Navigating Without a Compass: A Qualitative Study on Parents' Infant Formula Handling

The WHO guidelines on safe formula feeding emphasize the importance of proper handling with professional guidance. However, many infants worldwide are given unsafe formula, with parents struggling with handling procedures. Despite the prevalence of formula feeding, research on formula handling in Swedish settings is limited. This study explores and describes parents' practices and experiences in handling infant formula, their experiences of information on safe handling and their potential needs. Individual semi-structured interviews were conducted with 15 mothers who had experienced formula feeding their infants. Data were transcribed verbatim and analyzed using qualitative content analysis. One overarching theme was identified: "Navigating alone without a compass, with a desire for a safe journey", along with four categories: (1) Varying degrees of safe handling, (2) Challenging but doable, (3) The centrality of guidance and support, and (4) Aspects that also matter. Mothers used varying degrees of safe methods for preparation, storage and cleaning. Although they perceived the methods as feasible, they encountered numerous challenges. Moreover, they received insufficient professional information, relying mainly on informal sources. While guidance and support were requested, they also desired inclusion, as the lack of information and support caused feelings of shame and guilt. Positive emotions surrounding formula availability, shared feeding responsibilities and increased parental freedom influenced its use and handling, as did cost-related constraints. This study suggests that guidance on safe formula feeding is not a priority in the healthcare continuum. To promote optimal health in infants, the results highlight the need to review the quality, implementation, understanding, and adherence to national and local formula feeding guidelines.