by Dr. Pamela Bandelaria, pediatrician

The presence of abdominal distension in your baby can be worrying.  You may be concerned that your baby has trouble passing a stool or is having difficulty breathing.   This article will discuss what having a distended abdomen means, the possible causes, and when to bring him/her to the doctor.

What is abdominal distension in a baby?

Abdominal distension is when the baby’s abdomen's girth or size is bigger than normal, and when the abdominal wall is observed to be on a higher plane than the chest wall when the infant is lying on her back. Other sources describe abdominal distension as a quantifiable change in abdominal circumference.

Abdominal distension occurs when substances, such as air (gas) or fluid, accumulate in the abdomen causing its expansion. It is typically a symptom of an underlying disease or dysfunction in the body, rather than an illness in its own right.

What are the causes of abdominal distension?

When your baby is born, her gut is initially gasless.  With feeding, she swallows gas, and it filters down to the stomach and intestines.  This occurs within the first 24 hours after birth. Sometimes the excessive swallowing of air causes the appearance of abdominal distension.  Abdominal distension can also be a sign of infant colic. Babies who experience colic may cry continuously and can be inconsolable.  It is thought to be from the buildup of gas in their intestines, and is linked to allergens (milk, egg, nuts, fish) which can be found in a mother's breast milk. It usually starts at the 2nd or 3rd week of life, lasts for more than three weeks, and disappears by the time the baby is three or four months old. The repetitive air swallowing due to crying may also make it seem that your baby has abdominal distension.

Another cause of abdominal distension is the retention of poop.  While it is normal for a baby not to pass stool every day, and even up to two or three days, you may consider visiting your healthcare provider if your baby goes for more than seven days without passing a stool, is fussy and you notice expansion of the abdomen.    

Furthermore, when your baby is born, her abdominal wall is very weak.  This can lead to a gap between the abdominal muscles, known as diastasis recti.  A weakened abdominal wall can also lead to the internal organs pushing into a muscle or surrounding tissue, which is known as an abdominal hernia. Both these conditions can commonly occur in infants due to the weak abdominal wall. As the abdominal wall strengthens with movement, these two conditions should resolve on their own. 

Other causes of abdominal distension, requiring immediate attention, are the obstruction of the gastrointestinal tract. This can occur anywhere in the tract but usually occurs in the small or large intestine. The obstruction may be congenital or can be caused by other factors.  Your baby will likely be inconsolable and won’t be able to stop vomiting if it is an obstruction. Visit your healthcare provider if you suspect your baby has a gastrointestinal obstruction.

Another pathological cause of abdominal distension is sepsis or infection, which can cause a lack of movement of the gastrointestinal tract, leading to obstruction. It can also cause perforation of the gastrointestinal wall, resulting in sepsis.   Your baby will appear bloated, but will also have an extremely high fever, and will more than likely be vomiting.  This condition requires emergency care.   

Is abdominal distension the same as bloating?

Bloating is usually associated with air in the gastrointestinal tract or gassiness. In adults, it is described as a tight feeling or having a sensation of fullness. However, in infants, it is hard to say if they are experiencing bloating because they cannot speak yet. Bloating may present as abdominal distension, and may be caused by other underlying conditions.

What relieves abdominal distension?

You may ask, ‘What should I do if my baby has abdominal distension?’ To be able to relieve abdominal distension, you must first know what is causing it. If the abdominal distension cause is excess air (bloating), simple techniques such as burping after feeding can relieve it. Once your baby is fed, keep their head upright and burp them for a few minutes, until they relieve the buildup through a burp. Keeping your baby’s head upright to burp not only ensures that there will be less gas buildup in the gut but also ensures that the milk the baby consumed goes all the way to the stomach and not back up to the mouth. Milk going back up to the throat is dangerous because it can enter the lungs and cause aspiration pneumonia. This can lead to difficulty in breathing and can be dangerous.

If your infant is experiencing colic, there are certain ways by which your baby’s fussiness can be relieved. A daily routine or a predictable schedule can be helpful so that the baby can get used to periods of wakefulness and sensory stimulation, and at the same time get enough sleep. Other soothing techniques to alleviate colic include swaddling the baby, rocking the baby in a gentle motion, giving him/her warm baths, or providing white noise (vacuuming, clothes drier, hairdryer, or the sound of a car engine). Limiting sensory stimulation such as dimming the lights may also be helpful. If other gastrointestinal symptoms accompany the colic or if there is a family history of allergy and you are breastfeeding your baby, try eliminating certain foods, such as milk, egg, wheat, nuts, fish. If you are formula feeding, you can try to switch to a hypoallergenic formula. Beware of overfeeding your baby.

Abdominal hernias and air trapped between diastasis recti may resolve spontaneously. In the case of an abdominal hernia, you may want to visit your healthcare provider if it does not resolve in a matter of months.

When should I be concerned about abdominal distension?

As previously mentioned, some cases of abdominal distension resolve on their own.  However, if the techniques mentioned above do not alleviate your baby’s symptoms, it is best to seek a doctor's care. Certain signs, however, warrant an immediate doctor's consult. An important warning sign is vomiting or constipation, which are signs of gastrointestinal obstruction. Changes in the appearance of your baby’s stool, including blood or excessive mucus, can also be a warning sign. Other signs include fever, increased sleepiness, decreased feeding, poor weight gain, and signs of respiratory distress.  Abnormal gestures, twitching, or upward rolling of eyes, may suggest your baby is having a seizure. If any of these occur with abdominal distension, it is best to consult a doctor for evaluation.

Conclusion

Abdominal distension is a cause of huge concern for new parents.  This is because so many things can cause it, and the discomfort experienced by babies is magnified because they cannot communicate or describe how they feel. However, being aware of the aforementioned signs and symptoms can alert you as to when to visit your doctor.   Furthermore, even if your baby’s abdominal distension is nothing serious, it may ease your mind to have him/her evaluated by a doctor.