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Mixed feeding for twins, triplets or more

Some mothers plan to breastfeed but also want to have the option to use infant formula occasionally. For others because of ongoing difficulties with one or more babies, family demands or changing circumstances the decision is made to change to partial breastfeeding or mixed feeding.

What do I need to think about if I want to mix feed?

If you feel that mixed feeding is the right option for you, then it is worth considering the following:

• Think about first getting your milk supply established so that you continue to have flexibility in offering breastfeeds. If you breastfeed or express 8-12 times in 24 hours in the first few weeks this will establish your breastmilk supply and you are more likely to continue partially breastfeeding as long as you wish. Remember any excess breastmilk can be frozen and used for supplementation at a later date.

• A general rule of thumb is that the more breastmilk you give your babies the more protection they will receive from illnesses such as asthma, diabetes, gastroenteritis, ear and respiratory infections. So consider how you might maximise the amount of breastmilk each baby receives. E.g. if one baby is not breastfeeding at all you might decide to give him some expressed breastmilk occasionally.

• It is generally better to substitute a single feed with formula than to supplement or ‘top-up’ breastfeeds. In the early days it is generally better for babies to be given infant formula in the daytime rather than at night, when the mother’s hormones are at a higher level for breastmilk production. Breastfeeding at night therefore helps you to maintain your supply.

• Some mothers of twins or more report that being able to use the occasional substitute feed has helped them through a bad patch and has allowed them to continue breastfeeding.

• When feeding your babies infant formula try and keep to the little and often feeding pattern of a breastfeeding baby. In this way babies don’t get used to larger volumes of milk at certain feeds, which can then lead to the need to ‘top up’ with infant formula at each breastfeed. This is especially important if you are giving more than the occasional feed of infant formula.

• If you sense your breastmilk supply has dropped too low for your babies needs, then cutting out the infant formula for a few days and breastfeeding more frequently can help to bring the supply back - often within 48 hours.

• Some mothers report that their babies go happily between breastfeeding and a bottle, from a very early stage. But some seem less happy to do this. Therefore you might want to wait until you feel the breastfeeding is going well before you start to introduce bottles.

• If you are thinking about introducing some infant formula at a later stage and are worried about your babies taking a bottle, some mothers say it is helpful to introduce an occasional bottle at around six weeks (of expressed breastmilk or infant formula) and continue to give them a bottle once or twice a week. However, there is no research to support this idea.                                                               

Positioning for feeding one by the breast and one by the bottle

  • Sit on the floor with your back against the sofa and a bouncy chair between your legs or sit on the sofa with the bottle fed baby sitting square to you, propped up with cushions.

REMEMBER: however much breastfeeding you do there is no limit on the amount of time you can spend skin-to-skin or just cuddling with your babies. Keeping in tune with your babies needs and responding to their cues for food and comfort will help to keep that close bond with your babies.

Bottle Feeding

Bottle-feeding is a more expensive option with multiples. However, one major advantage is that both parents – and anyone else – can share in the task. This may be an important consideration for those parents who also need to spend time with their other children and for families coping with three or more babies at once.

Current guidelines for preparing infant formula are that to reduce the risk of infection each feed should be made up at the time it is needed and that the water should be at no less than 70°c when the formula powder is added. If not at home, vacuum flasks can keep water above 70°c for several hours. The powder can then be added when the feed is required.

Always use the scoop provided with the infant formula powder and add the exact amount as instructed on the label. Then cool the feed to feeding temperature by running the bottle under the cold tap or placing in a container of cold water

Storing and then using made up formula milk may increase the chance of a baby becoming ill and should be avoided. Discard any feed that has not been used within two hours.

Make sure you understand the basics of feeding and sterilisation before you leave hospital. 

Feeding provides a great opportunity to spend some one to one time with your babies, it helps get feeding off to a good start and helps you get to know each other and to start to build a lovely relationship. Every baby is different and taking some time with him/her during feeding helps you get to know their individual needs and feeding patterns.

Feeding together versus separate formula feeding

If you have help it is generally recommended that your babies are fed separately to maximise the interactions with the parent/adult. See the link below on Unicef's Responsive Bottle Feeding for more information.

If both (all) your babies wake together, it is possible for one adult to feed two babies at once using one of the following positions:

• Older babies may be positioned each in an infant seat and you can sit between them both of them (support your back against a wall/sofa/chair), holding a bottle in each hand.

• You can prop one baby in an infant seat and hold one baby in your lap, again holding a bottle in each hand. Alternate which baby is on your lap at each feed so each baby has a turn being held close on your lap. 

Please note: babies should never be propped up with a bottle, left unattended during feeding or fed lying down as there is a serious risk of choking.

Talk to your midwife or health visitor when they visit or call if you feel you need more support regarding positioning your babies safely and comfortably during feeding. The number to contact them should be in your red book. 

Winding/Burping

When each baby has had enough milk hold them upright and gently rub or pat thier back to bring up any wind, as per NHS choices information for burping single babies. Do this for each baby. Don't try to burp both babies at the same time if feeidng by yourself.

For information on how to bottle feed including equipment, preparing bottles, and common bottle feeding faq’s please follow the links to the latest nhs guidelines:

www.nhs.uk/Conditions/pregnancy-and-baby/Pages/bottle-feeding-advice.aspx

For formula milk common questions:

www.nhs.uk/Conditions/pregnancy-and-baby/Pages/infant-formula-questions.aspx

For a step by step guide to preparing a formula feed:

www.nhs.uk/Conditions/pregnancy-and-baby/pages/making-up-infant-formula.aspx

For information on responsive bottle feeding the Unicef Baby Friendly Initiative has created this document. Click here to download.

 

 

 

 

 

 




 

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