It’s a Gas: The Lowdown on Burps and Farts in Kids

Beans, Beans the magical fruit

The more you eat, the more you toot.

The more you toot, the better you feel,

So eat your beans at every meal.

Why is it that we pass gas? More than you may know, there is great wisdom to be found in this legumecentric song sung on playgrounds from here to the boys room. In the interest of scientific and medical inquiry, we will deconstruct this time honored ditty and its connection to eructations (belching)  and flatus (aka The Fart). These phenomena of human beings  offgassing, if you will, creates an interesting nexus of biochemistry (fermentable sugars!), alimentary shenanigans (colonic bacteria?), social awkwardness (it was him!), and for some children and adolescents, a need for treatment (Please don’t cut the cheese!).  Hold your nose. Cover your ears. On we go.

Be assured, investigators have worked hard to characterize how much humans  burp and break wind each day? Any passive observer can tell you that newborns to infants tend to pass discrete, quick packets of gas after meals and working towards filling their diapers. As kids grow, these become more substantial, and as solid foods enter our diet, more smelly. Grownups pass between 200-2000 cc of gas from the top or bottom of their GI tract, about a dozen times a day on average. .  Unfortunately, decorum and technology have not established screening tools to distinguish how we get to sit far from the 2 liter people.  Anyway, let’s look at these eruptions separately. First, a pondering of burps, and then a consideration of when we break wind.

The common burp arises from gas trapped in the stomach.  For the most part, kids ingest air unconsciously, and create a head of pressure inside their belly. Famously, burps come from children who are ingesting carbonated beverages.  However, kids and adults can swallow air into their stomach in a number of ways, including gulping food, using a straw, chewing gum, smoking, or in swallowing air unconsciously or by habit.  This “aerophagia” or ‘air eating” is a low cal diet, to be sure, but can make kids feel bloated, or their bellies distended. In one extreme case, a child with tourettes syndrome who compulsively swallowed air, nearly perforated his bowel with the bubble he created in his gut. Happily, burps are more often annoying or amusing than dangerous.

Burps happen when the pressure on the esophageal sphincter becomes sufficient that the gas is vented out the esophagus and out the mouth, allowing the host to belch delicately into a napkin, or to recite the alphabet at arena volume while they eructate.  Burps tend to be less fragrant than their farty counterparts due to the fact that they are mostly ingested air. Sometimes, however, downstream gassiness in the intestine through indigestion or infection, may vent upstairs, causing unpleasant, garlicky, or malodorous belches.

By elementary school, many kids have mastered some voluntary control over their esophageal sphincter, and can produce prodigious burps on demand. By contrast, infants tend to have esophageal sphincters with far less tone or control. Hence, a little bit of meal can come up with that eructation, thus explaining the ‘wet burp.’  You can pick the parents of younger kids out at the holiday party; look for the milky skidmark on the shoulders of their nice clothing.

How to treat kids with troublesome burping? For infants, it can be a bit complicated, and we’ll turf that discussion for another day. For children school age and older however, simply observing if a change in lifestyle is warranted may be enough. Avoiding the use of straws, hard candies or gum, or working to eat less ravenously (think teen boy, here) may mitigate the situation. The bigger complaint and mystery, though, seems to come from the gas passed down below.

While burps may create a sort of social peccadillo during conversations–dismissed immediately with a contrite ‘excuse me,’–episodes of flatus seem to halt traffic , clear lunchcounters, and to silence rooms of chatting people.   The life cycle of farts is a bit more complicated. Let’s turn to our song to break it down, so to speak.

Beans, Beans, the magical fruit.

In the main, flatus is a benign, quotidian aspect of life of the human child. Farts may be bothersome, and are rarely pathologic.  And, the propensity of a young gut to produce more or less of the invisible airborne gifts is principally shaped by the diet. Enter beans, and other legumes.  They are not magical; they don’t produce gas spontaneously. Rather, it is the ingestion of complex sugars in beans, called  raffinose, stachiose that provide fuel for the bacteria that live symbiotically in our colons. We lack enzymes to break down these carbs in our guts, and they are metabolized and ferment down there in the dark, by our gut flora. As they are broken down, gas products are produced.   If you must know (and I think you do), hydrogen, nitrogen and methane contribute most to the volume when we backfire, sulfur containing gases, called mercaptans tend to produce the degree of odor (think the SBD).

