Gas

Symptoms often linked with gas in infants
What causes gas in infants?
Reducing the amount of air your baby swallows
Making changes to your baby's diet
Why medications don't work!
Relieving gas symptoms naturally
When to see a doctor
How we can help!

Symptoms often linked with gas in infants

Burping/belching
Flatulence (passing gas)
Abdominal bloating or distension
Abdominal pain or cramps
Vomiting
Diarrhea
Constipation
Crying
Sleep disturbances

1. Burping/belching

A burp or belch is the process of expelling air from the stomach; air which has been swallowed. (Gas is rarely produced in a baby's stomach.) Burping large amounts of air is due to swallowing large amounts. Babies swallow air when they are...

eating
drinking
crying
swallowing saliva; and
sucking on a pacifier.

2. Flatulence (passing gas)

Passing gas (out the other end) is the result of swallowed air and gas produced in your baby's intestines (bowel), due to one or more of the following...

Normal digestion.
An incomplete break-down of food or milk.
A gastro-intestinal infection.
A side effect of medications (prescribed or over-the-counter) or herbal therapies.

In the majority of babies, where parents complain of excessive flatus, there are no recognizable disorders of the intestinal tract. Often what can seem like large amounts of gas is in fact very normal! Most parents don't realize that a baby can pass gas up to 20 times a day and without other gastric symptoms this is considered normal. (Crying and gas are most often not related to the same cause.)

3. Abdominal bloating or distension

Excessive amounts of gas can cause distension of the abdomen or a bloated feeling. More commonly in babies, abdominal distension is the result of a full stomach from normal feeding, or possibly over-feeding. (See our article on hungry baby for information on why some babies over-feed.)

4. Abdominal pain or cramps

Abdominal pain can range from mild to severe and can last anywhere from a few minutes to days, depending on the cause. Cramping can be continuous OR it can present in waves or spasms.

It's not easy to tell when a baby has pain. Parents often become concerned when they observe normal infant behavior. For example, young babies regularly fuss, grunt, groan, pull faces and strain as they pass gas or a bowel movement. This is due to the gastro-colic reflex and not necessarily a sign a baby has pain.

It is a common belief that when a baby draws up his legs while crying that this is a sign of abdominal pain, but this is not always the case. Young babies naturally pull up their legs (into a fetal position) when they become distressed - for any reason.

What can appear like pain may simply be a sign a baby is distressed. Babies often become distressed, and scream inconsolably for long periods of time, for reasons that have nothing to do with pain or discomfort. (See Crying baby and Infant colic for examples of why babies become distressed.)

5. Vomiting

Vomiting is not the same as spitting up (also known as spilling or posseting). Spitting up, which is associated with gastro-esophageal reflux, occurs spontaneously and unlike vomiting is effortless.

Vomiting is associated with a gastro-intestinal infection; a food or milk allergy or intolerance; or a side effect from medication. Diarrhea is also frequently linked to conditions that cause vomiting. (Diarrhea and/or excess gas are not symptoms of gastro-esophageal reflux.)

6. Diarrhea

Excessive gas and diarrhea present together when a baby experiences...

A gastro-intestinal infection.
Food or milk protein allergy or intolerance.
Secondary lactose intolerance (following a bout of gastroenteritis).
Lactose overload (also know as functional lactase deficiency).
A side effect of some medications or herbal treatments.

Digestive disorders, such as food or milk allergies or intolerances, which also present with symptoms of excessive gas and diarrhea, often involve other symptoms such as wheezing, rash, nasal congestion, eczema, vomiting, bloody stools and failure to grow.

WITHOUT DIARRHEA it is likely the amount of gas your baby passes is NORMAL and any distress due to other reasons.

PLEASE NOTE: Frequent, watery bowel movements are normal for a breastfed baby and not necessarily diarrhea. However, a breastfed baby CAN also have diarrhea. (See Diarrhea for more information.)

7. Constipation

Excess gas can be a symptom of constipation. A baby is considered to be constipated when they have dry, pebbly stools. Parents often become concerned because the frequency of their baby's bowel movement decreases; this alone is not a sign of constipation. Parents also become concerned about constipation when their baby appears to be straining and yet passes normal stools. This is most often due to the gastro-colic reflex. (See Infant reflexes for more information.)

