Supporting Your Feeding Journey: Evidence-Based Guidance for Combination Feeding

Leigh Campbell
Dec 11, 2025
3 min read

By Dr. Leigh Campbell, MD, IBCLC, NABBLM-C, PMH-C Founder, Bloom & Grow Lactation Medicine

Nurturing Each Family, Protecting Every Drop

Feeding your baby is one of the most intimate and impactful parts of early parenthood. Yet, it can also bring unexpected challenges, pressures, and emotions. As a breastfeeding medicine physician, my goal is to meet families where they are—compassionately, with expertise, and with an understanding that every journey looks different.

For some families, exclusive breastfeeding unfolds smoothly from the start. For others, temporary or partial supplementation becomes part of a thoughtful, medically guided plan. This approach — known as combination feeding — can serve as a bridge that supports both your baby’s growth and your ongoing lactation goals.

What Is Combination Feeding?

Combination (or “combo”) feeding means providing both breast milk and formula. For some families, this is a short-term plan while addressing early feeding challenges; for others, it’s a long-term strategy that fits their unique needs and circumstances.

In my clinic, combination feeding is never seen as “giving up” on breastfeeding. It’s a tool used to preserve, protect, and rebuild milk supply while ensuring that your baby’s nutritional needs are safely met.

Why Supplementation May Be Needed

There are evidence-based, medical reasons a baby may require additional milk beyond what is being transferred at the breast. Common examples include:

Infant weight loss beyond physiologic norms (per ABM Protocol #3: Supplementary Feedings in the Healthy Term Infant).
Delayed onset of lactogenesis II (milk “coming in” after day 4–5).
Infant medical needs, such as hypoglycemia, dehydration, or late preterm birth.
Maternal factors affecting supply, such as previous breast surgery, hormonal or thyroid conditions, insulin resistance, or polycystic ovary syndrome (PCOS).
Separation from the infant, NICU hospitalization, or return to work before lactation is fully established.

In each case, the goal is to address the underlying cause, protect milk production, and create a clear plan for either weaning off supplementation or maintaining a balanced feeding rhythm.

Protecting Milk Supply During Combination Feeding

Milk production depends on regular and effective milk removal. When a formula is introduced, maintaining supply requires intention and structure. We often design a plan that includes:

A plan for breastfeeding or pumping sessions every 2–3 hours during the early weeks.
Paced bottle feeding to mimic the physiology and rhythm of breastfeeding and help prevent bottle preference.
Monitoring milk transfer through pre- and post-feed weights and signs of milk transfer while feeding.
Support for maternal nutrition, hydration, and sleep is all critical to lactation physiology.

Combination feeding does not necessarily mean decreased milk supply. With a medically informed plan, many parents maintain or even increase production over time.

Honoring the Parents’ Well-Being

Maternal and parental mental health are integral to successful feeding. If anxiety, exhaustion, or intrusive thoughts are affecting your ability to rest, pump, or enjoy your baby, supplementation can sometimes create space for recovery and healing. As a Perinatal Mental Health-Certified (PMH-C) physician, I provide care that integrates both physical and emotional well-being.

Supporting lactation and supporting the parent are not opposing goals — they are care partners.

Physician-Level Lactation Support Matters

Even when a formula is used, medical oversight remains essential. A lactation medicine physician can:

Evaluate milk supply, glandular tissue, hormonal function, and infant oral anatomy.
Address nipple trauma, infection, mastitis, or pain that interferes with feeding.
Create individualized supplementation plans (including method, volume, and frequency) in accordance with current guidelines from the Academy of Breastfeeding Medicine and the American Academy of Pediatrics.
Coordinate care with your baby’s pediatrician to ensure holistic monitoring of growth, safety, and development.

Your care deserves more than generic advice — it deserves an expert, evidence-based partnership.

Informed, Supported, and Connected

Combination feeding is not a reflection of failure. It’s one of many medical tools we can use to ensure that both parent and baby thrive while protecting the long-term potential for breastfeeding success.

My role is to help you understand your options, address the root causes of challenges, and build a feeding plan that honors your goals and your baby’s health.

You and your baby deserve compassionate, comprehensive care — not all-or-nothing messages.

If you’re in Mississippi and seeking individualized, physician-guided lactation care, Bloom & Grow Lactation Medicine is here to support your journey with evidence, empathy, and expertise.

Book an Appointment | Visit bloomandgrowlactation.com

References📚

Academy of Breastfeeding Medicine Protocol #3: Supplementary Feedings in the Healthy Term Infant (2022).
American Academy of Pediatrics. Policy Statement: Breastfeeding and the Use of Human Milk (2022).
World Health Organization. Exclusive Breastfeeding for Six Months: Best Start for Infants (2021).