Do You Give Gas Drops Before or After Feeding

Jenny Wheat

Editor's Note: In "Dear Pediatrician," Dr. Natasha Burgert answers questions about babies, children and young adults for Forbes Health. Have a question? Email her atdearpediatrician@forbesadvisor.com.

What Can I Do For Baby Gas Relief?

When new parents arrive at my pediatric office with gassy newborns, it can be hard to tell who's been crying longer—the baby or the parents. Although baby gas is harmless, a fussy, gassy baby can make anyone feel helpless. Here are a few tips and tricks to help a baby with gas (and their parents) feel better.

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Why Babies Get Gas

Regardless if a baby is being fed formula or human milk, all food is new to a newborn. To digest and absorb nutrients, a baby's immature gut needs to build up enzymes and microflora. Gas is an expected result of this process ^[1] Zeevenhooven J, Browne PD, L'Hoir MP, de Weerth C, Benninga, MA. Infant Colic: Mechanisms and Management. Nat Rev Gastroenterol Hepatol. 2008;15(8):479-496. .

Babies get gassy tummies from ^[2] University of Michigan Health, Abdominal Gas and Colic. https://www.uofmhealth.org/health-library/hw28959. published May 27, 2020, Accessed 7/14/21. ^[3] Woodley FW, Ciciora SL, Vaz K, Williams K, Di Lorenzo C, Jadcherla, S. Novel Use of Impedance Technology Shows That Esophageal Air Events Can Be Temporally Associated With Gastroesophageal Reflux Disease-like Symptoms. Pediatr Gastroenterol Nutr. 2020;70(1):e7-e11. ^[4] Iacovou M, Ralston RA, Muir J, Walker KZ, Truby H. Dietary Management of Infantile Colic: A Systematic Review. Matern Child Health J. 2021;16(6):1319-1331. :

• Normal digestion
• Poor latch on the breast or bottle nipple
• Formula intolerance
• Neurologic immaturity
• Limited body movement
• Air swallowing while crying
• Using a pacifier

In addition to the digestive process, gas can get into a baby's gut through air swallowing. Babies can swallow air during feeding, when using a pacifier and while crying ^[5] Woodley FW, Ciciora SL, Vaz K, Williams K, Di Lorenzo C, Jadcherla, S. Novel Use of Impedance Technology Shows That Esophageal Air Events Can Be Temporally Associated With Gastroesophageal Reflux Disease-like Symptoms. J Pediatr Gastroenterol Nutr. 2020;70(1):e7-e11. . The swallowed air gets trapped in the gut and causes discomfort. When gas pains make a baby cry, babies can swallow more air. This vicious cycle makes the situation worse for babies and parents alike.

3 Baby Gas Remedies

There are many ways to help baby gas pain. I encourage my patient's families to try a variety of approaches to see which is most helpful.

1. Burping. Burping helps to remove swallowed air from the upper gastrointestinal tract. Holding your baby upright while gently patting their back until gas is released is a technique parents have used for millennia, even though small studies haven't demonstrated strong evidence that burping prevents gas pain ^[6] Kaur R, Bharti B, Saini SK. A Randomized Controlled Trial of Burping for the Prevention of Colic and Regurgitation in Healthy Infants. Child Care Health Dev. 2015;41(1):52-56. . If your baby doesn't burp after a few minutes, continue feeding or try some tummy time to help a baby to burp on their own.
2. Tummy time. Placing a baby on their stomach while awake helps to relieve gas pains. By gently increasing the abdominal pressure, tummy time pushes gas bubbles up and out. Tummy time is also a great way to strengthen the head and neck muscles needed to reach early motor milestones.
3. Feeding position. Let gravity help get the air out by using an upright feeding position. Make sure your baby has the correct latch on the bottle or breast while feeding. If bottle-feeding, hold the bottle in the best position to keep milk, not air, in the bottle nipple during feeds. If you are not sure your feeding technique is correct, ask your pediatrician or lactation expert for help.

Does Massage Help With Baby Gas?

Infant massage is another way to help your baby move tummy bubbles. Massage also supports bonding and sensory stimulation between an infant and parent ^[7] Zeevenhooven J, Browne PD, L'Hoir MP, de Weerth C, Benninga, MA. Infant Colic: Mechanisms and Management. Nat Rev Gastroenterol Hepatol. 2008;15(8):479-496. .

Choose a time of day to perform infant massage, typically first thing in the morning or as part of the nighttime routine. Baby-safe lotions or oils can decrease friction during a massage, but are not needed. Move your hand across your baby's tummy in a clockwise motion to push bubbles forward. You can also move your baby's legs like they're riding a bike to encourage gas release.

Infant massage should be pleasant and soothing. Watch your baby for any signs of increased distress, and stop if your baby seems uncomfortable.

Do Baby Gas Drops Work?

Although the medical evidence isn't particularly strong, I have many families that swear by various supplements to help with baby gas pain. These supplements are safe for infants to use as recommended on the product label, or with physician guidance.

