Managing Colicky Babies

What is colic? Babies cry, but some babies cry unconsolably for hours. This extreme crying in young babies is called colic. All babies cry, but your baby may have colic if they cry for more than 3 hours a day, at least 3 times a week, for over 3 weeks5^. Colic usually starts in the first few weeks of life and babies may cry more often in the evening and at night. Colic is difficult, but there are things you can do to help soothe your baby. If you are worried about your baby's crying, talk to your doctor. L. reuteri is a soothing probiotic naturally found in breast milk and has been clinically shown to: Reduce crying time in colicky babies2,3^ Support a healthy and balanced gut flora in your baby's digestive system3 Promote regular stools and tummy comfort4   Reduced crying time in colicky babies in as little as 1 week2^   ≥ 3 days/week   ≥ 3 weeks/month   ≥ 3 hours/day   Signs your baby may have colic Speak to your doctor if your baby’s crying is accompanied by fever, vomiting or diarrhea, if you feel there is a significant change in behaviour or could be due to an injury.   Lots of crying Clenched hands Gas, bloating, cramps Legs drawn to chest Red Face Things you can do to help Swaddle & side-to-side rockingWalking White noiseSoothing Probiotics (L.reuteri) ^In breastfed infants. 1Vandenplas Y, et al. Prevalence and Health Outcomes of Functional Gastrointestinal Symptoms in Infants From Birth to 12 Months of Age. J Pediatr Gastroenterol Nutr. 2015;61(5):531-537. 2 Chau K et al. Probiotics for Infartile Colic: A Randorized, Double Blind, Plscebo Controlled Trial Investigating Lactobacilus reuteri DSM 17938. J Pediatr. 2015;166(1):74-78. 3Savino F et al. Lactobacillus reuteri DGM 17938 in Infantile Colic: a Randomized, Double Blind, Piscebo-Controlled Trial. Pediatrics. 2010;128: e528-e533. 4Concorullo P et al. Lactobacillus reuteri (DSM 17936) in infarits with functional chronic constipation: a double blind, randomized, placebo controlled study. J Pediatr. 2010;157(4):598-602. 5HealthLink BC. Colic. September 2023. https://www.healthlinkbc.ca/pregnancy-parenting/parenting-babies-0-12-months/baby-health/colic Accessed February 2023.

You may be thinking about changing your baby’s formula whether it’s due to their age or digestive issues like fussiness, gas and spitting up. Regardless of the reason, it’s best to speak with your doctor before switching your baby’s formula. Once you have the go-ahead, here’s some things to consider when doing the switch. Why switch baby formulas Many parents choose to switch formulas for different reasons such as adapting to different dietary needs or preferences, feeding issues, or transitioning to a different stage formula as their baby grows. How to switch formulas Most babies will do well on different brands of the same type of infant formula and can transition to the new formula right away. Be patient, it can take up to 5 days for some babies to adjust. How to choose which formula to switch to Talk to your baby’s doctor Your baby’s doctor should be consulted for any questions about your baby’s health.They know your baby's unique needs and can help guide your formula choice based on any potential intolerances or other dietary requirements your baby might have. Your doctor may recommend switching to a lactose-reduced or soy-based formula. If your doctor suspects your baby has an allergy, they may recommend hypoallergenic formula designed for babies with allergies. Choose the right stage Look for formulas that are age-appropriate for your little one. Different formulas are designed for different stages, such as newborns or infants 6 months and older. Read the label instructions Remember to carefully follow the preparation instructions on the label for the product you are using. Instructions can vary from product to product and between infant formula brands. Tips for switching formulas Don’t worry about alternating or combining the new formula with the formula you’ve been using: Baby’s transition to the new formula can happen right away. Avoid mixing different formulas! Formulas aren’t meant to be combined. Plus, if the reason you decided to switch formulas is because baby is experiencing digestive issues, you won’t be able to identify the cause if you are mixing formulas. Give your baby 3 to 5 days to get used to the new formula: The adjustment could happen right away or it may take some time to adapt. While you’re transitioning, your baby may go through some