8. Crying

Infant gas is often considered to be the same as infant colic; however they are not the same. Although a baby with infant colic may also have gas (possibly due to swallowing air while crying), a baby with gas does not necessarily have colic. Studies have shown that gas alone does not cause the level of distress and/or discomfort experienced by a 'colicky' baby.

9. Sleep disturbances

Understandably, a baby with a tummy ache will have trouble sleeping; either falling asleep or staying asleep. However, there are many, more common reasons for a baby to have a disturbed sleep pattern other than abdominal discomfort. (See Why babies become over-tired.)

MYTH: A common belief is a baby will become "blue around the lips" when he has wind/gas. This is not true. A bluish tinge around a baby's lips is due to increased blood circulation... which is often more obvious when a baby is crying (for any reason).

What causes gas in infants?

1. Swallowed air

Swallowed air is the most common cause of gas in the stomach and is the major reason for burping or belching. Swallowing some air is unavoidable. Big and small alike, we all swallow air. Infants swallow air...

During breast and bottle feeding.
While eating solid foods. (Eating or drinking quickly greatly increases the amount of air swallowed.)
During episodes of intense crying.
When swallowing saliva.
While vigorously sucking on a pacifier.

In a breastfed infant, swallowing large amounts of air may be linked to poor latch-on and/or a fast and plentiful supply of breast milk. In a bottle fed infant swallowing large amounts of air may be due to an unsuitable feeding nipple which is too small, too short and/or too fast for the baby.

MYTH: A common belief is that babies will swallow air if they are taken outside on windy days or travel in the car with the window down. Both of these are untrue.

2. Normal digestion

Acid produced in the stomach, is neutralized by digestive secretions as it passes into the intestines (bowel) and the resulting reaction creates gas as a by-product. Some of this gas is absorbed into the blood stream and exhaled out of the lungs. The rest of the gas will continue through the intestines/bowel and is passed out as flatus.

Where bowel movements are 'normal', most likely the amount of gas is also normal. (See diarrhea for more on what normal infant bowel movements look like.)

3. Incomplete breakdown of food or milk

An incompletely breakdown of food and/or milk can result in excessive gas and diarrhea. In infants these symptoms are commonly due to...

Immaturity of the digestive system.
Digestive disorders.
Malabsorption problems.

A small number of babies may experience excessive gas and diarrhea due to an inability to adequately digest one or more of the proteins, carbohydrates (sugars and starches) or fats found in milk (including infant formula), juices and some foods. This is due to insufficient production of necessary digestive enzymes, believed to be related to immaturity of an infant's digestive tract.

Both breast and formula fed babies may continue to display gastric symptoms, such as excessive gas and diarrhea, following a gastro-intestinal infection, due to secondary lactose intolerance. Often mistaken for lactose intolerance is lactose overload. Lactose overload (also known as 'functional lactase deficiency') commonly occurs in healthy, thriving breastfed babies under the age of 5 months. Although the symptoms are almost identical to lactose intolerance, the management of these two conditions is quite different.

A tiny number of formula fed babies may experience gastric symptoms due to milk protein allergy or intolerance. Although rare, similar symptoms can also develop in breastfed babies, as a result of an allergy or intolerance to proteins, from cow's milk or other foods, which are transferred through breast milk from the mother's diet.

Gastric symptoms may also occur when a child starts on solid foods or juice. Symptoms may develop due to carbohydrate malabsorption, where carbohydrates are not completely digested (broken down). These foods include sugars such as raffinose in beans; lactose in milk and dairy products (as mentioned above); fructose in onions, artichokes, pears and wheat; sorbitol in fruits such as apples, pears, peaches and prunes; and starches found in potatoes, corn, noodles, oats and wheat.

The amount and type of fiber contained in a food impacts on the amount of gas produced. Not all fiber causes gas. Some fiber is soluble and other insoluble, describing whether it can be absorbed or not. Fibers found in oat bran, beans, peas, and fruits may cause gas, whereas fiber found in many other foods may not. It depends on what is eaten and how much is eaten. A high fiber diet will generally produce more than a diet containing less fiber.

