What medications are suitable for children with gastroesophageal (GI) distress characterized by gas and bloating?

From the Guidelines

For children with gassy stomachs, simethicone drops (such as Infants' Mylicon or Little Remedies Gas Relief) are generally safe and effective, and should be considered as the first line of treatment. The typical dose is 0.3-0.6 mL (20-40 mg) given orally up to four times daily after meals and at bedtime for children under 2 years, while older children can take 40 mg (chewable tablets or liquid) four times daily 1. These medications work by breaking up gas bubbles in the stomach and intestines, making them easier to pass.

Alternative Treatment Options

Beyond medication, several non-pharmacological interventions can be tried, including:

• Gentle tummy massages in a clockwise direction
• Bicycle leg movements for infants
• Warm baths to help relieve discomfort
• Dietary adjustments, such as reducing gas-producing foods in the mother's diet for breastfed babies, or trying different formulas for formula-fed babies
• Limiting carbonated beverages, chewing gum, and gas-producing foods like beans and certain vegetables for older children

When to Consult a Healthcare Provider

If symptoms persist beyond a few days or are accompanied by fever, vomiting, or changes in bowel movements, it is essential to consult a healthcare provider 1. Additionally, while antacids and histamine H2 antagonists may be considered for older children and adolescents with gastroesophageal reflux disease (GERD), their use should be approached with caution due to the risk of tachyphylaxis and potential side effects 1. Proton pump inhibitors (PPIs) may also be effective for treating GERD in children, but their use should be carefully considered due to the potential risks of overuse or misuse, particularly in infants 1.

From the FDA Drug Label

Use for the relief of pressure and bloating commonly referred to as gas Purpose Antigas For gassy stomach in children, simethicone (PO) can be used for relief of pressure and bloating.

• The medication is indicated for antigas purposes. 2, 2

From the Research

Medication for Gassy Stomach in Children

There are several options for managing a gassy stomach in children, particularly those with lactose intolerance.

• Lactose intolerance is characterized by the inability to digest lactose, a sugar found in milk and other dairy products, due to a deficiency of the enzyme lactase 3, 4, 5.
• Symptoms of lactose intolerance include abdominal pain, bloating, diarrhea, and gas, which can be managed through dietary changes and supplementation 4, 5.
• Treatment options for lactose intolerance include a low-lactose diet, lactase supplementation, and potentially, colonic adaptation by prebiotics 3, 5.
• Probiotics and prebiotics may also be beneficial in alleviating symptoms of lactose intolerance, although more research is needed to confirm their effectiveness 6.
• It's essential to note that lactose intolerance can be part of a broader intolerance to poorly absorbed carbohydrates, and a low FODMAP diet may be necessary to manage symptoms in some individuals 5.

Diagnostic Methods

Diagnostic methods for lactose intolerance include:

• Genetic testing to identify lactase deficiency 3, 4
• Hydrogen breath test (HBT) to measure the amount of hydrogen in the breath, which is produced when undigested lactose is fermented by bacteria in the colon 4
• Lactose tolerance test to measure the body's ability to digest lactose 4
• Quick lactase test to measure the level of lactase enzyme in the small intestine 4

Management and Prevention

Management and prevention of lactose intolerance involve:

• Avoiding or reducing lactose-containing foods 3, 4, 5
• Using lactase supplements or lactose-free products 3, 4, 5
• Incorporating probiotics and prebiotics into the diet to support gut health 6
• Considering a low FODMAP diet if symptoms persist 5