Gas drops, gripe water...what can I do to help my baby?
Your baby is crying and fussing more. Nothing you do seems to help. Is it gas? Is it reflux or silent reflux.....what even is the difference? A Google search and poll of your friends and family may leave you with lots of opinions and even more questions.
What is right for your baby? Will gas drops help? Thinking about changing your diet or trying and herbal remedy?
Before you give your baby a supplement, let's review the evidence and make a plan to talk with your baby's provider.
Simethicone “gas drops” has very low evidence to support its use. Research has not found reduction in crying or colic-like symptoms. Some parents do report that simethicone seems to help their babies but research shows that the outcomes are similar with placebo. However, the risks of using it are low.
Gripe water is not a specific product and can have variable ingredients so there aren’t any good research studies which show that it’s helpful for fussiness or GI symptoms. There are risks associated and some babies have increased fussiness and GI symptoms, so I generally don’t recommend using gripe water.
There is better evidence for the use of specific infant probiotics with the most research for L. reuteri for fussiness and colic symptoms. There is variability among product quality and you should choose one specifically meant for infants (many packages will state not to use for children under 6 months, however this is a legal statement and not a medical warning).
Probiotic supplements have some evidence to crying time is decreased, reducing reflux by improving digestion (increasing gastric emptying time), and can help decrease gas by encouraging the growth of beneficial gut bacteria and reducing gas-producing coliform bacteria)
Probiotic supplementation of infants is also linked to improvements in stooling patterns, with effects linked to specific strains and infant populations. In healthy term infants, supplementation with Bifidobacterium longum subsp. infantis (M-63) led to a decreased frequency of defecation and fewer watery stools, along with a shift toward a bifidobacteria-predominant gut microbiota and lower stool pH, without adverse events. Similarly, direct infant dosing with multi-strain probiotics resulted in lower stool frequency and softer stools compared to maternal dosing, and faster colonization with bifidobacteria. Bifidobacteria is the same beneficial bacteria which is fed by HMOs (Human Milk Oligosaccharides) which make up the second largest solid component of human milk and which specifically feed only bacteria! This is a case of "you are what you eat" with baby's diet directly affecting gut microbiota growth! For infants with functional gastrointestinal disorders, Lactobacillus reuteri supplementation increased stool frequency to normal ranges for those with constipation and reduced regurgitation and crying time, with no significant adverse effects. In infants with diarrhea, L. reuteri supplementation tended to reduce the number of stools, though this was not always statistically significant in every study. In preterm and very low birth weight infants, multiple systematic reviews and guidelines, including those from the American Gastroenterological Association, support the use of certain probiotic strains (combinations of Lactobacillus and Bifidobacterium spp., B. animalis subsp. lactis, or L. reuteri) to reduce the risk of NEC. Safety precautions should be considered and high-quality products selected to reduce risk. Probiotic supplementation is not recommended for infants born under 1000 g, <42 weeks adjusted age, or for those with chronic or acute GI conditions. They should not be used during acute illness, either.
For generally healthy and full term babies, the risks of probiotic supplementation are low with no serious adverse affects reported
For recommendations on which specific probiotic products may be helpful for your baby, please consult a licensed medical provider and speak with your child's Primary Care Provider.
References:
The Gut Microbiome in Adult and Pediatric Functional Gastrointestinal Disorders - PubMed Early Probiotic Supplementation of Healthy Term Infants With Bifidobacterium Longum Subsp. Infantis… Seeding the Infant Gut in Early Life-Effects of Maternal and Infant Seeding With Probiotics on Stra… Effect of Lactobacillus Reuteri NCIMB 30351 Drops on Symptoms of Infantile Functional Gastrointesti… Prophylactic Use of a Probiotic in the Prevention of Colic, Regurgitation, and Functional Constipat…
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