--- title: "Combination Feeding: Making Breast and Bottle Work | Dalo Baby" description: "How supply responds when you swap a breastfeed for a bottle, which feed to change first, and a straight answer on nipple confusion from the actual evidence." canonical: https://dalofamilyapps.com/learn/breastmilk/combination-feeding --- [Home](/)/[Knowledge Hub](/learn)/[Breastmilk](/learn/breastmilk) # Combination feeding: how to make breast and bottle work [Dalo Baby Editorial](/learn/editorial-policy)Published September 4, 2026Last reviewed September 4, 20265 min read Combination feeding means breastfeeding alongside bottles of expressed milk, formula, or both. Supply follows milk removal, so replacing a breastfeed with formula lowers production and takes about five to seven days to settle. Change one feed at a time and wait a week before changing the next. ![Combination feeding: how to make breast and bottle work](/_next/image?url=https%3A%2F%2Fcdn.sanity.io%2Fimages%2F87uht7oc%2Fproduction%2F1a7cf2147e1bd03dbe5313a37d7eba3cef62d06e-1376x768.jpg%3Frect%3D176%2C0%2C1024%2C768%26w%3D800%26h%3D600%26fit%3Dcrop%26auto%3Dformat&w=3840&q=75) ## Key takeaways - Supply follows milk removal, so every decision is really about which removals you keep. - Replacing one breastfeed with formula takes about five to seven days for your breasts to adjust — change one feed, then wait a week. - The NHS suggests six to eight weeks of exclusive breastfeeding first where possible; earlier is a preference to work around, not a gate. - On nipple confusion: a review of fourteen studies found emerging evidence for bottles, very little for pacifiers, and no settled causality. - Keep the morning and bedtime feeds if you can; mid-morning and mid-afternoon are usually the least disruptive to swap first. In this article 1. [What combination feeding actually is](#what-combination-feeding-actually-is) 2. [The one number that governs everything](#the-one-number-that-governs-everything) 3. [When to start](#when-to-start) 4. [Nipple confusion, honestly](#nipple-confusion-honestly) 5. [How to make the switch](#how-to-make-the-switch) 6. [Which feed to swap first](#which-feed-to-swap-first) 7. [Going the other way](#going-the-other-way) 8. [What success looks like](#what-success-looks-like) Combination feeding gets discussed as if it were a compromise, or a first step towards stopping. For a lot of families it is neither: it is the arrangement that lets breastfeeding continue at all, through going back to work, through a second parent taking nights, through a supply that never quite reached exclusive. It has its own arithmetic, and getting that arithmetic right is what makes it stable rather than a slow slide. ## What combination feeding actually is Combining breastfeeding with bottle feeding — using expressed breast milk, infant formula, or both.[\[1\]](#ref-mix) That covers a wide range of arrangements, and the differences between them matter more than the label does, because each one has a different effect on your supply. Shape What it looks like Effect on supply Breast plus expressed milk Bottles of your own milk, given by someone else Neutral, as long as you express when the bottle is given Breast plus formula, some feeds Certain feeds are formula every day Supply drops to match the feeds that remain Breast plus formula top-ups Formula after a breastfeed, not instead of one Broadly neutral, but drifts downward if top-ups grow Three common shapes, and what each does to supply ## The one number that governs everything Milk production follows milk removal. That is the whole mechanism: the breast that is emptied often makes more, the breast that is not makes less, and nothing you eat or drink changes that relationship much.[\[6\]](#ref-km) So every decision below is really the same decision — which removals are you keeping? The practical version of that: when you replace one breastfeed with a formula feed, it takes around five to seven days for your breasts to adjust to the change.[\[2\]](#ref-form) That is your unit of time. Change one feed, wait a week, then change the next. 5–7 days for your breasts to adjust after each breastfeed you replace with a bottle of formula (NHS)[\[2\]](#ref-form) ## When to start If you have a choice, the NHS advises breastfeeding exclusively for the first six to eight weeks before introducing bottles, because exclusive breastfeeding is what establishes production in the first place.[\[1\]](#ref-mix) If you do not have that choice — and plenty of people do not — the guidance is a preference rather than a gate. Starting earlier means paying more attention to expressing, not that the plan is doomed. Prioritise the breastfeeds you want to keep The NHS advice when combining is to keep breastfeeding regularly and prioritise it where you can. In practice this means deciding in advance which feeds are staying — usually the first morning feed and the bedtime feed — and treating those as fixed rather than as the ones you drop when the day goes wrong. ## Nipple confusion, honestly It is the fear that gets raised first and it deserves a straight answer. A review of fourteen studies for and against found emerging evidence for nipple confusion as it relates to bottle use, and very little evidence for it with pacifiers — while noting that the central difficulty is causality: it is genuinely hard to tell whether bottles cause babies to refuse the breast, or whether they are markers of other things already going on.