Gas Pain in Infants and Newborns Symptoms, Causes and Remedies to End a Baby's Sufferingreviewed by Angelika Rampal, MD on July 23, 2013
Gas discomfort upsets almost every baby to some degree and it affects both breast-fed and bottle-fed babies. While gas pain is common and can afflict a child at any age, it is particularly bothersome in newborns and young infants between one and four months of age, as their immature guts are developing. Furthermore, some babies seem to suffer more than others due to inborn and environmental factors.
Gas is a common symptom of intestinal disorders, but it is rarely a sign of a serious problem, according to Donald Schiff, M.D. and Steven Shelov, M.D. at the American Academy of Pediatrics.
When tummy upset strikes a child, a parent's first instinct is to find a safe and natural solution, but babies obviously can't tell us the location and nature of their problem. Thus, knowing and observing the signs of intestinal gas is necessary to identify an effective remedy.
What are the Signs and Symptoms of Infant Gas?
Burping and Belching
Burping is a natural way of expelling gas built up in the stomach and you should encourage your child to burp during and immediately after a meal. However, if your baby hiccups, burps, belches or spits up excessively, it may indicate that too much air is being swallowed during feeding.
Spitting up is common in babies and can be normal. Most babies spit up, and it is often accompanied by a burp, during or soon after a baby's feeding. However, sometimes it can be due to the type of formula, particles in breastmilk, eating too much or too fast, or it can be associated with gas build-up.
Gas has buoyancy and trapped gas essentially acts like a cork in the intestines, causing the flow of gastric juices to slow or stop. A swollen abdomen could be a sign that gas is trapped in the intestines, causing built up pressure to accumulate. Built up pressure thus causes bloating of the abdomen, resulting in pain and discomfort. A baby's immature digestive system may be unable to cope effectively and some babies may experience painful cramps.
It is quite normal for babies to pass gas around 15-20 times per day. Gas can enter the digestive system through several sources including normal digestion of nutrients in milk and formula and air swallowed during feeding and crying. However, an excessive amount of gas may point to incomplete digestion of food due to a newborns' very immature digestive processes, which have not had time to build up adequate beneficial flora (probiotics) and enzymes in the gut. Bad bacteria, viruses and other infections can also cause excessive gassiness, flatulence and even diarrhea. These infections may require medical attention.
Crying is simply how babies communicate a need. As such, crying occurs frequently and for any number of reasons, like hunger, discomfort, loneliness, pain, tiredness, or gassiness.
According to the "Dunstan Baby Language" system, a baby will cry out with an "Eh" sound if gas is trapped in the stomach and needs to burp, whereas an "Eairh" crying sound will be uttered if gas is trapped in the intestines. Though not scientific, this system or language may be helpful for some parents.
Parents tend to describe a gas cry as sharper and more acute as if a baby is in pain. With intestinal gas, you may notice your baby's face turn red, fists clench, knees pull up into the chest, or straining and grunting sounds.
If your baby cries for three or more hours per day and at least three times per week he may have colic.
Restlessness or Insomnia
Any form of discomfort will make it more difficult for baby to sleep...likewise for concerned parents.
What Causes Babies to Experience Gas Pain?
Gas is a natural by-product of digesting the nutrients in breast milk or formula and the digestive system normally expels it without any discomfort whatsoever. However, since gas is buoyant it creates pressure in the opposite direction of gastric flow. When gas becomes trapped in the intestines it causes a painful pressure build-up. There are several factors that contribute to this:
Incorrect Feeding Technique
A poor latch onto the breast or bottle results in too much air being swallowed at meal times.
Crying can cause your baby to swallow air, especially if he cries in hunger for a long period before a meal. Since crying is both a symptom and a cause of gas it can create a self-reinforcing cycle that worsens the problem.
The human digestive system is so complex that it has its own nervous system, the enteric nervous system, which controls the transportation of gut contents in a wave-like motion called peristalsis. A newborn’s gut is continuing to develop after he is born. The gut may still be learning to process food, gas and stool effectively. Gas may also be present due to immaturity in the gut’s microflora, carbohydrate metabolism and hormonal regulation. Gas may also be a symptom of constipation.
