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Ask Dr. Sears: Combo-Feeding Tips

Q. My milk flow is generally slow and my daughter doesn't get enough at a feeding, so our lactation consultant has suggested that we supplement with formula. Sometimes, I'll only express two ounces of milk at a time, but I'm wondering if I can I mix the breast milk I've expressed with an equal amount of formula in the same bottle for a feeding?

A. Yes, it's perfectly fine to mix breast milk and formula in the same bottle. Also, you can both breast- and bottle-feed successfully. However, there are certain rules of the game that combo-feeders have learned. In our practice, when a mother needs to combo-feed (for example, when returning to work), we recommend ways that Mom can continue to keep her milk supply up while giving her baby supplemental bottles. If you choose to supplement without actively maintaining your breast milk supply, you run the risk of your milk dwindling, leading to weaning before you and your baby is ready. Here are a few ways to keep things flowing:

Think milk! Once upon a time, it was considered routine to tell breastfeeding mothers to give their baby a bottle for all kinds of unnecessary reasons, such as "to get the baby used to it," and to give the mother relief from nursing. Studies have shown that this kind of advice undermines the confidence of a mother because it implies that you won't have enough milk for your baby; and that often becomes a self-fulfilling prophecy. The newest trend in breastfeeding-friendly hospital nurseries is to not send mom home with a discharge pack containing formula or give her any advice that suggests that she may not have enough milk. Producing breastmilk is not only a physical experience, it's emotional as well. While you feed your baby, imagine your milk flowing, and imagine yourself making lots of milk. If you worry you won't ave enough milk for your baby, you won't.

Breast association. You want your baby to associate you with feeding, and to know that milk is coming from your breast, not a bottle. Your baby should associate breastfeeding with nutrition and comfort. When you must give her a bottle, have Dad or a caregiver offer it.

Feed more frequently. "Frequency" is the magic word for increasing milk supply. Breastfeeding your baby at least every two hours is an optimal schedule to follow.

Nap-nurse and co-sleep. A couple times a day lie down and breastfeed your baby off to sleep. The relaxing environment of napping with your baby will often work increase your milk supply. Also, co-sleeping with your baby is another method that is thought to help.

Sling feed. Wear your baby in a sling-type carrier as often as you can throughout the day, as proximity fosters feeding. If your baby is inches away from her favorite food, she's likely to eat more often!

Finally, remember to take care of yourself. If you are happy and rested, you will make more milk. From the description of your feeding pattern, I'm concerned that if you continue increasing the frequency of bottle-feeding, your milk supply will also continue to dwindle. But if you reverse the trend and think of bottles as a supplement, or in addition to your daughter's primary source of food -- breast milk -- your supply should at least stay the same, if not improve. I hope you can work out a feeding plan that you enjoy. You're going to spend more time feeding your baby than any other single interaction during the first year -- so, enjoy it!

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