Posted tagged ‘gas’

Farts don’t hurt: The truth about gas

April 9, 2012

The Pediatric Insider

© 2012 Roy Benaroch, MD

“My baby seems gassy. Should I use Mylicon drops? My doctor says they don’t work, and I don’t want to give medicine unnecessarily. What else can I do?”

I wrote about this recently, though the post was a little bit silly. I’ll try again, seriously this time.

Little babies do seem gassy a lot. They squirm and fart and kind of ball up, and sometimes getting pretty upset. But one thing I know for sure: farts don’t hurt. They just don’t. They don’t hurt me, and they don’t hurt you, and I can’t imagine why they would actually cause pain in a little baby.

Though farts don’t hurt, they might feel kind of weird. To a little baby, all sorts of sensations are new: the feel of air on the skin, breathing, seeing, stretching out little legs– all of that’s new, and all of that might feel weird and surprising. I’m surprised, honestly, that newborns aren’t more upset, more of the time. Think about how you’d feel with all of this new stuff going on. Add on to that the perfectly normal (but new) feeling of gas burbling around and passing out, and you might get one worried little baby.

When little babies get upset, parents wonder what’s wrong, and what they ought to do about it. No one likes to see a baby cry! Drug companies know that, and are happy to provide a remedy. In this case, it’s a product called “simethicone”, the so-called “active ingredient” in Mylicon and dozens of other “gas medicines.”

Simethicone has been around a long time, as an anti-foaming agent. Add simethicone to a sudsy bath, and all of those little bubbles coalesce into a few larger bubbles. It can’t make the gas actually disappear or go away. But it can reduce the surface tension on the little bubbles, turning them into fewer, larger bubbles. (Simethicone, you’ll be happy to know, is used in industrial applications as an agent to reduce foaming from some soaps and detergents.)

But think about it: what possible good would it do to turn a bunch of foamy, little bubbles into a few larger bubbles? Are larger bubbles easier to pass? Would one large bubble “hurt” less than 100 small bubbles?

There are no human studies– none, ever– that have shown that simethicone helps with any symptoms in any people of any age. It does seem to help, some, with endoscopy procedures by reducing the little foamy bubbles that might make it hard to see through a scope. But that’s it. That’s the only situation in medicine where it might conceivably help in any way.

Simethicone does seem safe. There are no reported side effects, though at least one report suggests that giving simethicone to a baby might interfere with the absorption of other medications. Other than that, though, since it doesn’t do much of anything, it’s not surprising that there are no side effects. (As an aside: any ‘real’ medicine that has real, genuine biologic effects must have at least some side effects. If any sort of herb or homeopathic stuff is promoted as being free of any side effects, it’s because it has no biologic effects whatsoever.)

If it’s safe, why not try it? I suppose it’s OK to try, but my biggest problem with simethicone (and other placebos) is that it sends the wrong message to parents, and seems to contribute to a long-term philosophy of health and illness that I think is a big mistake. Gas,  farts, and most cases of newborn fussiness are not a medical problem. Babies with these symptoms should be evaluated to make sure there is nothing medically wrong, and then parents should be reassured and taught good soothing techniques. By encouraging the use of medicine for gas (and other benign, normal things humans put up with), we’re perpetuating the idea that all symptoms need medicineand all problems need a medical approach. This is wrong, wrong, wrong. Parents shouldn’t be taught that their kids need medicine for every problem. What parents need is to make sure their kids are OK, and how to help them feel better when they’re upset, and the warning signs to look for that might mean the doctor needs to be contacted. What we don’t need is more parents relying on the medicine cabinet to solve their problems.

What about herbal and other more “natural” cures for gas? Those are, at best, just different placebos, and possibly something worse. Since there’s essentially no regulation of the market for “supplements”, parents have no idea what’s in those bottles. It’s probably just a nothing-safe-placebo, but who knows? If you’d like a placebo, at least choose one you know is safe. How about plain water? That’s exactly what homepathic products are.

Better yet, save your money. Stay away from Mylicon, and stay away from the “alt-med” cures too.

If you’ve got a fussy baby, your first step is to try to figure out if there’s a medical problem that needs to be addressed– I’ve written about that before. As long as there’s no medical issue, your best bet is calm, soothing things to help your baby relax. Often a tight swaddle, gentle rocking, a pacifier, and/or a white noise machine can be a big help. You’ll also need to make sure you get some rest and have someone else who can help give you a break during those long evenings! If mom (or dad) is having an especially hard time handling baby fussiness, they ought to talk to their own doctors about their own health problems—postpartum depression is very real, and can certainly contribute to making babies fussy and difficult. Fortunately, the weird feelings of “gas” go away by the time babies are about 3 months old, once they’ve gotten used to the normal sensations of their bodies. Until then, gentle & calm reassurance is the best “medicine.”