Food Sensitivities and Allergies
Breastmilk contains traces of foods from the mother’s diet. Some babies may be sensitive to these traces of foods according to La Leche League. One study by researchers at the University of Minnesota found a link between maternal diet and colic symptoms. Maternal intake of cow's milk, onions, cruciferous vegetables (e.g. cabbage, broccoli and cauliflower), and chocolate intake were associated with more colicky symptoms in babies. However, in most cases, there is no reason for a mother to restrict her diet, especially from healthy foods. If you suspect a food sensitivity or intolerance, try keeping a food journal to track symptoms like gas, spit-up or fussiness. If you feel that your baby would benefit from dietary restriction, talk with your doctor. In a formula-fed infant, a trial of a hypo-allergenic formula may help if a baby is reacting to the cow’s milk protein.
Too Much Lactose
Breastmilk is often thought of as containing foremilk and hindmilk. The foremilk, which comes first, contains more of the sugars, lactose, while the following hindmilk is richer in fat. Some experts believe that too much foremilk may result in a relative lactose overload. This may contribute to gas or fussiness in babies. Many lactation experts recommend attempting to empty each breast before moving on to the next.
Some mothers may have an over-supply of breastmilk, a condition known as hyperlactation syndrome. In this situation, milk letdown is often fast or forceful, causing babies to gag or be fussy with feedings. Please contact your doctor or lactation consultant if you are interested in learning more about milk over-supply or breastmilk composition.
Overfeeding can cause problems if a baby's tummy can't cope with too much food at once. "Feeding too fast may produce lactose overload and increased intestinal gas from the breakdown of excessive lactose" says Bill Sears M.D., a renowned pediatrician, professor of pediatrics at the University of Irvine, and author of The Baby Book.
Transient Lactase Deficiency (TLD)
A temporary inability to produce sufficient quantity of the enzyme "lactase", essential for digestion of "lactose" is a proposed explanation for some cases of colic or infant gassiness but the link is unproven. In general, babies are not lactose intolerant and lactose intolerance does not develop until around age 2, if it is going to develop at all. In fact, the lactose in breastmilk is credited for enhanced absorption of minerals and production of healthy gut flora.
Introduction of New Foods
New foods can make a baby gassy as his gut learns to process them. An excess of high sugar foods, like juices, can also cause a baby to have looser stools or gas.
Our digestions are aided by literally trillions of beneficial bacteria (probiotics) that collaborate with our bodies digestive enzymes to efficiently break down food and nutrients. Emerging evidence suggests that some healthy bacteria, like L. reuteri, may play a role in reducing gas and perhaps even crying and fussiness. L. reuteri preparations are available for pediatric use. Yogurts are also a great source of probiotics. Several studies have shown that the introduction of oral probiotics or probiotic foods can help gassy babies if administered over a period of several weeks. Interestingly, breastfed babies do have a slightly lower incidence of colic, gas and reflux and this could be due to the existence of probiotics in breast milk.
Tips for Relieving Gassiness in Babies and Newborns
Occasional bouts of gassiness in babies are inevitable, but when the condition becomes persistent and uncomfortable a caregiver can choose from several natural remedies:
Feed Baby at an Angle: If breastfeeding, keep your baby's head and neck elevated above his stomach while feeding. If he is bottle fed, feed in a vertical position and tip the bottle slightly so that air can rise to the top, while
milk / formula sink to completely cover the nipple. Using a bottle with a curve or angle can help.
Burp During and After Feeding: Pediatricians suggest burping in the seated position as an initial option but you can also burp your infant by holding him upright or over the shoulder. Orlando pediatrician Gregory Gordon M.D., suggests burping by rocking baby gently in a seated position. Try burping him in the middle and after a feeding session. Be patient as it may take a few minutes for the bubbles and gasses in infant's tummy to surface but if a baby does not burp within a few minutes, it is ok to move on.
Talk to a Lactation Consultant if Breastfeeding: Ensure that your baby's mouth is latching on properly and that each feeding is neither too fast nor too slow. La Leche league advises that baby should be fed in a comfortable position. Contact a lactation consultant or La Leche League for support.