[\[5\]](#ref-nip) So the honest position is not "it is a myth" and not "never give a bottle". It is: bottles are a real variable worth handling carefully, a slow-flow teat and a paced, upright position remove most of the flow advantage the bottle otherwise has, and the plan does not collapse if it happens. [Paced bottle feeding](/learn/breastmilk/paced-bottle-feeding) is the technique that does the work here. ## How to make the switch ### One feed at a time Slower is not just gentler on your baby, it is the only way to tell what a change actually did. 1. 1 Pick the feed to replace first One feed a day, chosen deliberately. Not the one your baby is most attached to, and not the one your supply is strongest at. 2. 2 Offer the first bottle when everyone is calm Not tired, not ravenous, and — if you are the one who usually breastfeeds — ideally offered by someone else, in a different room or position. 3. 3 Use a slow-flow teat and a paced position Upright baby, near-horizontal bottle, frequent breaks. This is what stops the bottle becoming the easier option. 4. 4 Hold it for five to seven days Give your breasts time to adjust before you change anything else. This is the step people skip, and skipping it is how engorgement and mastitis happen. 5. 5 Then repeat, or stop Combination feeding is not a route to anywhere in particular. If the current balance works, staying there indefinitely is a perfectly good outcome. ## Which feed to swap first There is no universal answer, but there are patterns worth knowing. Supply is typically highest in the early morning, which makes that feed both the easiest to keep and the most costly to lose. The evening is often when supply feels lowest and a baby is fussiest — which makes it tempting to swap, and also the feed where a bottle most often becomes permanent. - Keep the first morning feed if you can; it is usually the strongest and the easiest for a sleepy baby. - Keep the bedtime feed if it is part of how your baby settles — replacing it changes two things at once. - Mid-morning or mid-afternoon feeds are usually the least disruptive to swap first. - If the swap is for work, practise it at the same clock time as the real thing, at least a week ahead. - If your baby refuses the bottle entirely, that is a common and solvable problem in its own right — see [bottle refusal](/learn/breastmilk/bottle-refusal). ## Going the other way Combination feeding is not one-directional. If you have been bottle feeding and want to breastfeed more, supply can be encouraged back up — it takes time and it is harder than maintaining it, but it is a real option rather than a lost cause.[\[3\]](#ref-adj) - Breastfeed as often as you can while your baby is calm rather than frantic. - Skin to skin during feeds, which encourages both production and feeding. - Start each feed on the side your baby did not take from last time. - Reduce bottles gradually as supply comes up, rather than in advance of it. - Express between feeds; [power pumping](/learn/breastmilk/power-pumping) is one structured way to do that. Do not drop feeds faster than your body can follow Cutting breastfeeds quickly risks engorgement and mastitis — milk building up faster than it is removed, with a swollen, hot, painful area and often flu-like symptoms. Allow about a week per feed dropped, and if a red or hot patch appears alongside feeling unwell, get it seen the same day. ![](/_next/image?url=%2Fimages%2Fmilk-stash-icon.webp&w=256&q=75&dpl=dpl_HDQuuA58EiAncPne4fumhEvNhdFC) Dalo Milk Stash Keep track of which feeds are which Dalo Milk Stash logs breastfeeds, expressed bottles and formula in the same timeline, so a plan like "replace the 2pm feed this week" is something you can actually check you did. [Dalo Milk Stash](/apps/dalo-milk-stash) ## What success looks like Any amount of breastmilk is a real outcome, and combination feeding is the arrangement that keeps a lot of families in that category for months longer than they otherwise would have been. The measure that matters is a baby growing well and a parent who can sustain the plan — not the proportion on any particular day. National health services publish their own guidance on combining breast and bottle, and the practical detail differs a little between them, so it is worth reading your own alongside the principles here,[\[1\]](#ref-mix) including what it says about the challenges that come up while combining.[\[4\]](#ref-chal) In this article 1. [What combination feeding actually is](#what-combination-feeding-actually-is) 2. [The one number that governs everything](#the-one-number-that-governs-everything) 3. [When to start](#when-to-start) 4. [Nipple confusion, honestly](#nipple-confusion-honestly) 5. [How to make the switch](#how-to-make-the-switch) 6. [Which feed to swap first](#which-feed-to-swap-first) 7. [Going the other way](#going-the-other-way) 8. [What success looks like](#what-success-looks-like) ## References & disclaimer We link every source we used. Where guidance differs by country, we cite the authority that applies where you are. 1. 