Q&A: 5-year-old with excess gas

It's a scatalogical kind of Monday.

Rachel writes:

"My daughter will be 5 in about two weeks.  She has been complaining on and off about a "stomachache" that seems to come and go randomly.  It never seems severe and to be quite honest, I'm not sure its not a ploy for extra attention, as it never hinders her activities.  However, she has been VERY gassy and "poots" ALL the time.  At the dinner table, outside playing, sitting watching TV...you name it, she poots!  She, of course, thinks it funny.  I, on the other hand, am wondering if perhaps she has an intolerance to something in her diet.  Any ideas? 

 

ps...She was on soy formula as a baby, as she didn't tolerate the milk based formula.  I haven't noticed any problems since then...until now."

It does sound a lot like she's having a problem with something she's eating. I think I'd start eliminating with the usual suspects: dairy, wheat, soy, cruciferous vegetables (cabbage, cauliflower, broccoli, Brussels sprouts). I'd also cut out all the fake sugars if she's eating any--I know a couple of adults who've told me that aspartame or Splenda make them gassy. (It wasn't like they just up and told me out of the blue--we were talking about kids and digestive stuff, and it came up. I mean, people tell me stuff, but not that much stuff.)

You should probably start a diary of what she eats, and also when she complains about the stomachaches, and record any really excessive periods of gas, too. I'm betting that after a week or so you'll figure out a pattern. Don't forget to keep track of the stuff she eats when she's not with you (at school or a babysitter's or a relative's house).

Hmm. I'm trying to think of something mildly funny to say about this problem, but can't really come up with anything, because 5-year-old farts are really smelly and gross.

I can't imagine what any of you would need to share about this, but I'm sure there's something you're dying to say on the topic, so let loose.

Comments

[Leah]

I am lactose intolerant (mildly) and it often manifests itself as gassiness and mild stomachaches. In the research I've done, people from cultures that don't drink cows milk (Pretty much everyone except Europeans) often lose their ability to tolerate lactose at around age 5. This is the time by which biologically they would have been weaned from breastmilk which is high in lactose.

Skim milk is the worst for triggering lactose intolerance. Higher fat milk products (like ice cream!) are easier to digest (the fat helps the lactose slide through the system). Yogurt is great, as the bacteria digest the lactose ahead of time. Same with cheese (especially aged cheeses). Someone with a severe lactose intolerance wouldn't be able take even those probably, but I can handle a lot of dairy as long as I stay away from low-fat products.

I don't really like the Lactose-free products, as I think my intolerance caused a natural aversion to the taste of milk. Especially since in kindergarten they used to force me to drink it and then I would come home with a stomachache every damn day. But you could try those and see how she does with them.

Good luck!

[Meramoo]

Kraft and Cracker Barrel cheeses don't have lactose in them, it says so in tiny print on the bottom right of the back of the package. In general, the harder the cheese/the longer it's been aged, the less lactose there is.

My L.I. manifests itself mainly as gas, and the Lactaid FastAct works very well for me. I had a blood test done about a year ago to diagnose it, drank a lactose-doped drink and had my blood sugars tested every 30 min. for 2 hours to see if it was being digested.

[Beth]

Does she chew any gum at all? Moxie mentioned artifical sugars, but sugar alcohols can be a problem too. Almost all gum is now completely sugarless, and malitol, xylitol, sorbitol can cause really painful, airy gas in some people. I can do aspartame and sucralose with no problem, but sugarless gum kills me. If her gas is prolific but mostly odorless, you might check her diet for sugar alcohols.

[hedra]

meramoo, interesting that they did a blood test for that! The test my son had was a breath test - they test for hydrogen in the breath after consuming a concentrated dose of lactose. Easy as breathing into a tube, and can be done with small children. The worst part is getting them to drink the stuff. Oh, and staying at the lab/hospital for 3 hours for the full set of breath samples. Sigh.

5-7 yrs is the usual onset of lactose intolerance (at least visibly - it shows up gradually over time). Gassiness, stomach-ache, and loose stools (usually about 20-40 minutes after consumption) are typical, but symptoms might not show up for 24 hours or so (my son's symptoms were of the 'delayed' type, which also seems to come with a bit less gas).

There are other intolerances that can cause gas. Gluten ('wheat' though also found in other grains), casien (not the milk sugar but the milk protien), fructose (you'd likely have seen that before now, as it is worst around 1-3 years old), etc. And some intolerances to other foods (like mild allergic reactions) can cause enough inflammation or GI damage to reduce lactase enzyme production, creating a 'secondary' lactose intolerance (that is, remove the other offending item, and the lactose digestion will improve).

ALSO important to know is that lactose and other carbohydrate intolerances (sugars, really) can show up temporarily after a GI infection, and can take weeks or even months to recover from. If she's had a tummy bug in the last few months, that could be the cause, and she might not be lifetime intolerant. Fortunately, the milk/soy protien intolerance of infancy is typically outgrown by 3 years old, completely, so it is more likely to be lactose or even beans/vegetable fibers than the more challenging (diet management-wise) gluten or soy.

Oh, and the other thing with lactose digestion is that if you stop triggering the lactase production, the body stops producing it. So you can shift from 'mostly tolerant' to 'intolerant' just by not eating dairy at all for a couple of years.

If it is just normal, typical lactose intolerance, you can do a couple of things to help.

* You can use a lactaid-type enzyme product (b-galactose enzyme, I think) taken with each dairy consumption event. Lactaid has some relatively pleasant chewables.