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Gas drops, teething tablets, and pinkie straighteners

February 6, 2012

The Pediatric Insider

© 2012 Roy Benaroch, MD

A carnival. A white-toothed, perfectly-haired Huckster stands on a platform in front of a crowd of parents.

The Huckster: “Step right up! I’ve got what every parent needs! A fix to one of The Most Serious problems your child has—right now!”

Boscoe’s mom: “There’s nothing wrong with my Boscoe! He’s the very picture of health!”

The Huckster: (looking down with concern at Boscoe, aged 2) “Hmmmm… yes, yes, I can see why you’d say that, Ma’am. But I can tell he’s headed for trouble! Just look at that pinkie!”

The Huckster reaches down, and picks up Boscoe, who continues to eat his cotton candy. His mouth is blue and sticky (the child, I mean.) The Huckster holds up Boscoe’s pinky finger to the crowd.

The Huckster: “Look!”

The crowd gasps, and inches forward.

 Boscoe’s mom looks apprehensive, but confused. She turns her head sideways.

Boscoe’s mom: “That’s his pinky. I don’t see anything wrong with it.”

The Huckster: “It looks ok now, sure, but if you look at it from the side— Behold! It isn’t straight!”

Pandemonium ensues. The crowd erupts in fearful chatter. A woman faints. Sirens can be heard in the distance, and strobe lights from the nearby Tilt-a-whirl along with inexplicable gusts of smoke add to the mayhem. The Huckster seems to have grown taller, looming over the crowd.

 Boscoe continues to eat his cotton candy.

Boscoe’s mom, joined by several other onlookers, wails: “What can we do?”

The Huckster: “I have just the thing you need!”

From the depths of his topcoat The Huckster draws out a handful of devices, each of which looks like two pencils held together by rubber bands. The crowd pushes fistfuls of money at him, buying each for $19.95.

There is a sneaky and pervasive influence on health expectations, and I’ll bet most of us have fallen for it. Companies—The Hucksters—are trying to sell you things. And often, to sell them, they’ll first convince you that your child has a problem. Then, surprise, they’ll turn out to have the perfect thing to fix it.

Take “gas drops.” Usually made of simethecone (sold in common brands like Mylicon, and many others), these products “cure” your child of “gas.” But it’s just The Huckster at work. The truth is, farts do not hurt. Sure, newborns might be surprised and alarmed at the weird, unexpected feelings of stuff moving around in their little tummies, but that’s not pain, and it’s not anything that needs medicine. What it needs is love and support and reassurance, so babies learn that they don’t have to worry about these normal sensations. Gas and farts are a normal part of life. They are not a medical condition that needs a cure.

No medical study has ever shown that any gas remedy (including simethecone, but also gripe water and anything else you can find) actually helps alleviate any symptoms. It helps The Hucksters, but they certainly won’t help you or your child. If you’re using them, and they seem to work, it’s because symptoms we call “gas” always come and go. You give the gas drops when there are symptoms, and the symptoms improve—because they always improve. Go ahead and give the gas drops when there aren’t symptoms, and you’ll likely see that soon enough symptoms will start up again. Because they come and go, no matter what “medicine” you’re giving.

Another example: teething tablets. Study after study has shown that teething children have no consistent symptoms. The only thing teething causes is teeth. Sure, infants often have fussy times, or loose stools, or feel warmish—but they do that whether they’re getting teeth or not. It’s not the teeth, it’s the child. Teething is not a medical problem, but there sure are a lot of Hucksters who will tell you otherwise. And they’ll sell you something, too!

The vast majority of these nonsense cures are perfectly safe, and they’re actually not very expensive. So what’s the harm? The biggest problem I see is that parents get convinced that their children have many problems, and that every problem needs a cure. Most kids are very healthy, and few kids actually need any kind of medicine at all. That may sound weird, coming from a doctor, but honestly I will tell you that 90% of the “cures” given to our children (whether prescription, non-prescription, alternative medicine, voodoo magic beans, or stuff purchased at a carnival) are completely unnecessary and do nothing to help your child.

Don’t fall for The Huckster. Save your money, hug your child, and stay away from the drug store. If you do go to the carnival, take the rides, but don’t be taken for a ride. Tell The Huckster your child’s pinky is straight enough, and go get yourself a hot dog instead.