other slight changes—mainly to their stool pattern, gas and how often they spit up. Minor changes to baby’s stool pattern, gas or how often they spit up are normal when transitioning to a new formula Is switching formulas safe? Switching baby formulas is generally considered safe and common but it's important to talk to your baby’s doctor before making any changes. Why choose GOOD START®? GOOD START formulas are tummy friendly and easy to digest*. Designed with baby’s comfort in mind, only GOOD START formulas have comfort proteins, which are 100% whey proteins that have been partially broken down using our unique process for small tummies. Whenever you may decide it’s time for formula, choose GOOD START PLUS. It’s our closest formula to breast milk and the only non-GMO† baby formula with Comfort Proteins™, Probioticsǂ, DHA, and 2’-FL. Switching to a formula for sensitive stomachs Designed to give sensitive tummies extra comfort, GOOD START SOOTHE is easy to digest* and has 30% less lactose compared to other GOOD START milk-based formulas. It is our most advanced formula for fussy tummies and is the only formula with probiotic L. reuteri. Over 90% of parents who switched to GOOD START SOOTHE said their baby was less fussy after the first feed.1 *Like all infant formulas †Ingredients not genetically engineered. ǂProbiotics only in powder format. <2>References 1 Czerkies L et al., JPHN. 2019;1(1):19-26.

Health Canada recommends that, for the nutrition, immunologic protection, growth, and development of infants and toddlers, you breastfeed exclusively for the first six months and you sustain it for up to two years or longer with appropriate complementary feeding.1,2 If you need help breastfeeding, healthcare professionals, family and friends can often provide support, encouragement and advice during this period of learning to feed your new baby. There are a variety of reasons you may choose to supplement breast milk with formula, like: Baby isn’t gaining weight as quickly as your doctors would expect, mom’s milk is taking time to come in, or on rare occasions, you’ve been advised by your doctor to avoid providing breast milk in order to protect your baby due to health concerns. Here’s some information about your formula choices to help determine what’s best for you and your baby. The facts Unlike regular cow’s milk, infant formulas contain the recommended amounts of protein, carbohydrate, fat, vitamins and minerals required for baby’s healthy growth & development. Healthcare professionals recommend cow’s milk-based, commercial iron-fortified formula for infants who aren’t exclusively breastfed because it offers a complete source of nutrition for your baby during the first year.1,* All infant formulas in Canada meet strict nutritional standards, but not all formulas are the same. 100% whey, partially hydrolyzed protein is a type of cow’s milk protein that has been partially broken down into smaller pieces. Hospitals don’t carry all infant formula brands. Look for a formula with the benefits of probiotics, 2’-FL, and DHA There have been many scientific advancements to infant formulas—consider choosing a formula that contains: ProbioticB. lactis: Probiotics are part of what gives breast milk its natural protective qualities. Probiotic B. lactis contributes to baby’s healthy gut microbiota and supports their developing immune system.2 Probiotic L. reuteri: Probiotic L. reuteri contributes to baby’s healthy gut microbiota and helps to reduce fussiness3,4and mild spit-ups.5,+  2’-FL HMO: HMO are bioactive compounds found in breast milk that offer protective benefits for your baby. HMO support your little one’s digestive health and developing immune system. One of the most abundant types of HMO in breast milk is called 2’-FL.6-8 DHA: DHA contributes to your baby’s normal physical brain and eye development. Formats Infant formula comes in three different formats and you can choose one, two or all three for your baby—whatever your daily routine can handle! Ready-to-Feed Formula New to formula? This easy-to-use format was made for your convenience. Comes in a ready-to-use sterile nurser form (Attach nipple. Warm**. Feed!) Do not mix with additional water.