Gas and Reflux

     All infants have periods of time when they are fussy. The most common reason for a fed, dry infant to be fussy is that he is tired. When an infant is fussy or has loud, grumbling bowel sounds, it is commonly said that he has “gas” as if it is a medical problem. It is normal for the gastrointestinal tract to have air in it and the grumbling is the normal movement of the bowel heard before and after feedings. When an infant cries, even more air is pulled into the stomach, so the tummy can get even more distended. The crying is causing the “gas” – the “gas” is not causing the crying. Far too much concern and energy is put into burping, changing formulas, changing nipples and worrying about diet – all in the name of preventing “gas”. Air comes up and food goes down through the gastrointestinal tract and parents don’t really need to do anything to help that process.

     When an infant spits up frequently, it is now common to diagnose him as having reflux. True gastroesophageal reflux (GERD) is rare in infants, but spitty infants are frequently given medications called proton pump inhibitors (PPI) just on the history without a real evaluation. A large study of prescribing practices in the US showed a 16-fold increased use of one of the popular forms of PPI from 1994 to 2004. The FDA has not approved PPIs for children younger than a year of age, but most infants on these medications are much younger. There is no good scientific evidence that PPIs relieve distress in infants better than placebo, and there are definite side effects that can result from using PPIs. Before automatically asking that their infant be placed on reflux medication, it would be better if parents look at other causes