Sunday, September 14, 2014

Tummy Gas

     I am often asked about gassiness. The gas in our stomach and intestines is both swallowed air and created in our gut as we digest things that we eat and drink. That is true with infants, children, and adults. The gas is normally passed from above (belching or burping) and below (flatus or farting). Many times the gas does not cause any significant pain. So what is important is whether the gas causes pain. Many times the stomach discomfort happens first and we do not know that is the culprit is gas until it is relieved. A full, uncomfortable belly in a toddler that is relieved by passing gas or an infant that fusses for 20 minutes until they pass gas then calm down are good examples. Babies that pass gas frequently but are not uncomfortable are thought to be just fine -- we do not consider that gas to be a problem. In that case, the swallowed gas or created gas is just moving through their system.
     Is there anything we can do to reduce or relieve the gas that is swallowed? Yes. (1). For breastfed infants, a good latch helps them swallow less air. For bottle fed infants, the nipple and bottle combination may make a difference. Sadly, there is not one perfect bottle for every baby. In fact, if the bottle/nipple combination your infant is using is not working for them, you may have to try a few. Some brands that may be helpful: Dr. Brown's, Evenflo Pure Comfi, Playtex with drop-in liners, and Bare Air-free. (2). For infants bothered by the gas they swallow, making sure you do your best to burp them well after the feedings. Young infants may need to be burped after each breast or ounce of formula or pumped breast milk. (3). Simethicone (as generics and name brands such as Mylicon©, Gerber©, and others) gas drops can help some infants. The simethicone breaks up the gas into smaller, more comfortable gas bubbles. For infants, the dose is 0.4 milliliter by mouth as often as every feeding. Simethicone is very safe and can be used every feeding for as long as your child needs the drops. 2-11 year olds, the dose would be 0.4 milliliters per dose.
     Is there anything we can do to reduce and relieve the gas produced in the intestines? Yes. (1). Here is a terrific recent article in our Columbus Dispatch that has a great review of the issue with a chart of the low-FODMAP foods and beverages (I realize you may need to be a Dispatch subscriber to fully access this article). Another good source of information is here from Stanford. If your breast-fed infant has troubles with gas, the most common food and beverages we suggest avoiding for the mother are milk and dairy, asparagus, peas, and cabbage. But as you can see from the FODMAP information, there are MANY foods that may cause more gas. You will likely need to do some detective work at home to discover what you eat or drink that causes more gassy discomfort for your infant. Dramatically reducing or stopping your intake of those things that bother your infant should help your infant. (2). For infants who are formula fed, there are many infants bothered by gas who improve with a formula change. Similac Sensitive©, Similac Total Comfort©, and Similac Soy Isomil© are the formulas that I would recommend if you are going to try something different, in that order. Give a new formula at least 5-7 days to see how it works because it takes 3 days for the previous formula to get out of their system.(3). Massaging a baby's tummy can help if they are crying with gas. Gently massaging in a clock-wise motion is recommended. You can use some baby oil to lubricate your fingers.
     For toddlers and older children bothered by tummy gas, consider these things to help: (1). Encourage chewing with the mouth closed. (2). Encourage your child to eat slower. (3). Avoid carbonated beverages, such as sodas. (3). Consider changing the food and beverages that your child takes in -- especially milk and dairy. Check out the FODMAPs data for other ideas of foods to reduce or eliminate. As said before, it can take some significant detective work at home (consider a food dairy) to figure out what aggravates their tummy and what helps. (4). Consider the simethicone gas drops. Just 0.4 milliliter by mouth every 4 hours or every meal may help reduce the gas pain.
     Call during regular office hours if the above measures are not helping your child or you have other questions not answered here.

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