Many mums who choose to practice mixed feeding are able to express and store enough breastmilk to meet their baby’s requirements. Expressing your milk means you can continue to give your baby the benefits of breastmilk even when you are absent.
For mums who are unable to breastfeed or express breastmilk to meet all of their baby’s requirements, mixed feeding with infant formula may be considered. The decision to use infant formula is an important and complex one with many considerations. Once babies are on formula and their reliance on breastmilk is being reduced it can be difficult to reverse this feeding style, particularly if breastmilk is not being expressed to maintain supply, as your own milk supply will diminish.
It is important to seek advice from your health care professional in advance of making a decision to transition from breastfeeding to either partial or total infant formula feeding.
Whether you choose to mix feed with expressed breastmilk or with infant formula, here are some tips to assist.
Tips for mixed feeding with expressed breastmilk or infant formula
- Wait for breastfeeding to become established, at least 6–8 weeks before introducing a bottle.
- When possible always offer the breast first for a feed, followed by the bottle if you are doing top up feeds. Breastfeeding is nutritionally superior to expressed breastmilk.
- Adopt the practice of expressing at least the same amount of breastmilk your baby takes from a bottle to keep up your supply.
- If you are using a combination of expressed breastmilk and infant formula, offer the breastmilk first.
- If your baby is being bottle fed whilst you are away from your baby and your circumstances allow it, try to express at feeding times to maintain your supply.
It is recommended to exclusively breastfeed your baby until around 6 months of age and there is no alternative to breastmilk that will provide the same optimal balance of nutrition and protection during a baby’s growth and development. However, sometimes breastfeeding may not be possible for a variety of reasons including illness, or the mother’s return to paid work. At such times when breastfeeding is not possible, the practice of breastfeeding at some feeds and bottle or cup feeding with expressed breastmilk at others, known as ‘mixed feeding’, may be used.
Of those mums who choose to practice mixed feeding, many are able to express and store enough breastmilk to meet their baby’s requirements. Expressing your milk means you can continue to give your baby the benefits of breastmilk even when you are absent.
If you do choose to introduce mixed feeding with expressed breastmilk, here are some tips to assist.
Mixed feeding tips
- It is recommended not to introduce a bottle for feeding expressed breastmilk until breastfeeding is well established. This is usually when a baby is 6-8 weeks old.
- Feeding your baby with expressed breastmilk will require a bottle. It is recommended to introduce a bottle at around 8 weeks as, by this stage, breastfeeding is usually well established and it is unlikely your baby will resist a new kind of nipple (breast and bottle require different types of sucking).
- When possible always offer the breast first for a feed, followed by the bottle if you are doing top up feeds. Breastfeeding is nutritionally superior to expressed breastmilk.
- Adopt the practice of expressing at least the same amount of breastmilk your baby takes from a bottle to keep up your supply.
- If your baby is being bottle fed whilst you are away from your baby and your circumstances allow it, try to express at feeding times to maintain your supply.
If you intend to bottle feed your baby you will need to buy appropriate infant feeding equipment, including bottles, teats and sterilising equipment.
Baby bottles
You will need to have between 2 to 6 bottles. If you intend to use a bottle for all your baby’s feeds, it will be ideal for you to have around 6 bottles as babies typically feed around six times per day for the first four months. As babies grow, the volume of breastmilk or infant formula which is needed to meet their nutritional requirements increases and by four months, babies typically drink around 220mL at each feed. Therefore, whilst baby bottles are available for purchase in a range of sizes and smaller bottles are most suitable for young babies, by the time your baby is four months of age larger bottles capable of holding 220mL will be necessary.
When selecting baby bottles look for:
- Bottles with leak proof caps, discs and teats.
- Whilst plastic or glass bottles are a matter of choice, plastic bottles are less likely than glass to shatter or break (ensure plastic bottles are labelled ‘BPA-free’).
- Bottles with clearly marked measurement guides that will endure over time.
- Bottles with a wide rather than a narrow opening can be more easily cleaned with a brush.
Teats
If you intend to use a bottle for all your baby’s feeds, a minimum of 6 teats will be necessary. There is no one teat that will suit all babies and over time you will discover which teat works best for your baby.
When selecting teats:
- Check the product label to confirm that the teat design is appropriate for your baby’s age as different teats will have different flow rates and it is important that the flow rate is comfortable for baby.
- Check and replace teats regularly. Discard as soon as you notice any signs of deterioration including discolouration, stickiness, swelling or cracking.
Choosing the right formula
Breastfeeding is best for mother and baby and support should be accessed early if difficulties exist with feeding, attachment, low supply, or any other aspect of feeding. The World Health Organisation (WHO) and UNICEF recommend exclusive breastfeeding for the first six months, with continued breastfeeding up to two years of age and beyond recommended by WHO and UNICEF.