§ Concentrate Formula "Add Water" concentrated liquid infant formula is easy to use and prepare for added convenience Requires additional amount of sterilized water§ Mixes easily (No clumps or scoops!) Powder Formula Convenient Great value! Requires powder be added to desired amount of sterilized water§   Introducing Infant Formula: Step-by-Step Follow these simple instructions to supplement breastfeeding with formula or transition to formula feeding: Substitute one mid-day breastfeeding with a bottle-feeding. Relieve your breasts between feedings by expressing small amounts of milk (only if necessary). Talk soothingly when you offer the bottle and give extra loving attention. Substitute another breastfeeding with bottle-feeding every 2-3 days until you reach your desired balance between breastfeeding and bottle-feeding. Some Additional Thoughts on Transitioning Do not replace two consecutive feedings on the same day when you first begin weaning. If you continue with breastfeeding in the morning and evening, or leave them as your last substitutions, you will have greater flexibility to return to work or share daytime feedings with others. The transition to formula may happen smoothly, but sometimes it takes a little longer. All babies and moms are different, so try to be patient, relax and enjoy your time together. * All breastfed and partially breastfed infants in Canada should receive a daily vitamin D supplement of 10ug (400 IU). +In breastfed babies. **Do not use a microwave oven to warm formula, as it can produce hot spots in the bottle that can burn your baby. § Your baby’s health depends on carefully following the label directions for preparation and use. References 1 Joint statement of Health Canada, Canadian Paediatric Society, Dietitians of Canada, and Breastfeeding Committee for Canada. Nutrition for Healthy Term Infants: Recommendations from Birth to Six Months. 2012. Nutrition for Healthy Term Infants: Recommendations from Birth to Six Months - Canada.ca 2Holscher H, et al. JPEN. 2013;36(1):106S-116S. 3Chau K, et al. J Pediatr. 2015;166(1):74-78. 4Czerkies L, et al. J Pediatr Health Nutr. 2019;1(1):19-26. 5Garofoli F, et al. Int J Food Sci Nutr. 2014;65(5):646-648. 6Bode L, et al. Glycobiology. 2012;22(2):1147-1162. 7Goehring K, et al. PLoS One. 2016;146(12):2559-2566. 8Storm H, et al. Global Pediatric Health. 2019;6:1-10.

To start things off, here’s a quick breakdown of the three formats of formula. Types of infant formula Ready-to-feed: Most convenient (no preparation required!) Concentrated liquid: Just needs to be diluted with water Powder: Great value! (Mix the powder with water) To ensure that you are giving your baby the right amount of nutrition, and to minimize the risk of bacterial contamination, it is essential to follow the label instructions, and prepare and refrigerate formula properly. Your baby's health depends on this. Before you begin: Storage and preparation dos and don’ts Dos Ask your baby’s doctor about infant formula, including how much and how often to feed. Carefully read the directions for preparation and use on the label so you can follow them accurately. Your baby's health depends on this. Wash your hands thoroughly before preparing infant formula. Feed your baby immediately after preparing the bottle. Always test the temperature of warmed formula before feeding (just use the inside of your wrist or the top of your hand). Don’ts Do not add extra powder or more concentrated liquid infant formula than indicated in the label instructions. Do not add any other ingredients (sugar or cereals) to the formula. Do not use formula from a package that may be damaged (e.g., dented, opened, leaking, or bloated) and discard the package immediately. Do not use a microwave oven to warm formula (it can produce hot spots in the bottle that can burn your baby). Do not store any remaining formula that your baby didn’t eat—discard it immediately (it’s not safe to store it for later). How to prepare baby formula: Step-by-step* Do not use a microwave oven to sterilize bottles or utensils. First and foremost, always sterilize your bottles, nipples, rings and all preparation utensils by placing them in a pot with boiling water, boiling for 5 minutes, cleaning the area where you’ll be prepping things and washing your hands. Ready-to-Feed Liquid Formula Preparation Shake the ready-to-feed Tetra Pak™ carton well and wipe the top with a clean damp cloth before opening. Pour ready-to-feed formula directly into a sterilized bottle—do not mix with additional water! Put the bottle in hot water until it is lukewarm (usually 1-2 minutes). Immediately close the opened Tetra Pak™ carton with the resealable cap and store it in the fridge—use the rest within 24 hours. Concentrated Liquid