1. [Introduction to mixed feeding](https://www.nhs.uk/best-start-in-life/baby/feeding-your-baby/mixed-feeding/introduction-to-mixed-feeding/) NHS Best Start in Life · Guideline 2. 2. [Introducing formula feeds](https://www.nhs.uk/best-start-in-life/baby/feeding-your-baby/mixed-feeding/introducing-formula-feeds/) NHS Best Start in Life · Guideline 3. 3. [Adjusting your milk supply](https://www.nhs.uk/best-start-in-life/baby/feeding-your-baby/mixed-feeding/adjusting-your-milk-supply/) NHS Best Start in Life · Guideline 4. 4. [Mixed feeding challenges](https://www.nhs.uk/best-start-in-life/baby/feeding-your-baby/mixed-feeding/mixed-feeding-challenges/) NHS Best Start in Life · Guideline 5. 5. [Clarifying nipple confusion](https://pubmed.ncbi.nlm.nih.gov/26181720/) Journal of Perinatology · 2015 · Review 6. 6. [Principles for Maintaining or Increasing Breast Milk Production](https://pubmed.ncbi.nlm.nih.gov/22150998/) JOGNN (AWHONN) · 2012 · Study * * * Before you act on this This guide is general information about healthy, full-term babies. It does not replace advice from your paediatrician, health visitor, midwife or dietitian, who know your baby. If you are worried about your baby's feeding, growth, breathing or sleep, contact a health professional. ## Questions, answered Will combination feeding reduce my milk supply? It depends which removals you keep. Bottles of expressed milk are broadly neutral if you express when the bottle is given. Replacing a breastfeed with formula does reduce supply, by design — it takes about five to seven days for your breasts to settle at the new level. When can I introduce a bottle without disrupting breastfeeding? Where you have the choice, the NHS suggests waiting six to eight weeks so exclusive breastfeeding has established your supply first. Where you do not, the advice is a preference rather than a rule — introduce earlier if you need to, and pay closer attention to expressing while you do. Is nipple confusion real? Partly. A review of fourteen studies found emerging evidence for nipple confusion with bottle use and very little with pacifiers, while stressing that causality is unresolved — bottles may be a marker of other difficulties rather than their cause. A slow-flow teat and a paced, upright position remove most of the risk in practice. Can I go back to exclusive breastfeeding after combination feeding? Often yes, though it takes longer than maintaining supply did. Breastfeed as often as your baby is calm enough to feed well, use skin to skin, start each feed on the less-used side, express between feeds, and reduce bottles as supply comes up rather than before it does. ![Dalo Milk Stash](/_next/image?url=%2Fimages%2Fmilk-stash-icon.webp&w=128&q=75&dpl=dpl_HDQuuA58EiAncPne4fumhEvNhdFC) Get it on your phone Dalo Milk Stash [Dalo Milk Stash](/apps/dalo-milk-stash) Part of [Pumping, supply and milk storage: the complete guide](/learn/breastmilk/pumping-supply-and-storage) ## Keep reading [ ![](/_next/image?url=https%3A%2F%2Fcdn.sanity.io%2Fimages%2F87uht7oc%2Fproduction%2F5638e6e236854bfbee9f586ebc9e6d2209fdc73a-1376x768.jpg%3Frect%3D7%2C0%2C1363%2C768%26w%3D440%26h%3D248%26fit%3Dcrop%26auto%3Dformat&w=3840&q=75) ### Paced bottle feeding: how and why A tipped-up bottle lets gravity set the pace. Pacing hands the speed back to your baby — horizontal bottle, upright baby, regular pauses — and makes overfeeding much less likely. ](/learn/breastmilk/paced-bottle-feeding)[ ![](/_next/image?url=https%3A%2F%2Fcdn.sanity.io%2Fimages%2F87uht7oc%2Fproduction%2F82e8d37d14b3ce7a25ed17c4bba853ae044e7833-1376x768.jpg%3Frect%3D7%2C0%2C1363%2C768%26w%3D440%26h%3D248%26fit%3Dcrop%26auto%3Dformat&w=3840&q=75) ### Bottle refusal: what actually helps, and what to do if nothing does A survey of 841 mothers found 27% said bottle refusal hurt their breastfeeding experience. The variables worth changing, in order — and the plan that works even if the bottle never does. ](/learn/breastmilk/bottle-refusal)[ ![](/_next/image?url=https%3A%2F%2Fcdn.sanity.io%2Fimages%2F87uht7oc%2Fproduction%2F64b8ee67b1d733a04b4c8e7bf7b18e109388a825-1376x768.jpg%3Frect%3D7%2C0%2C1363%2C768%26w%3D440%26h%3D248%26fit%3Dcrop%26auto%3Dformat&w=3840&q=75) ### Triple feeding: how it works, and how to stop Breastfeed, pump, top up, repeat. What one round costs you in a day, what the evidence actually supports, and the three honest ways out — the part most guides leave off. ](/learn/breastmilk/triple-feeding)[ ![](/_next/image?url=https%3A%2F%2Fcdn.sanity.io%2Fimages%2F87uht7oc%2Fproduction%2F9194c4b5cea4f05158e08fda8941895cfbf100cf-1376x768.jpg%3Frect%3D7%2C0%2C1363%2C768%26w%3D440%26h%3D248%26fit%3Dcrop%26auto%3Dformat&w=3840&q=75) ### Power pumping: the schedule, and what the evidence actually shows An hour of broken-up pumping that imitates a cluster feed. Here is the schedule, the physiology that supports it, and the part nobody has actually tested. ](/learn/breastmilk/power-pumping) ## Try the free tools - [Baby Milk & Formula Calculator](/tools/milk-volume-calculator) ## Development milestones - [0-3 months](/learn/milestones/0-3-months) - [3-6 months](/learn/milestones/3-6-months) [← All breastmilk guides](/learn/breastmilk) [Read as Markdown](/api/markdown?path=%2Flearn%2Fbreastmilk%2Fcombination-feeding)