What can be given to infants for relief of gas?

Management of Infant Gas

For otherwise healthy infants with gas symptoms, simethicone is FDA-approved but lacks proven efficacy, and the best approach is reassurance with conservative feeding modifications rather than medication.

Evidence-Based Treatment Approach

First-Line Management: Conservative Measures

• Start with lifestyle and feeding modifications before considering any medications 1
• For breastfed infants, reduce feeding volume while increasing feeding frequency 1
• For formula-fed infants, consider changing formula or using thickened preparations 1
• Keep infants upright or prone position when awake and under supervision 1
• A 2-4 week trial of maternal exclusion diet (restricting milk and eggs) is recommended for breastfeeding mothers whose infants have gas symptoms 1
• For formula-fed infants with persistent symptoms, extensively hydrolyzed protein or amino acid-based formula may be appropriate 1

Simethicone: FDA-Approved But Not Evidence-Based

• Simethicone is FDA-approved for relief of gas-related pressure and bloating 2
• However, high-quality evidence demonstrates simethicone is no more effective than placebo for infant colic or gas symptoms 3, 4
• A rigorous randomized controlled trial of 83 infants found that 37% responded to placebo alone, 28% to simethicone alone, and 20% to both—with no statistically significant differences between groups 3
• A Cochrane systematic review (18 RCTs, 1014 infants) found no difference in crying duration or response rates between simethicone and placebo 4
• Despite lack of efficacy evidence, simethicone has no serious adverse effects reported 4

Alternative Agents With Limited Evidence

• Herbal agents showed some benefit in reducing crying duration (MD 1.33 hours, 95% CI 0.71-1.96) but evidence quality is low and studies had major methodological flaws 4
• One small study found magnesium alginate plus simethicone more effective than thickened formula for gastroesophageal reflux symptoms, but this addresses reflux rather than simple gas 5
• Dicyclomine should be avoided due to serious adverse effects including excessive drowsiness (13%), wide-eyed state (4%), and prolonged sleep (4%) 4

Clinical Decision Algorithm

Step 1: Confirm the infant is otherwise healthy without alarm features (poor weight gain, bilious vomiting, bloody stools, fever)

Step 2: Implement conservative feeding modifications:

• Smaller, more frequent feedings 1
• Proper positioning during and after feeds 1
• For breastfed infants: maternal dietary elimination trial 1
• For formula-fed infants: consider formula change 1

Step 3: If symptoms persist after 2-4 weeks of conservative management, consider whether this represents gastroesophageal reflux rather than simple gas 1

Step 4: If parents insist on medication despite counseling, simethicone may be offered with clear explanation that it works no better than placebo but has no serious side effects 3, 4

Critical Pitfalls to Avoid

• Do not prescribe dicyclomine due to significant adverse effects including sedation and anticholinergic symptoms 4
• Do not use proton pump inhibitors or H2 antagonists for simple gas symptoms without confirmed gastroesophageal reflux disease, as these carry risks including increased community-acquired pneumonia, gastroenteritis, and candidemia 1
• Avoid thickening feeds in preterm infants due to increased risk of necrotizing enterocolitis 1
• Recognize that most "gas" complaints derive from misunderstanding of normal infant physiology rather than actual pathologic gas accumulation 6

Key Counseling Points

• Infantile colic and gas symptoms are self-limiting conditions that resolve by 4 months of age 4
• Parents often perceive normal infant crying as requiring medical intervention when reassurance is more appropriate 6
• The placebo response rate in infant colic studies is substantial (37% in one rigorous trial), suggesting that parental perception of improvement may not reflect true pharmacologic effect 3