There are a couple of factors to consider, but I think the 'jury is still
out on this' meaning I do not think we have a definite "you should not mix
ebm and formula together" or "it is ok to do so". Here are the factors to
consider:
-you do not want to waste any ebm so feed it first and then give formula if
no other ebm or donor milk is available and baby needs the
complement/supplement.
-possibility exists of the iron in iron fortified formula binding with the
breastmilk lactoferrin rendering it ineffective or less effective to do its
job(not sure if this is documented to happen or just theoretical)

Let's say you are working with a mother with a poor feeder and a very low
supply and no donor milk is available. Let's say she has 10cc available of
ebm to comp her baby and he is acting hungry. Would you have her feed a full
formula feeding and just keep expressing until she had a full feeding volume
of ebm, as one post suggested might be wise? What about the lovely method of
supplementing at the breast w/ a nursing supplementer. Surely the breastmilk
and formula are being mixed in that case? If the mother were supplementing
with bottle, and if no donor milk were available, based on my current state
of understanding, I would have the mother breastfeed, then feed any and all
available ebm and then make up the difference in formula at that same feed.
I would not separate these events by any lenght of time.

Laurie Wheeler, IBCLC, MN, RN
New Orleans Louisiana, s.e. USA




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