Clinical Reference Systems: Pediatric Advisor 10.0

DESCRIPTION

A normal but embarrassing part of the human condition is to pass bowel gas on a daily basis. Most people also belch or burp up stomach gas occasionally. In fact, the average adult on a regular diet passes gas 10 to 20 times a day. This amounts to approximately 1 quart of gas per day. Gas should not be considered excessive unless it occurs at more than twice the normal frequency.

CAUSES

The main causes of normal gas are swallowed air, gas-producing foods, and certain diseases that interfere with sugar absorption. Every baby is somewhat "gassy" because of swallowing air during sucking. This process is increased by sucking on a clogged nipple, a bottle that does not have milk in it, a pacifier, the thumb, or a blanket. Babies also swallow air during crying. Older children swallow air with gum-chewing. Children with nasal allergies swallow air if they are "sniffers." Some children have a nervous habit of frequent swallowing. The carbonation in soft drinks releases gas in the stomach. Stomach gas is more likely to pass into the intestines if a child is lying down. Gas (unlike food) can pass through the gastrointestinal tract in 20 minutes.

Some foods (such as beans) are made up of complex carbohydrates that are not completely digested in the small bowel. These foods are converted into gas by bacteria in the large bowel. Eating beans can increase gas production tenfold.

The most common medical condition that causes increased gas production is milk intolerance. The enzyme (lactase) that normally digests milk sugar (lactose) progressively decreases in amount between ages 4 and 20 in large segments of our population. Those most affected are Orientals, Blacks, and Eastern Europeans. The undigested lactose is converted into hydrogen by the bacteria in the large bowel. The amount of gas produced depends upon the amount of milk ingested. Symptoms of bloating, abdominal cramps, and increased passage of gas usually don't occur until a person drinks more than 1 quart a day.

Gas can be temporarily increased with bouts of infectious diarrhea. Gas can also build up behind constipation and can be released in large amounts.

HOME CARE

In general, passage of gas causes no symptoms. By age 5 or 6 most children can be taught to release gas in a socially acceptable manner. Gas does not need to be released by inserting anything in the rectum.

Air swallowing can be reduced by eliminating some of the habits previously mentioned.

Reduced intake of beans and carbonated beverages will decrease gas production in all children.

If you feel your child has a milk intolerance (especially if your family history is positive), reduce milk intake to 2 or 3 glasses a day. Milk does not need to be completely eliminated in most people with a lactose intolerance. Yogurt is easily digested and can be continued. If you suspect milk intolerance and symptoms persist after minor dietary changes, consult your child's physician about current recommendations for this disorder.

CALL YOUR CHILD'S PHYSICIAN DURING OFFICE HOURS IF:

• Your child develops loose stools that last over 7 days.
• Your child loses weight.
• You have other questions or concerns.