Vegetables - carrot, eggplant, broccoli, cabbage, Brussels sprouts, onions, artichokes and asparagus; and legumes - beans, peas, chickpeas, soybeans and nuts, can increase the amount of gas produced.

IMPORTANT

Many of these foods provide an excellent source of vitamins and essential nutrients and it is not recommended to exclude them from a child's diet, simply to find a balance.
It is known that babies lack sufficient digestive enzymes to adequately digest solid foods before the age of 4 months (or older for some babies). Recent recommendations for starting solids, for both breast and bottle fed babies in now 6 months.
This information relates to a child's diet not a nursing mother's diet. 'Gas producing foods' eaten by a nursing mother has little impact on her breastfed infant.

4. Gastro-intestinal infections

Gastric symptoms, including excessive gas and diarrhea, can be due to a gastro-intestinal infection (also known as gastroenteritis, a tummy bug, bowel infection, stomach flu or infectious diarrhea) are common in infancy. A gastro-intestinal infection can be caused by a virus, bacteria, yeast/fungus or parasites (protozoa, roundworms, tapeworms or flukes).

IMPORTANT: See a doctor if you suspect your baby has a gastro-intestinal infection. DO NOT give any medication, including intestinal worm medications (anthelmintics) to infants or children unless specifically advised to do so by your child's doctor.

5. Medications and over-the-counter drugs

Many medications given to children to treat...

infant colic
reflux
constipation
pain
fever
infections

...have side effects which can include gastro-intestinal upsets, abdominal cramping, excessive gas, diarrhea or constipation. If your child is currently on medication or an over-the-counter drug, discuss the possibility of these side effects with your doctor or pharmacist.

Herbal therapies are not without similar side effects. Talk to a herbalist personally before using any herbal remedies with infants or children.

Reducing the amount of air your baby swallows

1. While breastfeeding

Make sure your baby latches-on correctly, a poorly latched on baby will swallow more air. (See breastfeeding basics for more information about latch-on). If you are experiencing difficulties with latching your baby to your breast, seek the hands-on support of a qualified lactation consultant.
Where supply is plentiful and your baby is gaining large amounts of weight, offer only one breast at each feeding (alternate breasts at each feed).
If your milk supply is plentiful and let-down is strong and provides a rush of breast milk, which your baby experiences difficulty coping with, pump off approx an ounce of milk before latching your baby to the breast. (Freeze pumped breast milk for future use).

2. While bottle feeding

Read how long bottle feeding should take for different age groups and slow feeding down to the recommended time, by using a slower nipple and/or tightening the nipple ring.
If feeding continues to be too fast, encourage your baby to take a couple of brief breaks during feeding.
Experiment with different shaped nipples. For more information on choosing a suitable nipple see feeding equipment.
For additional tips on bottle feeding, see How to bottle feed your baby.

3. When your baby is eating solid food

If your baby is younger than 9 months of age, offer milk (breast or formula) 15 - 20 minutes before offering solids.
If your baby is older than 9 months, offer solids before milk (breast or formula). Offer small healthy snacks approximately mid way between main meals.

4. While using a pacifier

Unfortunately, both vigorous sucking on a pacifier and crying can cause a baby to swallow air. To remove your baby's pacifier may result in further crying, so you will need to weigh up the benefit.

5. While crying

Babies cry! Crying is essential for a baby's survival. Crying doesn't necessarily mean your baby has pain. Babies cry to communicate their needs. (Unfortunately sometimes they don't know exactly what it is they need.) It's not possible to avoid all crying.

Try to establish a flexible feeding and sleeping routine for your baby, where both you and he can learn to predict what the next step will be.

Making changes to your baby's diet

1. Breastfed infants

You may have already received advice to eliminate certain foods from your diet. This RARELY makes a difference, because contrary to popular belief, what a mother eats is NOT often the cause of her baby's distress.

RECOMMENDATIONS

See our article on lactose overload for tips to reduce gastric symptoms related to frequent feeding patterns.
Exclude the many other, MORE common reasons, for gastric discomfort, irritability and wakeful behavior (they may NOT be due the same cause) BEFORE going down the path of dietary restrictions.
If you suspect a food or milk allergy or intolerance seek professional advice from a doctor or dietician who SPECIALIZES in this field.