3 Supplements to Help Baby Gas Pain

1. Simethicone. Baby gas drops are bubble breakers. These large, silicone molecules travel through a baby's GI tract, breaking up gas bubbles along the way ^[8] Ingold CJ, Akhondi H. Simethicone . In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2021 Jan-. Accessed 6/16/21. . Simethicone is not absorbed by the body, so whatever your baby takes in will be pooped out. However, your baby might experience looser stools when gas drops are used excessively. In my experience, simethicone seems to work better as a preventive than a cure. Meaning, once a baby has gas pains, it's too late for simethicone to help. Instead, use simethicone to prevent bubble buildup. I encourage my patient's families to use gas drops frequently, offering a dose of the supplement before each feed.
2. Gripe water. Commonly used for upset baby tummies, this herbal supplement typically includes tinctures of chamomile or fennel—herbs that have been shown to decrease crying associated with tummy pain ^[9] Anheyer D, Frawley J, Koch AK, Lauche R, Langhorst J, Dobos G, Cramer, H. Herbal Medicines for Gastrointestinal Disorders in Children and Adolescents: A Systematic Review. Pediatrics. 2017;139(6). . Although not regulated by the Food and Drug Administration (FDA), gripe water is generally safe to try. I would choose alcohol- and sugar-free formulations made in the U.S. Follow the dosing recommendations on the label.
3. Probiotics. It's been theorized that a baby's immature and developing gut microbiome contributes to gas production ^[10] Zeevenhooven J, Browne PD, L'Hoir MP, de Weerth C, Benninga, MA. Infant Colic: Mechanisms and Management. Nat Rev Gastroenterol Hepatol. 2008;15(8):479-496. . As a result, researchers have investigated the role of probiotics in the prevention of gas pains. Some studies have suggested Lactobacillus spp. may decrease gas and the crying time of a fussy infant. However, the significance of probiotic supplementation for all children is still unclear ^[11] Pärtty A, Rautava S, Kalliomäki M. Probiotics on Pediatric Functional Gastrointestinal Disorders. Nutrients. 2018;10(12). . Probiotics are commonly available over the counter. In addition, some products combine simethicone and probiotics. Check the labels and follow the listed instructions.

Do Special Infant Formulas Help With Gas?

Since gas is made as a normal byproduct of digestion, it's impossible to eliminate all gas from being formed. However, there are infant formulas marketed for gassy, fussy babies. These formulas typically are formulated with more digestible proteins or alternative carbohydrate sources.

There is scant evidence to suggest hydrolyzed formula or reduced-lactose formula may decrease gassiness in formula-fed infants ^[12] Daelemans S, Peeters L, Hauser B, Vandenplas Y. Recent Advances in Understanding and Managing Infantile Colic. F1000Res. 2018;7. . Most doctors recommend an infant formula be tried for two weeks before making a switch, unless the baby is having a significant worsening of symptoms. Check with your pediatrician to see what they recommend.

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I'm Breastfeeding. Will Changing My Diet Help My Baby's Gas Pains?

Some parents report increased days of gassiness after a breastfeeding mom has eaten foods such as dairy, eggs, spicy foods or certain veggies. Although there is little evidence to support the relationship between maternal diet and infant abdominal pain, many mothers try elimination diets to explore a possible relationship.

Small studies have supported dairy elimination as a helpful way to reduce a baby's GI discomfort ^[13] Iacovou M, Ralston RA, Muir J, Walker KZ, Truby H. Dietary Management of Infantile Colic: A Systematic Review. Matern Child Health J. 2021;16(6):1319-1331. . But even after years of pediatric practice, I'm still not sure which babies improve after their mom stops eating dairy and which babies simply improve over time.

If you want to try an elimination diet to help with gas pain, avoid dairy (or the food you suspect is contributing to your baby's gas pains) for two weeks. As a general rule of thumb, if a diet change has not made a difference for a baby within that time, their mom can add the restricted food back into her diet.

I Have A Very Gassy Baby. Is This Normal?

Gas is not a medical condition. Baby gas pains are typically brief and relieved when a baby burps or farts. The good news is infant gas pains improve over time. By the age of 4 to 6 months, the gut has matured and your baby can move more efficiently, decreasing the bouts of pain ^[14] Zeevenhooven J, Browne PD, L'Hoir MP, de Weerth C, Benninga, MA. Infant Colic: Mechanisms and Management. Nat Rev Gastroenterol Hepatol. 2008;15(8):479-496. .

Why Is My Baby More Gassy at Night?

Gas accumulation is a function of gut motility and positioning. As our body rests, our digestion slows. Gut slowing results in more gas buildup ^[15] Orr WC. Gastrointestinal Functioning During Sleep: A New Horizon in Sleep Medicine . Sleep Med Rev. 2001;5(2):91-101. . During the night, you and I have the luxury of moving our bodies when we feel this discomfort. Our body movement releases any trapped gas bubbles, allowing us to burp or fart to relieve the painful pressure.

Babies can't freely move while they sleep. At night, we tightly swaddle our babies and lie them on their backs to sleep. This technique is important for infant soothing and decreasing the risk of SIDS, but limits the movement of tummy bubbles ^[16] TASK FORCE ON SUDDEN INFANT DEATH, S. Y. N. D. R. O. M. E. SIDS and Other Sleep-Related Infant Deaths: Updated 2016 Recommendations for a Safe Infant Sleeping Environment. Pediatrics. 2016;138(5). . Tummy gas builds during quiet rest until the pain wakes your baby up.

When Should I be Worried About My Baby's Gas Pain?

If your baby is showing any of the following symptoms, something besides gas may be causing your baby's pain ^[17] Reust CE, Williams A. Acute Abdominal Pain in Children. Am Fam Physician. 2016;93(10):830-836. . Call your pediatrician's office for advice.

• Lengthy periods of inconsolable crying (3 hours or more)
• Bouts of inconsolable crying most days of the week
• Blood in baby's stool
• Poor weight gain
• Frequent vomiting
• Vomit that is green, black, or red
• Fever or other signs of illness

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"Dear Pediatrician" is for informational purposes only and should not substitute for professional medical advice, diagnosis or treatment. Always seek the advice of your child's pediatrician or other qualified health providers with any questions about a medical condition.

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Sources

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Source: https://www.forbes.com/health/family/baby-gas-relief/

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