Formula Preparation Bring water to a rolling boil for 2 minutes and let it cool to lukewarm temperature (37°C) before mixing. Shake the Tetra Pak™ carton well and wipe the top with a clean damp cloth before opening. Pour equal amounts of measured-out formula and sterilized water into a sterilized bottle. Do not over or under dilute unless directed by a healthcare professional. Cap the bottle and shake well. Immediately close the opened Tetra Pak™ carton with the resealable cap and store it in the fridge—use the rest within 24 hours. Test the temperature of warmed formula on your wrist before feeding. Feed immediately. Throw out any unfinished formula within 1 hour after feeding. Powder Formula Preparation Bring water to a rolling boil for at least 2 minutes and let it cool to lukewarm or body temperature (37°C) before using. Pour measured, sterilized water into a sterilized bottle. (Always put the water in your bottle first—it’ll help the powder dissolve better as you add it, rather than trying to add water to a bottle that you’ve already put powder in. For best mixing results, use lukewarm water prior to adding powder.) Add the appropriate number of scoops of powder, as directed on the label. Do not over-dilute or under-dilute unless directed by a healthcare professional. Cap the bottle and shake it well, until the powder is completely dissolved. Test the temperature of warmed formula before feeding. Note: Only prepare one bottle at a time. Infant formula storage* Ready-to-feed formula storage after opening After opening the carton, if there’s formula left, recap it immediately, refrigerate it upright, and use it within 24 hours. Concentrated liquid formula storage after opening After opening, if there’s any formula remaining in the carton, recap it immediately, refrigerate it upright, and use it within 24 hours. Powder formula storage after opening After opening the can, keep it tightly covered with the lid and use within 1 month. Store the container in a cool, dry place. Sterilizing bottles in advance of feeding While preparing and filling bottles in advance may seem like a good idea, preparing and then storing formula is not recommended. Following the manufacturer's label instructions is important for the health of your baby. One safe way to save time is to sterilize bottles and fill them with the appropriate amount of sterilized, cooled water ahead of time. If you choose to measure out the appropriate amount of water ahead of time, do not add the formula until feeding time. This will shorten the preparation process once feeding time arrives. Once the formula is added to the measured water, the bottle must be warmed in hot water to bring it to a lukewarm temperature. Remember, your baby’s health depends on you carefully following the directions for preparation and use on the label. How long is powdered formula good for after opening the container? Once open, powdered formula will stay fresh up to one month and does not require refrigeration. How long is formula good for after warming? You should avoid using a microwave to warm formula. After warming the prepared formula, it’s recommended to feed your baby right away. The bottle should be used within 2 hours from the time it was warmed. Don’t refrigerate and reuse formula that has been previously warmed. How long can formula sit out for? Never leave any unused prepared or opened liquid formula at room temperature for more than 2 hours. Once you’ve fed your baby, discard any formula remaining in the bottle within 1 hour. Important formula preparation and storage notes Check the expiration date prior to using any formula. Throw out any containers that have expired. Never leave any unused prepared or opened liquid formula at room temperature for more than 2 hours. Feed formula immediately and discard any formula remaining in the bottle within 1 hour after a feeding. Immediately close and store any opened ready-to-feed or concentrated liquid Tetra Pak™ carton in the refrigerator for no more than 24 hours*. * Formula storage instructions are stated based on Good Start® infant formula products. Please consult the label for full preparation and use instructions. If using another brand of infant formula, please follow the directions stated on the label. Reference Health Canada. Preparing and handling of powdered infant formula. 2022. https://www.canada.ca/en/health-canada/services/milk-infant-formula/preparing-handling-powdered-infant-formula.html. Accessed July 2023.