For Healthcare Professionals only

Multiple FGIDs in Infants & its impacts on Quality of Life
By - Dr. Lalit Verma
MD, FAAP Paediatrics (USA) New York Medical College, CCST (Canada) Stollery Children’s Hospital , Consultant Paediatric Gastroenterology & Hepatology

In infancy, gut physiology and function are still developing and maturing. This may cause variable combination of GI signs and symptoms in otherwise healthy individuals that have no obvious structural or biochemical reasons. These are defined as Functional Gastrointestinal Disorders (FGIDs).1

In infants and toddlers, there are seven recognized FGIDs:1,2

S.No. Category Reported Worldwide Prevalence (%)
1 Infant regurgitation 30 -67
2 Infant colic 5-20
3 Functional constipation 3-27
4 Functional diarrhea 6-7
5 Cyclic vomiting syndrome 3.4
6 Infant dyschezia 2.4
7 Infant rumination syndrome 1.9

From birth to 6 months of age, more than half of infants display at least one FGID symptom.2,3 Regurgitation, infantile colic and functional constipation are the most common FGIDs in the first year of life whereas functional diarrhea, dyschezia, rumination syndrome and cyclic vomiting syndrome occur less frequently.2,4

Diagnostic Criteria for FGIDs-

Internationally agreed diagnostic criteria for FGIDs were first published in 1989 and these Rome criteria have been regularly updated, most recently in 2016.1

The ROME IV diagnostic criteria –

Infantile Colic Infantile Regurgitation Functional Constipation
Recommendation for HMF: Whom to start –
  1. An infant who is younger than 5 months when the symptoms start and stop.
  2. Prolonged periods of crying, fussing or irritability that occur without obvious cause.
  3. No evidence of failure to thrive, fever or illness.
Must include –
  1. Regurgitation 2 or more times a day for 3 or more weeks,
  2. Haematemesis, aspiration, apnoea, failure to thrive, feeding or swallowing difficulties or abnormal posturing and no retching in otherwise healthy infants aged 3 weeks to 12 months
Must include infants aged up to 4 years-
  1. With 2 or fewer defaecations per week,
  2. History of excessive stool retention
  3. History of painful or hard bowel movements
  4. Presence of a large faecal mass in the rectums
  5. History of large diameter stools that may obstruct the toilet. ¹
Impact on Family & Society –

FGIDs in general, and excessive crying in particular, may be extremely distressing for families and create possibilities to damage the relationships between parents and their children.5

FGIDs and related symptoms have been suggested to have the following impacts –

  • More postpartum maternal depressive symptoms.6
  • Tiredness and fatigue in mothers.7
  • Suboptimal social and emotional behavior of mothers during feeding.8
  • Early breastfeeding cessation.9
  • Parental insecurity, anxiety & stress.7,10
  • Loss of parental working days.11
  • Suboptimal mother and father-child interaction.12
  • Less positive social behavior of infants with their mothers; mothers less involved and less responsive to the positive signals of the infants.13
  • Challenges in quality of life of the family.14
Economic Impact –

Apart from disturbing family interaction, wellbeing and quality of life, FGIDs and related symptoms impact personal and public healthcare expenses significantly. These include –

  • Visits to healthcare professionals
  • Costs of prescribed treatments.
  • Over-the-counter or home remedies.
  • Loss of income for parents who had to take time off work.15
Long – Term Health Impact –

FGIDs and related signs and symptoms have been suggested to have the following long – term health impacts –

  • Higher prevalence of FGIDs later in life. It has been seen that 28% of infants with colic develop GI problems by the age of 13 years.16
  • More frequent abdominal pain.17
  • Sleeping problems later in life.17
  • Behavioral problems such as more difficulty with emotional regulation, frequent temper tantrums, or a more impulsive cognitive style.17
  • To conclude, the FGIDs and related symptoms are likely to have immediate as well as long-term impacts. Improved and proper management of FGIDS may help in controlling the scenario to a great extent.

References:-

  1. Benninga MA, Faure C, Hyman PE, St James Roberts I, Schechter NL, Nurko S. Childhood functional gastrointestinal disorders: neonate/toddler. Gastroenterology 2016; 150: 1443-5.
  2. Vandenplas Y et al. Prevalence and health outcomes of functional gastrointestinal symptoms in infants from birth to 12 months of age. J Pediatr Gastroenterol Nutr 2015; 61: 531-7.
  3. Iacono G, Merolla R, D’Amico D, Bonci E, Cavataio F, Di Prima L, et al. Gastrointestinal symptoms in infancy: a population-based prospective study. Dig Liver Dis 2005; 37:432-8.
  4. van Tilburg MAL, Hyman PE, Walker L, Rouster A, PAlsson OS, Kim SM, et al. Prevalence of functional gastrointestinal disorders in infants and toddlers. J Pediatr 2015; 166: 684-9.
  5. Vandenplas Y et al. Review shows that parental reassurance and nutritional advice help to optimize the management of functional gastrointestinal disorders in infants. Foundation Acta Pᴂdiatrica 2018; 107, pp. 1512-1520.
  6. Akman I, Kusḉu K, Ozdemir N, Yurdakul Z, Solakoglu M, Orhan L, Karabekiroglu A, Ozek E. Mothers’ postpartum psychological adjustment and infantile colic. Arch Dis Child 2006; 91:417-9.
  7. Kurth E, Kennedy HP, Spichiger E, Hösli I, Stutz EZ. Crying babies, tired mothers: what do we know? A systematic review. Midwifery 2011; 27::187-94
  8. Keefe MR, Kotzer AM, Froese-Fretz A, Curtin M. A longitudinal comparison of irritable and nonirritable infants. Nurs Res 1996; 45:4-9
  9. Howard CR, Lanphear N, Lanphear BP, Eberly S, Lawrence RA. Parental responses to infant crying and colic: the effect on breastfeeding duration. Breastfeed Med 2006; 1:146-55
  10. Vik T, Grote V, Escribano J, Socha J, Verduci E, Fritsch M, Carlier C, von Kries R, Koletzko B. Infantile colic, prolonged crying and maternal postnatal depression. Acta Paediatr 2009; 98: 1344-8.
  11. Indrio F, Di Mauro A, Riezzo G, Cavallo L, Francavilla R. Infantile colic, regurgitation, and constipation: an early traumatic insult in the development of functional gastrointestinal disorders in children? Eur J Pediatr 2015; 174: 841-2.
  12. Raiha H, Lehtonen L, Huhtala V, Saleva K, Korvenranta H. Excessively crying infant in the family: mother-infant, father-infant and mother-father interaction. Child care Health Dev 2002; 28: 419-29.
  13. van den Boom DC, Hoeksma JB. The effect of infant irritability on mother-infant interaction: a growth-curve analysis. Developmental Psychology 1994; 30: 581-90.
  14. Brown M, Heine RG, Jordan B. Health and well-being in school-age children following persistent crying in infancy. J Paediatr Child Health 2009; 45: 254-62.
  15. Glanville J, Ludwig T, Lifchitz C, Mahon J, Miqdady M, Saps M, Hock-Quak S, Lenoir-Wijnkoop I, Edwards M, Wood H, Szajewska H. Costs associated with functional gastrointestinal disorders and related signs & symptoms in infants: a systematic review protocol. BMJ Open 2016; 6:doi: 10.1136/bmjopen-2016-011475.
  16. Partty A et al. Infant distress and developmentof functional gastrointestinal disorders in childhood: is there a connection?. JAMA PEdiatr 2013;167:977-8.
  17. Savino F et al. A prospective 10-year study on children who had severe infantile colic. Acta Paediatr Suppl 2005;94:129-32