Quality of life of infants with functional gastrointestinal disorders

Key Messages

 
Although benign and with favorable outcome, functional gastrointestinal disorders (FGIDs) cause significant parental worry and anxiety.

In FGIDs, improving quality of life is the major goal of treatment.

Assessment of quality of life in these disorders should be a marker of effective management.


It is estimated that 20-30% of consultations during the first months of life are related to Functional gastrointestinal disorders (FGIDs).[1] Although FGIDs are benign and of favorable outcome, they cause significant parental worry and anxiety. FGIDs often occur in combination in the same infant, for example infant regurgitation associated with infant colic, which could complicate the message delivered to parents (Table 1).



Physicians and more generally health caregivers may also have concerns about complications that are fortunately infrequent: maternal postpartum depression, shaken baby syndrome, early cessation of breastfeeding or behavior and sleep problems, etc.[2] These complications are partly related to the difficulties for parents to manage these FGIDs. Few studies have investigated the quality of life (QoL) of infants and their families in cases of FGID. This is partly related to the difficulty of having QoL scales, validated and specific to these disorders in infants. In a large French observational study on 815 infants, QoL was assessed with the Infant Quality of Life questionnaire (Qualin), which is a general QoL questionnaire validated in several languages.[3] Medical management was mainly based on dietary advices: prescription of an infant formula targeting the GI symptoms, lifestyle advice and reassurance. In this study, improved QoL was associated in multivariate analysis with younger age, lifestyle and dietary advices as well as partial breastfeeding (Table 2 and 3). More recently, Bellaiche et al have performed a study on 2757 infants under 6 months recruited by private French pediatricians in order to compare infant’s QoL with a single FGID and to those with more than one FGIDs.[4]




The used questionnaire was also the adapted-Infant Quality of Life questionnaire. In their study, multiple FGIDs were very frequent and represented almost 78% of their cohort, with the combination of gas/bloating and colic being the most frequent (in 28% of cases). Multiple FGIDs was associated with lower QoL compared to single FGID at inclusion and at follow-up visit, as well as a lower body weight and a shorter breastfeeding duration, reflecting the difficulty of caring for these infants.

Using the PedsQL4.0 Generic Core Scale to measure QoL, Van Tilburg et al showed that the mean QoL score of infants suffering from FGID was 10 points lower on a scale of 100 than that of infants without FGID (p<0.001).[5] Another team found similar results in older children with FGID compared to healthy children.[6] Whereas FGIDs are not a life-threatening condition, QoL of infants and families is greatly impacted by these functional disorders. QoL is a marker of symptom severity that must be considered in the management of symptoms. It must therefore be the primary target of clinical management.

1. Vandenplas Y et al (2015) Prevalence and health outcomes of functional gastrointestinal symptoms in infants from birth to 12 months of age. J Pediatr Gastroenterol Nutr 61:531–537
2.  Zeevenhooven J, Browne PD, L’Hoir MP, de Weerth C, Benninga MA. Infant colic: mechanisms and management. Nat Rev Gastroenterol Hepatol. 2018;15:479–496
3.  Jung et al. Quality of life of infants with functional gastrointestinal disorders: a large prospective observational study. International Journal of Child Health and Nutrition. 2017; 6:62– 69.
4.  Bellaiche M, Oozeer R, Gerardi-Temporel G, Faure C, Vandenplas Y. Multiple functional gastrointestinal disorders are frequent in formula-fed infants and decrease their quality of life. Acta Paediatr. 2018 Jul;107(7): 1276–1282.
5.  Van Tilburg MA, Hyman PE, Walker L, et al. Prevalence of functional gastrointestinal disorders in infants and toddlers. J Pediatr 2015; 166: 684-9.
6.  Youssef NN, Murphy TG, Langseder AL, Rosh JR. Quality of life for children with functional abdominal pain: a comparison study of patients’ and parents’ perceptions. Pediatrics 2006;
117: 54–9.