Published January 23, 2026
5 Reasons Families Choose To Combo Feed: A Physician's Take
By family medicine physician Dr. Max Goldstein, MD
I frequently encounter parents who feel like outliers for not breastfeeding exclusively, but in reality this is the norm. The 2024 State of Feeding Survey found that while 80% of new parents intended to breastfeed exclusively, only 25% were doing so by six months. According to CDC data, 75% of U.S. families are using formula in some capacity by their baby's half birthday. And the majority of those are also still breastfeeding. Acknowledging combo feeding as a common, viable path is essential for providing realistic, patient-centered support.
Most families today utilize combo feeding because it provides a path that fits their specific needs. Whether driven by medical necessity, mental health, or the logistical reality of returning to work, a hybrid approach is often a sustainable way to ensure both baby and parents thrive, particularly if they’ve struggled to receive the support needed to breastfeed exclusively.
Shifting the focus away from 'exclusive' labels can help alleviate the pressure of postpartum anxiety and sleep deprivation, while also allowing partners to share in feeding duties. In this article, I will explore 5 common reasons families may choose to combo feed and the factors that may go into that decision.
1. Birth and Medical Factors Can Affect Milk Supply
Milk production is a process triggered by hormonal changes right after birth. When a baby is born and the placenta is delivered, a drop in progesterone signals the body to make milk. From that point on, milk production works like a supply-and-demand system: the more milk is removed (through feeding or pumping), the more one’s body is told to produce.
However, this physiologic process doesn't always start on a perfect schedule. About 1 in 3 first-time moms experience a delay in their milk coming in (Nommsen-Rivers et. al.) or have a lower-than-expected supply, especially in the early postpartum stage . Some common factors that can affect how quickly milk supply is established include:
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Long or complicated labor
Prolonged labor and/or difficult deliveries can increase physical stress and delay hormonal signaling needed for milk production.
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Cesarean birth
Parents who deliver by C-section are more than twice as likely to experience delayed milk production compared with those who deliver vaginally (Singh et al., 2023). Recovery from surgery takes time, and milk supply may take longer to build.
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Heavy bleeding after birth (postpartum hemorrhage)
Significant blood loss can temporarily affect the part of the brain that releases prolactin, an essential hormone in milk production.
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Pregnancy-related health conditions
Conditions such as obesity, gestational diabetes, gestational hypertension, and thyroid disease are all associated with a higher chance of delayed milk supply (Peng et al.).
In my practice as a family medicine doctor, I often see patients struggle with frustration and a loss of confidence when their milk supply doesn’t meet immediate expectations. In those moments, I remind them that there is no "one right way" to feed a baby; a slow start is often a physiological challenge, not a personal failure.
We must destigmatize combo feeding, as it is a vital tool that ensures a baby remains nourished and satiated while the parent’s body recovers. I have seen many families use formula or donor milk as a temporary measure and still go on to have long and successfulbreastfeeding journeys. While formula provides immediate nutrition, parents who wish to prioritize long-term breastfeeding can work with their healthcare team (including an IBCLC, or lactation consultant) to utilize evidence-based practices—such as skin-to-skin contact, hand expression, and frequent nursing and/or pumping—to stimulate milk production. By combining a flexible feeding plan with these stimulation techniques, we can protect the infant’s health while working toward the parent’s long-term feeding goals.
2. Newborn Medical Needs
Sometimes, the decision to combo feed has nothing to do with the parent’s body and everything to do with the baby’s immediate medical needs.
If infants are born prematurely or face health complications, they may require admission to the Neonatal Intensive Care Unit (NICU). In this environment, the priority is stability and growth. Breastfeeding requires significant physical exertion from a newborn, and breast milk may not be nutritionally sufficient based on gestational age, so combo feeding may be necessary to ensure the baby receives adequate nutrition while conserving their limited energy.
This may include a combination of:
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Direct Breastfeeding: When the baby is stable enough to latch.
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Expressed Breast Milk: Provided via pumping to ensure the baby gets the parent's antibodies and other bioactive and protective components of human milk
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Donor Milk, Formula, or fortifiers: Used to bridge the gap if the parent's supply is still developing or if the baby requires extra calories or nutrients.
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Alternative Feeding Methods: Utilizing bottles, syringes, or nasogastric (NG) tubes to ensure the baby receives nutrition without burning excess energy.
As a physician, I want to reassure parents that much like delayed onset of lactation or low milk supply, combo feeding due to a newborn’s medical needs is frequently a short-term necessity. In my practice, I often see families successfully transition to breastfeeding—and even exclusive breastfeeding—once their baby is medically stable.
