Gas And Reflux In Infants

     All infants in the first 2 months of life fuss a lot. All parents of fussy young infants want to know "what's wrong" and how it "cure"it. When an infant is fussy and also has loud, grumbling bowel sounds, or passes a lot of gas – from either end - it is commonly said that he has “gas” as if it was an actual medical diagnosis. However, there is no such medical diagnosis. Gas is not a disease. It is normal for the gastrointestinal tract to have air in it and abdominal grumbling is the sound of the normal movement of the bowel as the food moves down the tube. Infants can also get air into their intestine by crying. When an infant cries, air gets pulled into the stomach and normally either goes up with a burp or moves down the tube. It is important to realize that the crying causes the “gas” to be in the intestinal tract – the “gas” does not causing the crying. Far too much concern and energy is put into burping, changing formulas, changing nipples and worrying about diet just because the infant is thought to have “gas”. The burping and farting that infants do is the normal releasing of the air that is in the gut. Parents don’t need to do anything to help that process and there is no god evidence that it causes a baby to be fussy.

     In the last 20 years, the number of infants diagnosed as having reflux has skyrocketed. True gastroesophageal reflux (GERD) is actually rare in infants, but infants are frequently diagnosed as having reflux just on the history of spitting up a lot without a good medical evaluation. These infants are often given medications called protein pump inhibitors (PPIs) that decrease stomach acid. A large study of prescribing practices in the US showed a 16-fold increased use of one of the popular forms of PPIs from 1994 to 2004. The FDA has not approved PPIs for children younger than a year of age, but most of the infants diagnosed as having reflux and placed on these medications are much younger. The hope is that the medication will relieve the fussiness by “curing” the “reflux”, but there is no good scientific evidence that PPIs relieve distress in infants better than placebo and PPIs also do not decrease spitting up. This eliminates both of the reasons that PPIs are commonly given to infants. There are definite side effects that can result from using PPIs but, unfortunately, they are rarely discussed. Before automatically asking that their fussy, spitty infant be placed on reflux medication, it would be better if parents look at other causes of fussiness and discuss reflux realistically with their infant’s caregiver.