Gastrointestinal Disorders In Infants Research Articles

Research status and prospects of probiotics in functional gastrointestinal disorders in infants and toddlers

Functional gastrointestinal disorders (FGIDs) are common digestive system diseases in children, which can severely affect the growth and development of infants and toddlers. Probiotics therapy, as a relatively safe treatment method, have attracted the attention of researchers. However, their effectiveness in treating FGIDs in infants and toddlers is still unclear. This article reviews the mechanisms of probiotics in treating FGIDs in infants and toddlers, explores the reasons for the inconsistency in various research results, and aims to provide assistance for the clinical treatment of FGIDs in infants and toddlers and future research.

Drugs in focus: Domperidone.

Domperidone is a peripheral dopamine D2 receptor antagonist with prokinetic and antiemetic properties. Its prokinetic effects are mainly manifest in the upper gastrointestinal (GI) tract. Currently its use is restricted to relief of nausea and vomiting in children older than 12 years for a short period of time. However, among (paediatric) gastroenterologists, domperidone is also used outside its authorised indication ("off label") for treatment of symptoms associated with gastro-oesophageal reflux disease, dyspepsia and gastroparesis. Little is known about its efficacy in the treatment of GI motility disorders in children and controversial data have emerged in the paediatric literature. As its use is off label, appropriate knowledge of its efficacy is helpful to support an "off label/on evidence" prescription. Based on this, the purpose of this review is to summarise all evidence on the efficacy of domperidone for the treatment of GI disorders in infants and children and to report an overview of its pharmacological properties and safety profile.

Adapted goat milk formulas in infant nutrition: when, to whom and for how long

Breast milk is the gold standard for infant feeding. In case of its lack or insufficiency, this brings up the question about an affordable and adequate alternative. Adapted cow’s milk formulas are most commonly used, but the incidence of cow’s milk protein allergy in young children is increasing worldwide. Given the early onset of gastrointestinal disorders in infants, minimal digestive dysfunctions are often interpreted by doctors as sensitization to cow’s milk proteins or functional gastrointestinal disorders. However, there are conditions associated not with cow’s milk protein allergy, but intolerance. These conditions are difficult to diagnose, as the mechanism of development of cow’s milk protein allergy has not been sufficiently studied and is often not associated with an IgE-mediated immunological response. Food intolerance is associated with the enzymatic immaturity of the gastrointestinal tract and insufficient activity of intestinal microbiota. This article highlights the issues of cow’s milk protein allergy and food intolerance. In case of food sensitization and even minimal clinical manifestations of cow’s milk protein allergy, the choice of formula should always be made in favour of deep-hydrolyzed milk protein formulas. Goat protein formulas cannot be used in cases of cow’s milk protein allergy due to cross-sensitization effects. The aim of the article was to analyze a differentiated approach to the choice of infant nutrition in the absence of breastfeeding.

Prevalence and Risk Factors of Functional Gastrointestinal Disorders in Infants in Indonesia

Information regarding functional gastrointestinal disorders (FGIDs) in infants is currently lacking in Indonesia. This study aimed to describe the prevalence and risk factors of FGIDs in infants aged 6 weeks to 4 months in Indonesia. This cross-sectional study of 433 infants was conducted between September 2018 and February 2020. Information on FGIDs was collected using the Infant Gastrointestinal Symptom Questionnaire and the Feeding Practice and Gut Comfort Questionnaire. Adapted Rome IV criteria were used to define the FGIDs. The prevalence of regurgitation was 26.3%; 16.8% of the infants presented crying-related symptoms and 5.5% exhibited constipation. The statistical analyses revealed that constipation was associated with sex (odds ratio [OR], 2.74; 95% confidence interval [CI], 1.07-7.71; p=0.043), employment of the father (OR, 0.3; 95% CI, 0.12-0.77; p=0.01), and education of the mother (OR, 1.92; 95% CI, 1.07-3.51; p=0.031). Length at birth (OR, 0.74; 95% CI, 0.55-0.99; p=0.042) was associated with constipation. Length at visit (OR, 0.83; 95% CI, 0.76-0.91; p<0.001) was associated with regurgitation, and the weight at visit (OR, 0.58; 95% CI, 0.35-0.96; p=0.038) was associated with crying and/or colic. A history of parental FGIDs was associated with crying-related symptoms (OR, 2.12; 95% CI, 1.23-3.68; p=0.007). Regurgitation, crying, and constipation are common FGIDs in infants. Some parental and infant characteristics may be predictors for FGIDs. Further investigations are needed to evaluate the clinical relevance of our findings. Understanding the determinants of FGIDs will benefit healthcare professionals and parents to improve infant's quality of life and better manage these condition.