* You can take a daily probiotic/b-galactose product (where the probiotic is specifically the one what produces the same enzyme - note that these MUST be taken daily because that probiotic only survives about 24 hours in the gut). I know of one in particular (Digestive Advantage brand) for kids - there are several out there for adults, but they come in caplet/tablet form.

* You can use only low-lactose dairy foods (quality yogurts, hard cheeses) and full-fat dairy (the fats slow down the digestion so the limited production of enzyme has more time to work on the milk in the upper GI tract), and keep the total dairy intake to 2-3 servings a day (real servings, not 'double-cheese pizza giant slice' servings)

* you can limit dairy to one serving a day (again 'real' servings - I think 1-2 oz cheese, or 8 oz milk for an ADULT), as most lactose intolerance isn't a total lack of enzyme, just too little for a large volume of lactose at once.

* You can avoid dairy entirely. I can say from experience (I'm casien intolerant) that this isn't much fun, but it is definitely doable.

For the kids, we use Childrens Digestive Advantage for Lactose Intolerance, which is one of the combined enzyme/probiotic products (the only one my son can tolerate). It works well for us, so far, and it tastes relatively candy-like - plus/minus there, since they'll take it easily, but they also try to sneak it when not needed. Not cheap, but we buy it in bulk when it goes on sale, since I have two kids who are lactose intolerant, and another two who look like they might be headed that way... sigh. Darn genetics (in our case, it manifests much earlier than normal). They eat yogurt as well, though a lot of 'kids yogurts' aren't cultured all that long, and have more lactose left in them than the more sour 'adult-type' yogurts.

Good luck! Food and symptom diary is a pain in the rear to do (since you have to capture EVERY food, even tastes, snacks at school, etc.), but is highly useful. Our allergist took ours (we had to do eight weeks of it, ouch!) and then created a spreadsheet that marked what foods were consumed, then did columns for symptoms always showing up after the food that day, next day, and two days later. Anything that was eaten ever without symtoms following was excluded. Unfortunately, dairy was in there a lot, and it took the Lactose Tolerance test to find it.

[hedra]

oh, yeah, the sugar alcohols! sorbitol, mannitol, xylitol, pretty much all the '-ol' items... and also high-dose fructose products things sweetened with high fructose corn syrup or concentrated fruit juices, dried fruit-based snacks/leathers, apple and pear juice and pit fruits (peaches, plums - all of those have sorbitol naturally as well as fructose)... all can cause gas, and/or diarrhea. The typical american diet has more fructose than we can digest properly, and add any sorbitol in, or even small amounts of beans or vegetable fiber... it exceeds our capacity to digest it.

[Madeleine]

And Moxie thought we might not have anything to say! :-)

My daughter had soy/dairy intolerance as an infant which seemed to resolve around 18 mo to 2 y. She never liked milk after that and we constantly struggled to get her some calcium.

She developed persistant stomach aches at age 4.5 after a bad stomach bug. We were suspicious of the dairy (she'd recently ramped up on hot chocolate and yogurt tubes) so we took her off it. That reduced the little-bits-of-poop leaking problem but didn't eliminate the aches. (I wonder if Rachel's daughter is having any of that, in addition to the gas? No fun, but that's reality.)

She had the breath hydrogen test, and when we got home 3 hours later she had a terrible stomach ache, so we were sure she'd "passed" the test. It came back negative and we were confused.

We saw a Ped GI specialist, god love her, who said "That test wasn't negative, it was zero. That's a false negative." Probably because she'd taken antibiotics too recently, or just doesn't naturally have hydrogen-producing bacteria in her gut. The Ped GI concluded from our discussion that she doesn't digest dairy protein well, it clogs her up, and we should avoid it.

The breath test pain also suggests lactose (sugar) intolerance, since the drink is just lactose, with no protein. Not a big surprise, since my husband is LI and from a non-European background. (How the esteemed children's hospital failed to notify our ped that the lactose was a false negative, I don't know.)

And, just this weekend, we reached the "over do" point again with too frequent ice cream cones plus sheep's milk cheese at the farmer's market. (My husband can tolerate goat/sheep cheese, just not cow. She apparently can't tolerate too much sheep on the heels of too much cow.) So we've got to cut back again. Good thing I just bought popsicles, since sitting outside with a cold treat is her favorite warm weather snack, and I was suckered into too many ice cream cones last week.

Our saving grace -- I recently remembered how much I liked Tropical Fruit Tums when I was pregnant. Sure enough, they are the first calcium substitute she'll take. (Except the white ones, banana, ick. I don't eat those either. In a Jack Sprat imitation, those are the only one in the bottle my husband likes!)

A word of warning if you go this route: the CVS brand knock-offs were pronounced too chalky. My picky child must have name brand Tums. A nursing friend (with gassy baby) just told me the Berry Tums are good too. She said she likes the Walgreens knock-off but you'd better believe I won't try it.

[Madeleine]

Also, on the "Is she faking?" issue, I struggle with that also. Obviously anxiety and unhappiness can manifest as stomach aches without cause and we worry about getting suckered. And when my daughter doesn't want to go to sleep, a stomach ache is a sure way to get a little sympathy. But combined with the other symptoms, I'm more likely to trust in the complaint. The problem with food reactions, as Hedra describes in the "immediate, one day, two days" reaction tracking, is that it seems really random but it might not be.

[Jodie]

My 5 year old daughter farts all the time, and it can clear a room. She is quite proud of it, and will come out with "Uh oh, watch out, here comes a fart". Nice.

No help or suggestions. My daughter doesn't seem to have digestive problems, but man, can she toot.

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