Feeding your baby: breast, formula or both

You can combine breastfeeding with bottles of expressed milk or infant formula. You can also ask for help with bottle feeding itself. You can get support with the feeding plan you use, even if it changes.

Start with the feed in front of you

If breastfeeding hurts or feels difficult, ask someone skilled in feeding to watch and help. In the UK, a midwife or health visitor can support you; in the US, a lactation consultant can help with breastfeeding. Tell them what you want help with.

For bottle feeding, the NHS recommends first infant formula as the first formula for your baby. Follow its preparation instructions carefully. If you are concerned about an allergy, talk to your baby’s doctor before changing to a specialist formula.

Let your baby set the pace

Offer a feed when your baby seems hungry. During a bottle feed, hold your baby close in a semi-upright position, supporting their head. Keep the bottle horizontal, with a slight tilt, so the milk flows steadily. Allow breaks and stop when your baby has had enough.

Your baby does not have to finish the bottle. Never prop a bottle up or leave your baby feeding alone: they can choke on the milk. Holding your baby, talking to them and looking at them can make bottle feeding a time to be close.

Prepare powdered formula safely

Wash your hands and clean the preparation surface. Use clean, sterilised feeding equipment. Measure the water first, then add the exact amount of powder specified on the container using its supplied scoop. Extra powder or water changes the feed; keep to the stated proportions.

Advice differs between countries. In the UK, use fresh cold tap water, boil it and let it cool for no more than 30 minutes, keeping it at least 70C when mixed with the powder. Make feeds as needed rather than preparing a batch.

In the US, CDC generally advises following the container instructions using safe tap water. For babies younger than 2 months, born prematurely or with a weakened immune system, it advises extra precautions: boil the water, wait about five minutes, then mix the powder. These instructions differ from UK guidance.

Cool the prepared feed before offering it, and test it on your wrist. Never microwave formula, because uneven heating can burn your baby. Throw away formula left in the bottle after a feed.

In the US, CDC advises using prepared formula within 2 hours of preparation and within one hour of starting a feed, whichever comes first. If you will not start using it within 2 hours, refrigerate it immediately and use it within 24 hours. Discard any leftovers after feeding.

Changing to mixed feeding

Adding formula feeds can reduce your breast-milk supply. If you choose to introduce formula, doing so gradually gives your body time to adjust and reduces the chance of painful swelling or mastitis. Ask for support if you want to keep breastfeeding, increase breastfeeding or work out how expressing fits into your plan.

Vitamin D advice in the UK and US

UK guidance recommends 8.5 to 10 micrograms of vitamin D daily from birth to 1 year for breastfed babies. Babies having more than 500ml of infant formula a day do not need a vitamin D supplement under NHS advice.

US CDC guidance recommends 400 IU of vitamin D daily shortly after birth for babies receiving breast milk, including mixed feeding. For babies receiving only formula, supplementation is not needed when they drink 32 ounces or more daily. Ask your health visitor, pharmacist or baby’s clinician about a suitable product and follow the label.

Ask for feeding support early

Call 999 now (UK) or 911 (US), or your local emergency number, if your baby is difficult to wake or has difficulty breathing.

Contact your baby’s doctor urgently today (UK, US and elsewhere), or call NHS 111 in the UK, if your baby has fewer wet nappies than usual, seems unusually drowsy or has a sunken soft spot on their head. Do not wait for a routine feeding appointment for these symptoms.

Contact your midwife or health visitor in the UK, or your doctor or lactation consultant in the US and elsewhere, if pain is making you put off feeds or you are worried about supply. Ask for a feeding review and a chance to discuss your baby’s weight and growth. Bring a few notes about what happens during a feed and what you want to change.