It's the Gas, Gas, Gas

By Michelle Place, CRNP-P

We are (not always) what we eat

In our society fussiness in infants is most often attributed to food intolerance and gas even though studies show that fewer than 5% of fussy periods can be attributed to food intolerance. This is because we are hoping for an easy fix to stop the crying.
“If I cut offending food items from my diet, my breastfeeding baby will stop crying.”
“If I change to a different formula, my formula fed baby will stop crying.”
“If we can just fix the gas my baby will stop crying.”
I once took care of a breastfeeding mom who cut so much from her diet that she was basically surviving on plain baked chicken and rice, guess what? Her baby still had fussy periods. Breastmilk is made from what is in mom’s blood not what is in her stomach or digestive tract so even if what a breastfeeding mother has eaten makes her feel uncomfortable or gassy, it is unlikely to cause the same rumblings in her baby. For most young infants, no matter what they eat or no matter what their breastfeeding mothers eat, there will still be a level of fussiness.

Every baby is a gassy baby

Babies eat around the clock so their bowels move around the clock, producing endless gas. This means that frequency of gas is not a cause for concern. The gas is normal and it does not become trapped or cause any pain. In fact, it is rare that a baby will actually have discomfort due to gas, no matter what your mother keeps telling you. Another thing to keep in mind is that normal crying positions for babies include knees pulled to the chest and tightened stomach muscles, so this is not a good indicator of gas.
Since gas does not cause discomfort and the most likely cause of fussiness in newborns relates to an over stimulated nervous system (see previous blog “What is the Fuss All About?” for more information), it makes no sense for gas medicines or gripe water to make any difference. In multiple studies, so-called gas medications containing simethicone (such as Mylicon) have been shown to function only as placebos (in other words, no better than sugar water).  As a result, it is best if parents wait out the normal fussy period from 2 weeks to 12 weeks of age before blaming food, changing diets, or taking unnecessary medications unless, of course, there are accompanying issues which suggest other causes.

To Burp or Not to Burp, That is the Question

Now that we know we do not have to worry about gas causing discomfort, let’s take a minute to talk about burping. Parents are often concerned when they pat their baby on the back over and over and over and over and over and over and no burp comes out.
“What is the best technique?”
“How long should we try?”
“What will happen if my baby never burps?”
First of all, I would like to point out the fact that humans are the only animals who burp their young. Other animal babies somehow manage gas on their own without help from their parents. No one knows why we feel we have to help our babies manage their gas, it is just something that has always been done, passed down from generation to generation. Not everything we do for this non-reason makes a lot of sense so let’s turn to science for the answer.
In 2014 a study was published that separated 71 babies into two groups, one group was burped by their parents after feedings, the other group was not burped at all. The questions they wanted to answer was whether or not burping had any effect on fussy periods and/or spitting up, both of which are harmless but do cause a lot of stress for new parents.
The results showed that there was no difference between the groups with regard to crying episodes. That is to say, babies will be equally fussy or unfussy whether you burp them or not. They also concluded that the babies in the burping group spit up twice as much as the un-burped babies! Looks like other animals have it right, babies do just as well, or maybe even better, if we just leave them alone.

Grunting Baby Syndrome

New babies are so incredibly noisy! They make all kinds of snorting, grunting, barnyard  noises all day and all night. Just because they are noisy does not mean they are in distress. They are sleeping just fine through all of this, you are the one who is awake. Many parents are again concerned that this grunting and straining is caused by gas, stomach distress or difficulty stooling and if these could be relieved the noise would cease.
Part of the issue is a logistical one, I do not know if you have ever tried to go to the bathroom lying down, I would not recommend it. Things definitely come out better when gravity is on your side.
The other part of the problem is that new babies have a lot of trouble figuring out how to work their bodies. Think about when you need to have a bowel movement or pass gas, it is a complex maneuver that requires you to bear down in one place but relax in another. Unfortunately for newborns, these two actions are controlled by two separate nerves and, as a result, babies have trouble coordinating them at first. So, while they are pushing they may also be squeezing which results in a lot of noise and a lot of frustration. This frustration takes the form of crying, turning red or purple in the face, arms and legs working like crazy until they finally get it together at which time the crying stops and baby looks relaxed. As observing parents we feel anything but relaxed and interpret this as stomach pains relieved by the passage of gas or stool. We want to do whatever we can to make sure our baby is not uncomfortable. In reality, your baby was just angry that things were not working properly. Since this is obviously a skill that your baby must master, the best thing you can offer them is patience and time to figure things out.