Besides beans, other well known flatogenic foods can trigger similar chain reactions in the gut,including corn, broccoli, bell peppers, cauliflower, cabbage, milk, bread, eggs, and beer.  It doesn’t end there. Parents would do well to monitor their children’s reactions to artificial sweeteners(e.g. Equal or Splenda), candies containing complex sugars like mannitol and xorbitol, or soluble fibers in laxatives (eg Citrucel).  All of these provide fermentable ammo to our gut flora…and you know what that means. In short, these are the sort of items for you or your child to avoid before a long car trip or flight.

Less often, excessive flatus or persistent discomfort associated with it can be signs of a more complicated problem in infants and children. Recurring fussiness in infants, or concerns for belly distension and apparent indigestion may be a sign in some children of lactose intolerance  (an inability to consume dairy products), food sensitivity, formula intolerance, or conditions like celiac disease.

In primary care, we often recommend parents intensify their scrutiny of a child’s feeding and GI symptoms. Food diaries, a simple log of what got eaten and/or if symptoms followed (gas, discomfort, constipation or diarrhea), can help discern concerning patterns from the usual output.   From there, we can work with families to see if further evaluation, or if referral to a specialist is required.

The more you eat the more you toot? Sometimes: Indeed.

For healthy kids or families made miserable by their gassiness, there are some basic approaches that can help.  If a food diary suggests a connection between more belching, bloating, or incidents of flatus, then food avoidance or elimination is most effective.  Reintroducing the potentially offending food can clinch its status as a potential allergen or trigger.

The more you toot, the better you feel…

Sorta. Hippocrates was quoted as saying that “the passing of gas makes one whole.”  Presumably, the Father of Medicine referred to the relief associated with the relief of passing an unpleasant sensation, such as a nasal tickle before a sneeze, or the colic we feel before we wind is broken. Perhaps. However, most kids and adults agree that in more extreme cases, more ain’t necessarily better, especially for kids on the bus, in class, or during a piano lesson.

Past diet changes, research suggests some interventions that have some benefit for some children or young adults.

Simethicone: Also known as Gas-X in the grownup formulation, or Mylicon as an infant colic remedy, this medication interrupts the formation of gas bubbles.  For infants, we are taught in pediatric residency that it is a great treatment for parents during bouts of colic (meaning, um, it doesn’t work). It is not something I customarily turn to or recommend for children with gassiness.

Charcoal: Taken orally, or when used as an fragrance-absorbing agent for adults breaking wind into special cushions or briefs (who volunteered for that test marketing effort?), it may be employed by providers to adult patients who have harder to treat cases of flatus. Studies have suggested there are more effective options.

Beano (Alpha-galactosidase) is an oral supplement whose enzymatic action may help digest the complex sugars in legumes.  It is effective, but only to reduce gassiness when used for this narrow band of carbohydrates.

Antibiotics:  Rifampin, a medication used for infectious diseases including tuberculosis, may be effective when used for adult patients who suffer from excessive colonic gassiness.  It is not something I have ever seen used in the pediatric population.

Probiotics: There are protean formulations of these preparations of ‘healthy bacteria’ that can be taken to promote a more beneficial population of flora in the gut.  And for kids with periodic or persistent troubles with farting this can be a safe and effective alternative.  Preparations that contain Bifidobacterium and Lactobacillus species of bacteria seem to work best. I’d encourage parents to discuss this with their child’s provider if interested in trialling these supplements daily for a week or four.

So eat your beans at every meal.

I suppose of all the lines of this song, this is one where I might say, it depends. What are your goals? If a parent is trying to help reduce gassiness in their child, this might be the exact wrong idea.  For most kids, casually monitoring what they eat can head off trouble. Probiotics may be a safe and effective remedy for many children.

And so, for further reading, consider this superb  children’s book.

Cool beans!

Links:

http://www.medscape.com/viewarticle/729672?src=ptalk&uac=31951BR

http://heptune.com/farts.html

Photo above by Castucha

Cartoon below by me

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