2. Formula fed infants

Changing formula RARELY helps, particularly if there are NO significant gastric symptoms, such as diarrhea. Prolonged use of an INAPPROPRIATE infant formula may negatively affect your baby's development. (See Soy infant formula - Is it the best choice?)

RECOMMENDATION
If you suspect a food or milk protein allergy or intolerance see your doctor for advice on suitable formula.

3. When your baby is on solids

If your baby is less than 6 months old, STOP solids completely OR RESTRICT solids to 'low risk' foods.
If you are offering fruit juice to your baby on a regular basis, try CEASING this for a period of time. Offer water at these times instead.
Offer ONLY cereal specifically designed for babies. Some cereals are too high in fiber (and low in iron) for a young baby's digestive system to cope with.
High fiber foods should be introduced SLOWLY to allow your baby's bowel sufficient time to adjust.

Why medications don't work!

There is a huge array of medications (prescribed, over-the-counter and herbal remedies) on the market which are used to 'treat infant gas' and/or colic. The majority of these products aim to reduce the amount of gas in a baby's stomach by helping to facilitate a big burp.

Some medications act as muscle relaxants to "aid the passage of gas through the bowel". Of concern is that many of these medications contain alcohol or drugs that provide a sedative effect. In theory, these medications claim to relax the bowel, but in practice their effectiveness in the treatment of gas in infants remains unproven. What is often perceived as an improvement from their use may be due to the fact that they make the child sleepy.

Whatever these products aim to achieve, they are limited in their effectiveness in treating gas in infants by the fact that they do nothing to correct the cause of excessive gas and/or a baby's distress (which as mentioned previously, is not always due to the same cause). Medications do little to resolve the problem of a distressed, crying baby other than to provide exhausted parents with some relief by sedating the child.

Almost all medications (prescribed, over-the-counter and herbal remedies) have side effects. The side effects may outweigh any benefits of using medications to treat infant gas or infant colic. See Anti-colic medications for more on the effects and side effects of commonly used medications.

Relieving gas symptoms naturally

The following methods aim to provide temporary relief from tummy troubles related to gas. Unless the underlying cause of excessive gas is discovered and corrected, it's likely you will be faced with the same problem again and again. If gas in not the real reason for a baby's distress (as is often the case) these method may not provide much help at all!

1. Burping your baby

See Burping your baby for more information.

2. Water

Babies often seek to feed for comfort and not necessarily because of hunger. Offering a small amount of water (1 oz or 30 ml) can often help to satisfy your baby's unsettled tummy, when you feel he's not really hungry.

3. A warm bath

This may help your baby to relax. Also the warmth (body temperature only) may help the gas in his bowel to expand and be expelled.

4. A warm compress on baby's tummy

Warm a cloth diaper or towel in the microwave, then place it over your knee and lie your baby face down across the towel. (Make sure it's not too hot!)

5. Tummy massage

A tummy massage may help to relieve discomfort due to abdominal gas. Put some oil on your hands and gently massage your baby's abdomen in a clockwise direction using long stroking actions, alternate this with lifting his knees (by holding his ankles) and using a 'bicycle' movement.

RECOMMENDATION

Choose either a bath or a massage not both, as it can be over-stimulating. For babies younger than 5 months of age, massage and bath time need to be separated by a nap or night time sleep.
Do not massage your baby's abdomen if he has hiccups or has just been fed.

6. Soothing methods

You may find some additional tips on soothing methods helpful.

When to see a doctor

Any sudden change in your baby's behavior.
If your baby experiences prolonged periods of distress.
If your baby has frequent, watery bowel movements*
Before starting on medications or over-the-counter drugs - ask him/her to explain about potential side effects.
Before changing infant formula
If your baby develops any unusual symptoms.

* It is very normal for an exclusively breastfed baby to pass frequent watery bowel motions.

Written by Rowena Bennett
RN, RM, RPN, CHN, Grad Dip Health Promotion.

Added Nov 2003. Revised April 2004.

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Through a consultation at BabycareAdvice, we can help you to explore not only all the possible reasons for your healthy baby's excessive gas BUT more importantly his distress. (They are not always related to the same problem.) We can explain ways in which you can reduce your baby's gastric symptoms through feeding managment, and ways in which you can encourage his sleep and contentment.

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