If breastfeeding cannot be used as the sole form of nutrition for infants, a2 Platinum® Premium infant formula will be the formula of choice for families choosing a2 Milk® for overall wellbeing. It can also be used for infants with unsettled behaviour, colic, or digestive discomfort who do not have symptoms to suggest a cow’s milk allergy, gastroesophageal reflux or other conditions (as assessed following a medical review). If after two weeks on a2 Platinum® Premium infant formula, unsettled behaviour persists, medical advice should be sought. In addition, if you are still breastfeeding, your diet should be reviewed by an Accredited Practising Dietitian (APD), experienced in the area of allergy and intolerance. To find an Accredited Practising Dietitian in Hong Kong, visit Hong Kong Dietitians Association.
For infants over six months of age through to 12 months, a2 Platinum® Premium follow-on formula can be used either as a follow-on from a2 Platinum® Premium infant formula, or introduced to your child for the first time if transitioning from exclusive breastfeeding. For active toddlers from 1 to 3 years whose intake of nutrients and energy from their usual diet may be inadequate for growth and development, a2 Platinum® Premium toddler milk drink may be used to supplement the diet.
Find out more at:
- Family Health Service, HKSAR Department of Health – Guide to Bottle Feeding
- World Health Organisation – The World Health Organization’s infant feeding recommendation
Preparing and storing formula
Although preparing a bottle for your little one isn’t hard, like doing anything new, it may just take a bit of practice. So, to help guide you, we’ve put together a step-by-step guide to preparing a bottle of feed.
Preparing instruction
Before preparing formula, wash your hands thoroughly and wipe clean the preparation area. In preparing formula, strict hygiene practices must be used to prevent your baby becoming unwell from exposure to harmful germs.
Wash all equipment with warm soapy water and a bottle-cleaning brush (or through the dishwasher) and then sterilise all utensils by submerging the equipment in boiling water for approximately 5 minutes.
Boil drinking water in a pan or kettle. Read the feeding guide instructions on the product can to find out how much water and powder is needed. Taking care to avoid scaling, pour the required amount of water into a sterilised feeding bottle. The water should be no cooler than 70⁰C, so do not leave it for more than 30 minutes after boiling.
Measure the correct amount of cooled (previously boiled) water into a sterilised feeding bottle or sipper/feeding cup if your baby is around six months or older. The feeding guide on the can will advise the amount of water required to make up a feed. The water should always be put in the bottle before the formula powder.
Fill the enclosed measuring scoop with formula powder. Give the scoop a gentle tap on the side of the can to get rid of any major air gaps. Level the scoop off with the in-built leveler.
Always use the scoop provided with the formula because different formulas may have different scoop sizes. To help ensure your baby will be meeting their nutritional requirements, it is important to prepare the formula with the right amount of formula powder to water as prescribed on the can and according to the manufacturer’s instructions (unless under the specific guidance and instruction of a qualified health care professional such as your GP or paediatrician). Over-concentration or under-concentration can be harmful. For instance, if you add too much water, your baby’s feeds will be too diluted and they will not receive enough nutrition to help them grow well.
Screw the teat and/or cap on the bottle or sipper/feeding cup and shake gently until the formula dissolves completely.
Always test the temperature by allowing a few drops to fall on the inside of your wrist – it should feel lukewarm before feeding your baby. If it is too warm, cool the bottle under running water or in a container of cool water. If it is too cool, you can warm the bottle by standing it in a bowl of hot (not boiling) water for around 5-10 minutes or until the desired temperature is achieved. The time taken to warm the bottle should not exceed 10 minutes. Then always re-test the temperature on your wrist before giving to your baby. This is the traditional method and remains the safest way of heating bottles. Do not use a microwave oven for any formula preparation, because microwave heating can generate ‘hot spots’ within a prepared bottle or sipper/feeing cup and this can burn your baby’s mouth.
Feed your baby immediately and discard any unfinished formula. Any prepared formula which has been at room temperature for longer than 1 hour must be discarded. It is ideal to prepare only one bottle of formula at a time, although you might find it more convenient to prepare a sufficient number of sterilised water bottles to see you through a day. In this case, the sterilised bottled water should be stored in the refrigerator until ready for use. You can then warm the bottle with sterilised water by standing it in a bowl of hot (not boiling) water for around 5-10 minutes or until the desired temperature is achieved.
After the feed, wash all equipment so it is ready to be sterilised for next the feed.
Important Considerations
- Use a fresh bottle for every feed
- Test the formula is flowing out of teat by holding the bottle upside down and the formula should drip out at a constant, steady rate
- The feeding instructions on the pack will give you an indication of the number of feeds your baby may need per day. This feeding guide is a general guide only as every baby is different. You should seek advice from your qualified health care professional such as your GP or pediatrician if you have concerns about your baby’s individual needs
- If you are going out and need to take baby’s food with you, don’t take the formula already made up. It is best to take the pre-measured water in the bottle and the powder in a separate sterilised container or sachet. The water can then be warmed as specified above, after which you can tip the powder into the water when you are ready to feed your baby.
Storing Formula
- Check the expiry date of formula on the base of the can to ensure the formula has not passed its expiry (use-by) date.
- Keep the scoop in the can when not in use. There is no need to wash the scoop after preparing a bottle. However, if the scoop gets wet accidentally, you will need to wash and dry it thoroughly before putting it back in the can.
- Always keep formula in its original can and cover with the plastic lid to prevent contamination of the powder. Do not transfer the powder to another container because this is a high risk of contamination.
