Supplementing and combination feeding

Many babies get some of their milk from the breast and some from a bottle or cup, of pumped milk, formula or both. Families do this to top up a newborn, to go back to work, to share feeds, or simply by choice. Your baby can keep getting the benefits of breast milk alongside formula. Every family's mix is different.

Topping up a newborn

When a pediatrician suggests extra milk in the first days, the ABM's order of choice is:

Your own expressed milk.
Donor human milk, if your own milk isn't enough.
Formula, if donor milk isn't available or suitable.

Newborns take small amounts at first. Typical colostrum intake per feed at the breast:

Baby's age	Per feed
First 24 hours	2 to 10 ml
24 to 48 hours	5 to 15 ml
48 to 72 hours	15 to 30 ml
72 to 96 hours	30 to 60 ml

Follow your baby's cues and your pediatrician's advice on amounts.

Ways to give it

A cup, spoon, syringe, finger-feeding, a tube at the breast, or a bottle all work. No one method is proven better. A cup lets a baby set their own pace. If you use a bottle, pacing the feed may help.

Protecting your supply

Formula feeds can lower how much breast milk you make.
Express once for each supplement, or at least 8 times in 24 hours if your baby isn't nursing.
If you can, let nursing settle in first. It can take several weeks to feel confident.
Add formula gradually, so your body has time to adjust. This lowers the chance of swollen breasts or mastitis.
Going back to work? Start a few weeks before so you both can adjust.

Moving toward more breast milk

Nurse as often as you can, and express between feeds.
Expressing about 8 times a day, including once at night, is ideal.
Cut bottles gradually as your supply increases.

Paced bottle feeding

Paced feeding lets your baby set the speed, so milk flows only while they suck. It works for breast milk and formula.

Hold your baby close and semi-upright, with the head supported.
Brush the teat against your baby's lips and let your baby draw it in when the mouth opens wide.
Keep the bottle close to flat, just tipped enough that milk comes out only when your baby sucks.
Let your baby take breaks whenever they want one.
Stop at signs of fullness, even if the bottle isn't empty. Never prop a bottle.

Your baby will know how much milk they need, so there's no need to finish the bottle.

When to call your pediatrician

Your baby often refuses feeds, or seems hungry even after large bottles.
Coughing, choking or color changes during feeds.
Fewer pee diapers than usual, or any worry about weight gain.
You're thinking of donor milk or a formula change: your pediatrician can help you choose.