Gas, Bloating, and Bacterial Overgrowthadmin2021-01-29T15:38:06+00:00
Gas and bloating can be normal in babies and children, but if it is persistent, uncomfortable, or combined with other symptoms, it may become problematic.
What is Gas?
Gas is simply air trapped anywhere in the intestinal tract, from the stomach to the colon. Gas can only be relieved at the top and the bottom of the digestive tract, through burping or flatulence. The air typically comes from two places: air that is swallowed with food/drink or normal swallowing, and gas that is produced by the digestive process itself.
What is Bloating?
When gas becomes trapped anywhere in the digestive tract, bloating may occur. A child may experience a swollen abdomen, may look “pregnant,” or may have an uncomfortable feeling of fullness. While bloating may be caused by other conditions, including excess fluid in tissues, in most cases it is caused by trapped gas in the digestive tract. Children who cannot burp or pass gas may become bloated. In addition, children with poor motility or structural abnormalities may trap gas in their digestive tracts. Some conditions, especially bacterial overgrowth, may also cause an increase in the amount of gas that is produced during the digestive process, causing bloating in the small intestine.
When your baby or child does not tolerate a specific food or formula, the body’s response may include gas, bloating, and other gastrointestinal symptoms. The most common intolerance causing gas and bloating is an intolerance to dairy, called lactose intolerance, which is especially common in older children with heritage from Asia or Africa. Fructose, found in fruits and used as a sweetener in other foods and drinks, may also cause gas and bloating for some children. While these are two common food intolerances, children may be intolerant of almost any food.
Children who have slow motility, delayed gastric emptying, gastroparesis, constipation, or other motility issues may also experience gas and bloating. Slow motility or structural blockages not only stop food from passing through the digestive tract, but they also stop gas from passing through. Gas may become trapped in any part of the digestive tract.
Bacterial overgrowth is a condition when the normal bacteria or flora in the gut grows out of control. Typically, there is not enough “good” bacteria, while there is overgrowth of “bad” bacteria. Overgrowth of gut flora can cause gas, bloating, vomiting, abdominal discomfort, and other symptoms. Typically, excess bacteria causes greater production of gas in the small intestine. For more information on bacterial overgrowth, see our Bacterial Overgrowth (SIBO) page.
Children who consume gas-producing foods may experience excess gas. Common foods include beans, peas, and lentils, as well as vegetables like cabbage, onions, broccoli, cauliflower, and mushrooms. High-fiber foods and supplements may also cause gas or bloating. A high-fat diet may also contribute to slower motility, causing gas and bloating.
Children who have fundoplication surgery may experience gas and bloating. If the fundoplication wrap is working correctly, it should allow your child to burp; however, it is not uncommon for a fundoplication to be so tight that gas cannot escape upward. Venting can be particularly helpful for children unable to burp.
We all swallow air when we swallow food, drink, or even just our saliva. Sometimes children swallow too much air, leading to burping, bloating, and discomfort. The most common causes of excessive swallowing include the following:
Poor suck/swallow coordination
Other problems, usually developmental or neurological, that impair swallowing
Low muscle tone
Eating or drinking too fast
Drinking carbonated beverages, chewing gum, or sucking on candy
BiPAP, CPAP, ventilator, or oxygen use
Treatments for Gas and Bloating
In large part, the treatment for gas and bloating depends on the cause of the problem. If the cause is unknown, the first step may be creating a diary outlining your child’s food, drink, or formula intake, to determine how symptoms relate to feedings. Foods/drinks that are gas-producing can be eliminated from the diet, or a different type of enteral formula may be used.
The following other treatments may also be used:
Elimination of gas-producing foods, drinks, and formulas
Elimination of foods, drinks, or formulas that cause intolerances, including food allergens, lactose or fructose, gluten in children with celiac disease, and other similar foods.
Other dietary changes to find an optimal balance of fiber.
Feeding or swallowing therapy, especially in children who have difficulty coordinating their swallows, to prevent air swallowing.
Venting the feeding tube regularly or using a Farrell bag for continuous venting. This is especially necessary for children who have had a fundoplication surgery. See the sidebar for extensive information on venting.
Motility medications or treatments to improve gastric emptying, constipation, and other motility problems.
Probiotics to ensure optimal bacterial flora in the gut.
Antibiotics and other medications for severe cases of bacterial overgrowth.
Anti-gas medications, including simethicone drops, which break up gas bubbles, lactase enzyme supplements, or alpha-galactosidase supplements like Beano.
Anti-reflux medications, since reflux often causes excess swallowing of air.
If your child has a feeding tube that has at least one port into the stomach, you can vent air out of the stomach as needed. Some children need venting before each feeding, around the time of each diaper change, or after feeding. Other children need venting intermittently. You will learn how often your child needs to be vented.
A common way to vent is using a large syringe with the plunger removed. Insert the open syringe into the end of the long tube or into the extension set, then unclamp the tube. Gently pushing on the stomach (or raising your child’s legs to the chest) will help to move the air towards the tube and allow it to move out. Food may also come out. You should let it slowly run back in when finished. This is often referred to as re-feeding. For more information specific to venting with different styles of tubes, see our Living with a G-Tube page.
Bacterial overgrowth is a particular concern for many children with digestive disorders. Normally, the entire gut contains healthy bacteria, commonly called gut flora. When the amount of bacteria increases exponentially, or “bad” bacteria thrives instead of healthy bacteria, children may develop bacterial overgrowth. Bacterial overgrowth can be found throughout the gut, but is most common in the small intestine or small bowel. As a result, it is sometimes referred to as Small Intestinal Bacterial Overgrowth (SIBO), or Small Bowel Bacterial Overgrowth (SBBO).
Bacterial overgrowth typically leads to gas, bloating, diarrhea, vomiting, and abdominal discomfort. Severe cases may contribute to malnutrition due to malabsorption, along with conditions like anemia and vitamin deficiencies.
Causes of Bacterial Overgrowth
Bacterial overgrowth may be caused by a number of factors. Some of the most common causes are listed below:
Motility or structural problems that cause slow motility, delayed emptying, constipation, or otherwise slow the passage of food through the gut, causing extra bacteria to grow.
Frequent antibiotic use.
Malabsorption or other conditions that leave undigested food in the digestive tract.
Children without a gall bladder or who do not produce bile appropriately to break down food.
Children with cystic fibrosis or other conditions that affect absorption.
Children with an impaired immune system.
Surgery to the bowel, including removal of the ileocecal valve, which then allows stool to reflux into the small intestine.
Diagnosis and Treatment
Diagnosis is typically made once other causes are excluded. Breath tests may also help to determine if certain byproducts from digestion occur in large quantities, suggesting excess bacterial growth. Finally, a gastroenterologist may perform an upper endoscopy to examine tissue and the contents of the small intestine.
Treating bacterial overgrowth can be challenging, because it is difficult to rid the body of the bad bacteria without getting rid of all the helpful bacteria. The following treatments are typical:
Antibiotics, especially amoxillin-clavulanate, rifamaxin, or metronidazole
Correction of underlying issues, such as motility disorders, structural problems, absorption problems, or immune deficiencies