3. Breastfeeding Mechanics Are Not Always Simple
Breastfeeding is a complicated skill for both parent and baby. Sometimes anatomy can get in the way of breastfeeding, making combo feeding necessary. For example:
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Latch Difficulties: Tongue ties, lip ties, or cheek ties can significantly impair an infant's ability to create a functional vacuum and compress the breast tissue required to withdraw milk. This can result in inefficient feeding and maternal pain, often necessitating caloric supplementation to prevent neonatal weight loss or dehydration. While babies are typically screened for these ties in the hospital, and surgical intervention can often occur shortly after birth, tongue ties are sometimes missed during initial evaluations. If a baby continues to struggle with latching or causes persistent maternal pain, parents should seek a formal evaluation from a healthcare provider or lactation consultant.
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Anatomical variations: Structural variations, such as inverted or flat nipples, can present significant challenges to achieving a deep, sustainable latch. Working with a lactation consultant or medical provider can provide effective clinical options, such as the strategic use of nipple shields, to facilitate successful feeding.
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Pain and breast pathology: In my practice, I emphasize that breastfeeding pain is a clinical indicator of underlying pathology rather than a reflection of parental capability. Severe nipple trauma—including fissures, ulcerations, or bleeding—as well as recurrent mastitis or pain associated with infant teething, can make breastfeeding unsustainable. In these instances, use of bottle feeding and formula supplementation may be necessary to protect against maternal discomfort or allow the parent to heal while ensuring the infant’s nutritional needs are met.
4. Maternal Health Factors
There may be times during the postpartum season when a mother’s physical and/or mental health must take priority. Whether navigating a new diagnosis requiring medications that are incompatible with breastfeeding, or addressing mental health concerns such as postpartum anxiety and depression—which can be exacerbated by breastfeeding—a therapeutic pause from breastfeeding is sometimes medically recommended. Integrating combo feeding and/or introducing formula has many benefits in these cases, including:
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Reducing Stress: Integrating formula can lower the "all on me" pressure that may lead to burnout.
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Restoring Sleep: Sharing feeding responsibilities with a partner allows for longer stretches of restorative sleep, which is one of the most effective interventions for mood stabilization.
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Strengthening the Support System: When a partner or caregiver can take over a feeding, it fosters a shared responsibility that protects the mother from isolation during the early postpartum period.
5. Economic Health: Navigating Structural Barriers
In a perfect world, feeding would be a choice based solely on preference. In reality, it is often a decision shaped by policy. Economic health is a major determinant of how a family feeds their child.
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The Reality of the Return to Work: Without robust paid parental leave, many women return to the workplace before breastfeeding is fully established.
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Unpaid Pumping Breaks: In some states, hourly and part-time workers do not receive paid pumping breaks, which can increase the financial burden on breastfeeding parents due to loss of income.
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Logistical Hurdles: Inadequate time, lack of private space for pumping, and the sheer exhaustion of the "triple feed" (breast, pump, bottle) make exclusive breastfeeding unrealistic for many.
For these families, combo feeding may be a pragmatic and necessary tool. It is often the only way to balance the biological needs of a baby with the economic necessity of maintaining employment and maintaining their income.
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The Bottom Line
Parents combo feed for a wide range of reasons—medical, physical, mental, and systemic—most of which are invisible to the outside observer. In my practice, I see a significant disconnect between public perception of the benefits of exclusive breastfeeding and the clinical reality of infant feeding. While many families I treat feel as though 'everyone else' is breastfeeding exclusively, the data—and my own daily experience with patients—confirms that combo feeding is actually the norm. My hope is to destigmatize this reality; new parents already face immense stress, and added societal pressure or judgment can hinder their wellbeing.
How someone chooses to nourish their baby should not be viewed as a test of parental devotion. It is an act of care shaped by real bodies, real babies, and real-world constraints. Combo feeding is not a failure; it is a thoughtful, adaptive, and loving solution in a system that often fails to provide adequate postpartum support. At the end of the day, babies need nourishment, parents need support, and every family deserves compassion—regardless of what their feeding journey looks like.
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Works cited
Nommsen-Rivers, Laurie A., et al. “Delayed Onset of Lactogenesis among First-Time Mothers Is Related to Maternal Obesity and Factors Associated with Ineffective Breastfeeding.” The American Journal of Clinical Nutrition, vol. 92, no. 3, 2010, pp. 574–584.
Singh J, Scime NV, Chaput KH. Association of Caesarean delivery and breastfeeding difficulties during the delivery hospitalization: a community-based cohort of women and full-term infants in Alberta, Canada. Can J Public Health. 2023 Feb;114(1):104-112. doi: 10.17269/s41997-022-00666-0. Epub 2022 Jul 28. PMID: 35902540; PMCID: PMC
Peng Y, Zhuang K, Huang Y. Incidence and factors influencing delayed onset of lactation: a systematic review and meta-analysis. Int Breastfeed J. 2024 Aug 22;19(1):59. doi: 10.1186/s13006-024-00666-5. PMID: 39175092; PMCID: PMC11342634.
The content on this site is for informational purposes only and not intended to be a substitute for professional medical advice, diagnosis or treatment. Discuss any health or feeding concerns with your infant’s pediatrician. Never disregard professional medical advice or delay it based on the content on this page.