Dynamics of the mother-child relationship in the presence of functional gastrointestinal disorders in infants

Motherhood is still insufficiently explored regarding its psychological aspects. Maternity brings an innovative perspective in the diagnosis and treatment of various disorders of mother and child in the first year of life. Functional gastrointestinal disorders are the most common diagnosis in Pediatric Gastroenterology, being recognized as a group of diseases difficult to diagnose and manage. Among diagnosed and treated infants, some display a long-lasting suffering, which shows that a number of clinical aspects may be insufficiently explored. One such dimension is the one described under the term "birth-related illnesses", i.e. psychosomatic symptoms that occur in the infant as a result of a deficient or non-existent emotional relationship with the mother. This paper aims to illustrate how the mother-infant emotional relationship influences the functional digestive manifestations of the infant, their relational dynamics, and the development of symptoms, with and without specific maternal therapeutic intervention. The results represent an argument for the use of the mother-child dyadic therapy for improving the infant's digestive function.

Лечение функциональных гастроинтестинальных расстройств у детей раннего возраста

В статье изложены современные сведения об основных патогенетических механизмах развития и клинических проявлениях функциональных гастроинтестинальных расстройств у детей раннего возраста в соответствии с Римскими критериями ІV. Представлены требования к пробиотическим препаратам, которые применяются в современной медицине. Акцентировано внимание на основных характеристиках наиболее изученного пробиотического штамма Lactobacillus rhamnosus (LGG). Проведен анализ результатов клинических исследований с применением LGG с целью лечения и профилактики функциональных и органических заболеваний у детей. Представлены основные фармакологические свойства и характеристика продукта Актив Флора беби, который недавно появился на фармацевтическом рынке Украины, обоснованы и представлены основные показания к назначению продукта.

Функциональные гастроинтестинальные расстройства у детей раннего возраста: лечить, наблюдать или корректировать?

В статье рассмотрены функциональные нарушения желудочно-кишечного тракта у детей раннего возраста. Частота функциональных гастроинтестинальных расстройств является чрезвычайно высокой во всех возрастных группах, но у детей раннего возраста функциональные заболевания фактически являются вариантом нормы — наиболее часто практическому врачу приходится сталкиваться с функциональными нарушениями пищеварения именно у детей раннего возраста, что обусловливает повышенный интерес педиатров к их этиологии, патогенезу и терапии. Наиболее распространенными гастроинтестинальными нарушениями являются младенческие колики, срыгивания и запор: они составляют большую часть жалоб, с которыми родители детей первого года жизни обращаются к педиатру. Несмотря на то, что эти расстройства не представляют большой опасности для жизни и, как правило, не оказывают существенного влияния на здоровье детей в будущем, они в значительной степени влияют на качество жизни, приводят к большому количеству неоправданных госпитализаций, применению избыточной фармакотерапии, нарушают психологический климат в семье. Поэтому коррекцию функциональных гастроинтестинальных расстройств целесо­образно проводить не при помощи медикаментов, а путем назначения продуктов функционального питания, в частности заменителей грудного молока, которые получают дети, находящиеся на искусственном вскармливании. Вопросы, связанные с применением смесей, являющихся заменителями грудного молока, особенно способных корректировать малые пищеварительные дисфункции, являются актуальной темой для обсуждения клиницистов и врачей педиатрического профиля.

