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 with celiac disease may also experience gas and bloating as a reaction to consuming gluten.
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.
Children who cannot absorb certain types of carbohydrates or other elements of foods may also experience gas buildup when these elements remain in the intestine.
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
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.
For continuous venting, even while feeding, you can use a Farrell valve bag.