Mixed Feeding with Multiples

By Krista Gray, IBCLC. Last updated October 5, 2013.

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Many mothers of multiples want to breastfeed their babies but are unsure about committing to exclusive breastfeeding.  While it is completely possible for a mother’s body to make enough breast milk to nurse twins, triplets, and even quadruplets without supplementation there are many factors a mother must consider.  Weighing the pros and cons of breastfeeding multiples is important, but it is also not an all or nothing situation.  Mothers may also choose to do partial or mixed feeding with multiples. This means that some of their babies’ nutrition comes from breast milk and some from formula.

Breast milk is unique and unlike any other mammalian milk or infant formula.  Any amount of breast milk a mother is able to provide is a wonderful gift and should be celebrated.  There are multiple health benefits for both a mother and baby.  Breastfeeding will help with maternal-infant bonding – something that can be a challenge when there are multiple babies! Breastfeeding will also decrease feeding costs, visits to the doctor, time off work for illness, allergies, and health care costs both in the short and long term.

How does mixed feeding work with multiple babies?

There are several methods of giving mixed feeds with multiples:

  • Combination breastfeeding and bottle feeding
  • Combination breastfeeding and formula given via syringe, cup, finger feeding, etc.
  • Combination bottle feeding of expressed breast milk and formula
  • Exclusive nursing at the breast with an at-breast tube feeding device to supplement with formula
  • Breastfeeding with an at-breast tube feeding device and bottle top ups with formula or expressed breast milk

There are also several ways of supplementing breast milk:

  • Breastfeeding babies first then topping off with formula
  • Offering bottle as an “appetizer” then giving “meal and dessert” at the breast
  • Offering the breast to one (or more) and a bottle to one (or more) at a feed; then rotating who breastfeeds each time
  • Breastfeeding during the day (or night) and bottles the other times

There are different percentages of formula and breast milk given to babies:

  • Some mothers may start off giving majority formula but later build a strong milk supply and the majority becomes breast milk
  • Some mothers begin with a strong milk supply but allow it to decrease as they increase the percentage of formula given to babies
  • Some mothers give the majority or even all breast milk to a weaker or sick baby(s) and give formula to the stronger or healthier babies

There is no right or wrong way to provide mixed feeds to your babies.  One size does not fit all and the way a mother does this may change over time.  In fact, as her babies grow, one (or more) may take to breastfeeding more than another so a mother continues to nurse one and bottle feed another.

What are the risks of mixed feeding babies?

There are several risks to be aware of, as follows:

  • Decreased milk supply – Whenever a mother supplements her milk there is a risk of her milk supply decreasing.  This can be a slippery slope – as her milk supply decreases a baby receives increased supplementation, which cause her milk supply to further decrease until there is no more milk.
  • Nipple confusion – Babies may develop a preference for a certain feeding method – many times it is the fast flow of a bottle.  The flow of a bottle nipple is continuous whereas a baby at the breast must suck-suck-suck to have a let-down which lasts a minute or two and then there’s a pause before another let-down. Once a baby experiences the faster flow of a bottle they may get frustrated at the breast and begin to reject breastfeeding.
  • Health risks – While any amount of breast milk is a precious gift and wonderful for your baby, there are also well known and documented risks of formula.  Any amount of formula will change your babies’ intestinal flora to that of a formula-fed baby.  Any amount of formula will increase a baby’s chance of infection and illness. The more formula a baby receives the greater the chance of contracting infectious illnesses.  And, with multiples, if one baby gets sick it usually spreads to each baby.
  • Breast milk can be convenientWithout help, it can be easier and more convenient to breastfeed than give formula.  Breast milk doesn’t require mixing, heating, cleaning bottles, etc. so if mother is going to be feeding her babies it just makes sense to feed them in the most convenient way possible.  It is also a great way to multitask because breastfeeding requires touch and bonding that babies also need.  Even if mother does have help, it is many times easier for mother to breastfeed her babies and allow others to serve the breastfeeding mother.