Functional gastrointestinal disorders and the health visitor role

Bethany Boddy explores the guidance and evidence into functional gastrointestinal disorders in infants and how to support parents to support their infants

The frequency of and factors affecting functional gastrointestinal disorders in infants that presented to tertiary care hospitals.

This study aimed to determine the prevalence of infantile functional gastrointestinal disorders (FGIDs) based on Rome IV diagnostic criteria, and to determine the associated patient demographic and nutritional characteristics. A total of 2383 infants aged 1-12 months which were evaluated by 28 general pediatricians and pediatric gastroenterologists on the same day at nine tertiary care hospitals around Istanbul, Turkey, between November 2017 and March 2018, were included in the study. Patients included consulted the pediatric outpatient clinics because of any complaints, but not for vaccines and/or routine well child follow-ups as this is not part of the activities in the tertiary care hospitals. The patients were diagnosed with FGIDs based on Rome IV diagnostic criteria. The patients were divided into a FGID group and non-FGID group, and anthropometric measurements, physical examination findings, nutritional status, risk factors, and symptoms related to FGIDs were evaluated using questionnaires. Among the 2383 infants included, 837 (35.1%) had ≥1 FGIDs, of which 260 (31%) had already presented to hospital with symptoms of FGIDs and 577 (69%) presented to hospital with other symptoms, but were diagnosed with FGIDs by a pediatrician. Infant colic (19.2%), infant regurgitation (13.4%), and infant dyschezia (9.8%) were the most common FGIDs. One FGID was present in 76%, and ≥2 FGIDs were diagnosed in 24%. The frequency of early supplementary feeding was higher in the infants in the FGID group aged ≤6 months than in the non-FGID group (P = 0.039).Conclusion: FGIDs occur quite common in infants. Since early diversification was associated with the presence of FGIDs, nutritional guidance and intervention should be part of the first-line treatment. Only 31% of the infants diagnosed with a FGID were presented because of symptoms indicating a FGID. What is Known: • The functional gastrointestinal disorders (FGIDs) are a very common disorder and affect almost half of all infants. • In infants, the frequency of FGIDs increases with mistakes made in feeding. When FGIDs are diagnosed in infants, nutritional support should be the first-line treatment. What is New: • This study shows that only a third of children presented to hospital because of the symptoms of FGIDs, but pediatricians were able to make the diagnosis in suspected infants after appropriate evaluation. • The early starting of complementary feeding (<6 months) is a risk factor for the development of FGIDs.

Prevalence of functional gastrointestinal disorders in infants and young children in China

BackgroundThe prevalence of functional gastrointestinal disorders (FGIDs) in children, particularly from Asia, is largely unknown. There are not many studies done in Asia especially using the Rome IV criteria. The aim of this study is to assess the prevalence of FGIDs in infants and young children in a representative sample in China.MethodsA prospective, cross-sectional, community-based survey was conducted among healthy infants and young children between the ages of 0–4 years in Jinhua and Shanghai, China. A total of 2604 subjects (1300 subjects from Jinhua and 1304 subjects from Shanghai) completed a validated questionnaire on pediatric gastrointestinal symptoms. FGIDs in infants and young children were diagnosed using the Rome IV criteria.ResultsAccording to the Rome IV criteria, the prevalence of having a FGID in Chinese infants and young children is 27.3%. Infant regurgitation (33.9%) was the most common FGID among the 0–6 months old while functional constipation (7.0%) was the most common among the 1–4 years old. Risk factor analysis revealed that prevalence of infantile colic was higher with better maternal education and low birth weight. Prevalence of infantile regurgitation was significantly greater in males, living in a rural area, being exclusively breast fed at least up to 4 months and starting formula feeds within the first month. The risk of functional constipation was lower for infants who were delivered vaginally.ConclusionsInfantile regurgitation was the most common FGID in Chinese infants while functional constipation was most prevalent among young Chinese children.Trial registrationNetherlands Trial Registry Identifier: NL6973/NTR7161.

Innovation of Distal Refeeding in Infants.

