual needs may vary, and the key is to ensure the baby remains on their particular growth curve.
For babies under 1 month old and/or under 10 lbs, you can use the following formula as a guideline - if 10 lbs equals 25-35 oz/day, then 1 lb equals 2.5-3.5 oz. This means each day, a baby should receive approximately 2.5-3.5 times their weight in milk/formula up to 1 month or 10 lbs (whichever comes first). After this point, their intake stabilizes for a few months (usually somewhere in that range), except during growth spurts.
For example, an 8 lb baby (under 1 month old) may need 20-28 oz per day. If they are gaining well with breastfeeding plus 10 oz from the bottle (formula and/or pumped milk) per day, they are likely getting the remaining 10-18 oz from nursing.
Ultimately, you’ll rely on your baby’s hunger cues, diaper output, and weight gain to determine their needs. As nursing and milk supply change over time, you can adjust these amounts accordingly.