Use the Right Bottle and Formula if Bottle Feeding: The best kind of bottle will have a soft nipple that contours along your baby’s mouth and lips thus preventing air from flowing along with the milk. The milk should flow gradually and slowly so the baby has time to drink and swallow without gulping excessively. Sometimes, switching formulas may help reduce gas symptoms.
Even with perfect feeding protocol a baby may still feel discomfort from trapped gas and hiccups. Burping is not always effective because gas forms in the intestines as well as the stomach. If your little one still appears gassy, the following external therapies may help expel gas when applied approximately 30 minutes after feeding or upon onset of symptoms.
Football Hold: Carry your baby face down with the tummy resting on your forearm, legs straddling your wrist and chin resting near your elbow. Kathy Moore from About.com demonstrates here. Gravity will help apply pressure on the little tummy, which can help soothe and release gas. Give him a gentle back rub for additional pressure. A similar result can also be achieved by putting him face down on your leg, whilst you are seated.
Tummy Time: Let your baby spend time on his tummy while he is awake and you are observing. Gravity's gentle pressure can help push out trapped gas. This will also help your baby develop core, arm and neck strength!
Tummy Massage: While your baby is laying on his back, gently rub baby's tummy in a clockwise motion and then pull your hands down the curve of baby's belly. Some pediatric nurses use the "I Love You" massage - use two or three fingers and apply mild pressure around the abdomen and spell out the letters "I", "L", and "U". Repeat several times to help move trapped gas. "Tidley Pom," an infant spa line, demonstrates some infant massage techniques here.
Bicycling Baby's Legs: While your baby is laying face-up, slowly pump both legs back and forth as if riding a bicycle. The gentle circular motion creates movement in the intestines, which can help loosen trapped gas. New York pediatrician, Cheryl Wu MD, demonstrates.
Swaddling: Many babies are soothed by wrapping them up snugly in a blanket. Pediatrician Harvey Karp, MD, believes that swaddling simulates a sensation newborns experience in the womb. Many parents and child care providers swear by this method but in a controversial move, the American Academy of Pediatrics recently cautioned against swaddling. Parents should ultimately weigh the risks and benefits.
Baby Wearing: In many cultures, babies are constantly “worn” by caregivers. Your baby may like to be in an infant carrier. Please ensure the baby is able to comfortably move his head and breathe while in a carrier.
Pacifiers: Some babies are soothed by sucking on a pacifier, but vigorous sucking on a pacifier may contribute to swallowed air and subsequent gas. Make sure your baby is not hungry or asking for something else when you use a pacifier.
There are four types of gas drops and each works in different ways:
Simethicone: Simethicone is a drug that is marketed as an anti-flatulent remedy for gas relief. Simethicone is a defoaming agent that binds gas bubbles together on theory that they can be more easily passed. Simethicone preparations usually contain synthetic ingredients such as artificial colors and flavors, as well as emulsifiers and fillers. Simethicone gas drops are not advised in newborns due to one of the inactive ingredients. In studies simethicone has not been proven effective.
Tummy Calm: Tummy Calm® is the first and only FDA-regulated, homeopathic gas relief preparation. An over-the-counter alternative to gas drops with synthetic ingredients, Tummy Calm uses proven time-honored natural ingredients, providing safe and effective relief to gassy babies usually within five minutes or less. Unlike simethicone, Tummy Calm does not require constant dosing and does not contain any artificial colors or flavors. For more information about Tummy Calm visit our home page.
Gripe Water: For more than one hundred years, gripe water has been a trusted remedy to treat infant gas. Pediatricians, nannies and millions of parents all over the world have used it. The highest quality of gripe water should be FDA registered for safety and efficacy, contain all-natural ingredients and be manufactured according to strict FDA regulations for good manufacturing practices (GMP) for homeopathic medicines. Colic Calm is the only gripe water that meets these high standards, and it works quickly - usually within five minutes or less, providing safe and effective relief.
Probiotics: New Research suggests that supplementing with a pediatric probiotic may help ease some infant gastric problems if administered over a period of several weeks. If your baby has started eating solids, introducing a bit of yogurt into baby's diet will also introduce your baby’s gut to different strains of intestinal bacteria.
Please remember this information is not a substitute for medical advice or medical care. Please consult your doctor if your child is having fever, diarrhea, vomiting, poor feeding, prolonged crying or any other symptoms that concern you.