Background: Temporary diverting enterostomy might be the initial step while treating gastrointestinal disorders in infants. According to the level of the stoma, calorie, fluid, and electrolyte imbalance might occur. Totally parenteral nutrition (TPN), parenteral fluid, and electrolyte balancing are the choice of support. Owing to limitations of both, distal refeeding (DR) has been suggested as an alternative. However, in English literature, there is no recommended technique for how DR should apply. This article is aimed at evaluating our innovative DR approach, which was not reported earlier. Materials and Methods: Between 2015 and 2019, patients on whom DR was performed by a cuffed silicon-based tunneled catheter were obtained. Results: A total of 8 patients aged between 1 day and 7.5 years were included. Dislocation of the catheter and skin erosion were the minor complications that were observed. None of them necessitated TPN and vascular access. Moreover, patients could be discharged and were fully fed orally by their guardian at home, and any problem was observed during survival. Conclusion: Consequently, patients did not necessitate vascular access or TPN. They were all fully fed orally, and DR could be performed without a failure to thrive. Therefore, we believe that tunneled catheter DR is a safe and reliable method in infants. Institutional Review Board at Eskisehir Osmangazi University (Protocol no. 07/01/2020-26).

МИКРОБЫ ВНУТРИ НАС: СЛУЧАЙНЫЕ ПОПУТЧИКИ ИЛИ УСЛОВИЕ НАШЕГО ВЫЖИВАНИЯ? ИЛИ ЗАЧЕМ НУЖНЫ ПРОБИОТИКИ В ДЕТСКИХ МОЛОЧНЫХ СМЕСЯХ

This literature review describes evolutionary aspects of the formation of relationships between microorganisms and the human body. The formation of symbiotic relationships, which resulted in the formation of a holobiont, is discussed. Separate chapter of the article is dedicated to describing positive effects of Lactobacillus reuteri DSM 17938 strain for human health, including effective prevention and treatment of functional gastrointestinal disorders in infants.

A cross sectional survey in paediatricians pertaining to management of functional gastrointestinal disorders in infants: Indian perspectives

Background: Functional gastrointestinal disorders (FGIDs) in infants and toddlers possess extensive burden to the parents and healthcare professionals. Guidelines addressing the practices in diagnosis and management of FGIDs in infants in Indian subcontinent is unavailable. Hence this study assessed current knowledge, attitude and practice of pediatricians in diagnosis and treatment of FGIDs.Methods: A cross-sectional survey based on a structured questionnaire assessed pediatrician’s knowledge about prevalence and profile of most common GI disorders in pediatric age groups (birth to 12 months), association of FGIDs with different feeding practices, impact of FGID on quality of life, various management options and physician preferred method of treatment.Results: Colic was rated as the most common GI disorder, followed by gassiness/fussiness, regurgitation and constipation. About 59% pediatricians come across FGIDs more in formula-fed infants compared to breastfed infants (4.2%) and 93.9% pediatricians affirm that FGIDs affect quality of life. Approximately 91% pediatricians believed reassurance and education was the best management option, which was also reported as the preferred mode of management by about 89% pediatricians, whereas pharmacological therapies were the least preferred (1.6%). For breastfed infants suffering with regurgitation, colic or constipation, majority pediatricians opted for switching to 100% whey partially hydrolysed protein formula; sequentially followed by use of pre/probiotics and switch to extensively hydrolyzed protein formula.Conclusions: Parental education and reassurance offer an ideal mode of management of FGIDs. Partially hydrolysed protein formula may be considered one of the best management options irrespective of the FGID condition in infants who are breastfeed.

Функциональные нарушения пищеварения у детей раннего возраста. Результаты онлайн-анкетирования

