Common GI Woes in Infants

Gut Microbiota: Protecting Children from Within

In a recent webinar symposium organized by the Nestlé Nutrition Institute in collaboration with the Singapore Paediatric Society, experts discussed the evidence supporting the role of probiotics in managing common functional gastrointestinal disorders in children.

Happy spitters

Uncomplicated gastroesophageal reflux (GER) in an otherwise well child is relatively common. The management of “happy spitters” typically calls for a review of the frequency and volume of feeds, a check of the feeding technique, and plenty of reassurance that this symptom is normal. In many cases, management is expectant, and GER resolves without intervention. However, if the child presents with signs or symptoms of gastroesophageal reflux disease (GERD), such as pain and discomfort during feeds, feed aversion, poor weight gain, or signs of other complications, such as aspiration, then further management or specialist referral would be needed. Some children, such as those with neurologic impairment or structural abnormalities of the upper airway, may be at greater risk of complications associated with GER. Where GERD is complicated by reflux oesophagitis, empiric treatment with a proton pump inhibitor (PPI) for 2-4 weeks may be warranted; infants with poor weight gain, feed refusal, suboptimal symptom control, or inability to reduce/ stop PPI after 1-2 months should be referred to a specialist for further assessment.

Crying and fussiness

Excessive and inconsolable crying in infants is typically attributed to a condition called “infantile colic”.  Whilst fussing and crying in infants per se is associated with a range of functional gastrointestinal symptoms,[i] “infantile colic” in general is diagnosed after a careful history and physical examination to exclusion of organic causes. This can range from gastrointestinal conditions such as GERD, food allergies, to neurologic conditions, trauma or acute infections. The management of colic typically revolves around the use of probiotics in breast fed infants, and/or dietary modifications; maternal elimination diet in breast-fed infants or the use of hypoallergenic formula in formula-fed infants. As colic is a source of great stress and strain to families, parental education regarding colic, as well as ensuring that mothers receive adequate rest, empathy, support and time-out (baby-free time) is important.

Difficulties in passing stools

Infant dyschezia is characterized by an infant straining, screaming, crying, and turning red or purple in the face prior to the successful or unsuccessful passage of stools. The infant’s stools are typically soft or pasty in consistency. The behaviour resolves spontaneously as the infant learns to coordinate simultaneously the increase in intra-abdominal pressure with the relaxation of the pelvic floor muscles in order to pass stool. Parental reassurance is key to the management of this condition. Medical intervention, such as the use of laxatives or rectal stimulation are not necessary, and should be avoided.

Summary

Gastrointestinal woes are common among infants. Many of these resolve spontaneously and do not need extensive testing or treatment. Careful history taking, with the ability to recognize and rule out organic causes, will enable clinicians to reassure care-givers as well as intervene appropriately.

[i] Vandenplas Y, Ludwig T, Bouritius H, et al. Randomised controlled trial demonstrates that fermented infant formula with short-chain galacto-oligosaccharides and long-chain fructo-oligosaccharides reduces the incidence of infantile colic. Acta Paediatr. 2017;106(7):1150-1158.

Click here to read highlights from Prof Indrio’s speech on Probiotics for FGIDs

Click here to watch Prof Indrio’s speech on Probiotics for FGIDs