- Once a can of powdered formula has been opened, it can be kept safely for four weeks if stored in a cool dry place. Discard any unused formula after four weeks.
The Department of Health recommends that all infant feeding equipment be sterilised until the infant is at least 12 months old. Bottles and teats should be sterilised after each use and stored safely for as long as you use them.
There are several safe and reliable ways to sterilise infant feeding equipment.
First, wash the feeding equipment in hot water with a bottle or teat brush before sterilisation to ensure no traces of milk or milk residue remain, rinse with hot water and air dry, or alternatively dry with a clean paper towel.
Sterilise bottles and feeding equipment with one of the following methods:
Boiling
Fully submerge all infant feeding equipment in boiling water for 5 minutes. Remove from heat and allow to cool. Wash hands before removing the feeding equipment. Dry and store in a clean and dry location.
Steam steriliser (electric)
Ensure that all feeding equipment is dry and free from residual water before placing in the steam steriliser with teat and bottle openings facing down. Use the steriliser according to the manufacturer’s instructions. Wash hands before removing all items and store safely in a clean and dry location.
Sterilising solution
Follow the manufacturer’s instructions for preparing the solution, combining the correct amount of sterilising solution or tablet with the correct volume of water in a clean, plastic container. It is important that you fully immerse the bottles and teats in the container and ensure that no air bubbles are trapped inside them. Leave the bottles and teats in the solution for the required amount of time. Wash your hands before removing the infant feeding equipment from the solution. Do not rinse off the sterilising solution or there will be a risk of re-contamination. Drain the bottles and teats well on a clean dry surface. Bottles and teats can stay sterilised in the sterilising solution until needed for up to 24 hours.
After sterilising
- After sterilising your feeding equipment store any equipment not being used immediately in a clean container in the fridge.
- Re-sterilise all infant feeding equipment every 24 hours whether used or unused.
Breastfeeding is best for mother and baby and support should be accessed early if difficulties exist with feeding, attachment, low supply, or any other aspect of feeding. The World Health Organisation (WHO) and UNICEF recommend exclusive breastfeeding for the first six months, with continued breastfeeding up to two years of age and beyond recommended by WHO and UNICEF. This has been adopted by the Department of Health in Hong Kong.
If breastfeeding cannot be used as the sole form of nutrition for infants, a2 Platinum® Premium infant formula will be the formula of choice for families choosing a2 Milk® for overall wellbeing. It can also be used for infants with unsettled behaviour, colic, or digestive discomfort who do not have symptoms to suggest a cow’s milk allergy, gastroesophageal reflux or other conditions (as assessed following a medical review). If after two weeks on a2 Platinum® Premium infant formula, unsettled behaviour persists, medical advice should be sought. In addition, if you are still breastfeeding, your diet should be reviewed by an Accredited Practising Dietitian (APD), experienced in the area of allergy and intolerance. To find an Accredited Practising Dietitian in Hong Kong, visit Hong Kong Dietitians Association.
For infants over six months of age through to 12 months, a2 Platinum® Premium follow-on formula can be used either as a follow-on from a2 Platinum® Premium infant formula, or introduced to your child for the first time if transitioning from exclusive breastfeeding. For active toddlers from 1 to 3 years whose intake of nutrients and energy from their usual diet may be inadequate for growth and development, a2 Platinum® Premium toddler milk drink may be used to supplement the diet.
If you have any concerns about your baby’s tolerance to a new formula, consult your baby’s doctor, maternal and child health nurse or dietitian.
Note: When preparing your baby’s formula, be sure to use the scoop enclosed inside the formula can and use separate bottles for the different formula in order to ensure the correct preparation of each feed for your baby.
The Feeding Guide provided on each can of a2 Platinum® Premium infant formula, follow-on formula, and toddler milk drink is there to guide you on how much and how often to feed your baby. Different mixing ratios and scoops may be used for other infant formula products, so it is important to specifically follow the instructions on the can when preparing a2 Platinum® Premium infant formula.
There is much individuality in how much each baby will drink and variation in the amount that the same baby will drink from day to day. The following is a guide to how much babies of different ages will need to drink and the frequency of consumption. It is important to always be guided by your baby and allow your baby to drink to satiation point, even if this means discarding any unused formula in the bottle. Unlike breastmilk which changes composition as baby grows, infant formula concentration remains constant so it is only the volume consumed which changes as baby grows.
It is important to prepare the infant formula with the right amount of powder and water, as per the instructions provided on the can. This will help ensure your baby’s nutritional requirements are being met. If you add too much powder to your baby’s bottle your baby’s feed will be too concentrated. This can lead to constipation, causing your baby abdominal pain, bloating and discomfort when trying to do a poo. If you add too much water, your baby’s feeds will be too dilute and they will not receive enough nutrition to help them grow well.
Do not prepare formula with a different concentration to that which is prescribed on the can, unless under the specific guidance and instruction of a qualified health care professional such as your GP or pediatrician.
Guidelines aside, around 6 wet nappies daily, as well as a developmentally growing and thriving infant indicate that your baby is likely to be receiving enough infant formula.