Aim: to study the possibilities of online surveys for mothers using a questionnaire on the basis of the Rome IV criteria (2016) as a screening for functional gastrointestinal disorders (FGID) in infants and toddlers. Patients and Methods: an anonymous online survey of 477 mothers was conducted regarding the health condition of their children under the age of 4 years. The survey consisted of 2 question pools. The first pool included general questions regarding the age of the mother at the time of delivery, obstetric and gynecological history, feeding of an infant/toddler at the time of the survey. The second pool included questions regarding FGID in infants and toddlers on three separate topics: functional disorders of the first year of life; diagnosis of cyclic vomiting syndrome; bowel movement disorder. Results: among 130 infants, regurgitation was in 50% of cases (at the age of 6 months — in 75%, at the age of 6 to 12 months — in 35%), baby colic — in 49%. The incidence of functional constipation in children under 6 months was 5.8%, from 6 to 12 months — 7.6%, gradually increasing by 3–4 years to 21.5%. Toilet skills were taught to 15 (12%) children aged 1 year — 1 year 11 months, 58 (59%) — at the age of 2 years — 2 years 11 months, and 119 (98%) — at the age of 3 years — 3 years 11 months. Mothers who were unaware of their child’s physical development and/or defecation problems accounted for 20.1% of those who took part in the survey. Conclusion: online survey results of mothers coincide with modern statistical data on FGID disorder. The survey results generally reflect the anatomical and physiological patterns of the child’s GI development. Online survey on the detection of FGID in infants/toddlers allows to make a preliminary diagnosis, identify existing problems and determine further patient management tactics. KEYWORDS: functional gastrointestinal disorders, infant, toddler, Rome IV criteria, questionnaire for parents, functional constipation, online survey, baby colic, regurgitation, toilet skills. FOR CITATION: Dubrovskaya M.I., Gryaznova E.I. Functional gastrointestinal disorders in infants and toddlers. Online survey results. Russian Medical Inquiry. 2020;4(5):274–281. DOI: 10.32364/2587-6821-2020-4-5-274-281.

Birth Weight and the Development of Functional Gastrointestinal Disorders in Infants.

PurposeTo assess the association between birth weight and the development of functional gastrointestinal disorders (FGIDs) in the first year of life.MethodsThis is a secondary analysis of a prospective cohort multicenter study including neonates, consecutively enrolled at birth, and followed up for one year. At birth all infants were classified by birth weight as extremely low (ELBW), very low, or low when <1,000, <1,500, and <2,500 g, respectively, and by birth weight for gestational age as appropriate (AGA, weight in the 10–90th percentile), small (SGA, weight <10th percentile), and large (LGA, weight >90th percentile) for gestational age. FGIDs were classified according to the Rome III criteria and assessed at 1, 3, 6, and 12 months of life.ResultsAmong 1,152 newborns enrolled, 934 (81.1%) completed the study: 302 (32.3%) were preterm, 35 (3.7%) were ELBW, 104 (11.1%) were SGA, 782 (83.7%) were AGA, and 48 (5.1%) were LGA infants. Overall, throughout the first year of life, 718 (76.9%) reported at least one FGID. The proportion of infants presenting with at least one FGID was significantly higher in ELBW (97%) compared to LBW (74%) (p=0.01) and in LGA (85.4%) and SGA (85.6%) compared to AGA (75.2%) (p=0.0001). On multivariate analysis, SGA was significantly associated with infantile colic.ConclusionWe observed an increased risk of FGIDs in ELBW, SGA, and LGA neonates. Our results suggest that prenatal factors determining birth weight may influence the development of FGIDs in infants. Understanding the role of all potential risk factors may provide new insights and targeted approaches for FGIDs.

Minimal Gastrointestinal Disorders in Infants: When It Is Too Early to Treat

Functional and anatomical development coupled with functional immaturity of gastrointestinal tract present major risk factor for functional gastrointestinal disorders development in infants. The article discusses some aspects of aetiology, prevention and early treatments of gastrointestinal discomfort in infants.

