doi: 10.1136/ebn1011

Systematic review Mothers bottle feeding their babies feel negative emotions such as guilt and worry, and receive little information about bottle feeding Recent cultural changes, such as maternal employment outside the home, have had a negative impact on breast feeding. This systematic review examines the emotions and barriers that women encounter when attempting to formula feed their infants. The reviewers contend that whereas breastfeeding mothers receive much guidance and support, the needs of bottle-feeding mothers are largely neglected. Twelve electronic databases were searched for research articles relating to mothers ’ experiences of formula feed-ing. The review was restricted to English-language publi-cations from developed countries. Six qualitative studies and 17 quantitative studies were evaluated. One reviewer extracted data and assessed the methodological quality of each study included in the review. This reviewer’s con-clusions were verifi ed by one of the two co-reviewers. Results of the studies were summarised and combined using textual narrative and thematic analysis. The results of the six qualitative studies indicated that women who formula fed their infants experienced many negative emotions. They felt anger regarding excessive pressure to breast feed, a sense of guilt, failure and shame, worry about the effect of formula on their infant’s health and confusion about how to prepare infant formula properly. Women also reported lack of information from healthcare providers about the frequency of feedings and the correct amount of formula to give their infant per feeding. The reviewers suggest that this lack of information about correct bottle-feeding practices may contribute to overfeeding and subsequent child obesity. Usually two reviewers independently assess studies for inclusion in a systematic review and the methodo-logical quality of each included study.1 It was unclear from this research report whether two of the reviewers independently carried out these procedures. The method-ological quality assessment tool used in this review was