Functional gastrointestinal disorders in infants: Practice, knowledge and needs of Australian pharmacists

To determine the nature and extent of interactions between retail pharmacists and families of infants concerned about functional gastrointestinal disorders. A 15-question online survey was developed that could be completed by retail pharmacists in approximately 5 min. This survey aimed to obtain information relating to the frequency of interactions with parents of infants seeking advice and/or information about colic, gastro-oesophageal reflux (GOR) or constipation in pharmacies; what recommendations and/or advice was given by the pharmacists; from where the pharmacists obtained their information and what guidelines/recommendations they would value; and demographic information. A total of 362 pharmacists from every state and territory within Australia completed the survey. Conversations with parents/carers about constipation at least once a week were reported by 85% of pharmacists, with the equivalent percentages for GOR and colic both being 76%. In the case of constipation, medication was recommended in 70% of cases, and a nutritional approach was recommended in 67% of cases. Medication was recommended in 81% of cases of suspected colic, significantly greater than nutritional advice at 50%. For possible GOR, recommendations were similar, with medication being suggested in 66% and nutritional advice in 68%. GOR guidelines were the most sought after, with 42% of pharmacists placing such guidelines as their number one need. This survey indicates the need for greater emphasis to be given to reassurance by health-care professionals involved in the management of functional gastrointestinal disorders in infancy, as well as consideration of the construction of easily accessible, evidence-based national guidelines.

Cow's Milk Protein Allergy in Infancy: A Risk Factor for Functional Gastrointestinal Disorders in Children?

The role and prevalence of cow’s milk protein allergy (CMA) in functional gastrointestinal disorders remains unclear. The aim of this review is to update knowledge on the relationship between CMA and functional abdominal pain disorders (FAPDs) in children. Cochrane Database and Pubmed were searched from inception using general and specific terms for CMA and functional gastrointestinal disorders. CMA is reported as a predisposing or coexisting factor in a wide range of functional gastrointestinal disorders in infants and children. Pathogenesis of both conditions is complex and multiple mechanisms including dysmotility and hypersensitivity might contribute to the clinical manifestations. Data supporting the possible role of food allergies in the pathogenesis of FAPDs are limited. CMA may predispose to early life inflammation and visceral hypersensitivity, which in turn might manifest as FAPDs. The diagnosis of either CMA or FAPDs and distinction between them is challenging because of nonspecific and overlapping symptoms. Lack of accurate allergy tests in non-IgE (immunoglobulin E) mediated cases is also problematic. Oral food challenge, following an elimination diet, should be performed to diagnose a suspected non-IgE CMA allergy in children with FAPDs. In the management of FAPDs, an elimination diet should be considered for a limited period to verify if the symptoms improve or resolve.

Review shows that parental reassurance and nutritional advice help to optimise the management of functional gastrointestinal disorders in infants.

AimRegurgitation, infantile colic and functional constipation are common functional gastrointestinal disorders (FGIDs) during infancy. Our aim was to carry out a concise review of the literature, evaluate the impact of these common FGIDs on infants and their families, and provide an overview of national and international guidelines and peer‐reviewed expert recommendations on their management.MethodsNational and international guidelines and peer‐reviewed expert recommendations on the management of regurgitation, infantile colic and functional constipation were examined and summarised.ResultsRegurgitation, infantile colic and functional constipation cause frequent parental concerns, lead to heavy personal and economic costs for families and impose a financial burden on public healthcare systems. Guidelines emphasise that the first‐line management of these common FGIDs should focus on parental education, reassurance and nutritional advice. Nutritional advice should stress the benefits of continuing breastfeeding, while special infant formulas may be considered for non‐breastfed infants with common FGIDs. Drug treatment is seldom required, with the exception of functional constipation.ConclusionBy providing complete and updated parental education, reassurance and nutritional advice, healthcare professionals can optimise the management of FGIDs and related symptoms and reduce the inappropriate use of medication or dietary interventions.

Functional gastrointestinal disorders in the infants: diagnostics criteria and approaches to the dietary therapy

The functional gastrointestinal disorders in infants occur rather often. About half of the children has at least one of such signs of the functional gastrointestinal disorders as the spitting up, torminae, constipations, and the combination of several signs is ordinary. The formation mechanisms of the functional disorders are multivarious and they are determined not only by the anatomical and physiological particularities but by the autonomic and humoral regulation imbalances of the child’s organism as well. The protein and lipid composition of the mixture based on the goat's milk, Kabrita® Gold, contributes to the digestion improvement. The mixture can be recommended for the formula-fed infants with the functional gastrointestinal disorders in the absence of the atopy signs.