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Optimising the management of functional gastrointestinal disorders in infants — a summary for healthcare professionals

Writing in paediatric journal Acta Paediatrica, Salvatore et al. note that functional gastrointestinal (GI) disorders such as regurgitation, infantile colic and functional constipation are highly prevalent (see table below), impose a huge financial burden on parents and on public healthcare systems and may lead to parental anxiety, poor quality of life and short and long-term health consequences.

The financial impact includes the cost of prescribed treatments, over-the-counter or home remedies, visits to healthcare professionals and loss of income for parents due to time taken off work.

Much of this expenditure is being wasted on medicines that are not recommended in management guidelines, that are likely to be ineffective and could be harmful, according to the researchers.

They point out that most guidelines emphasise that first-line management of functional GI symptoms should focus on parental reassurance and nutritional advice. This advice should stress the benefits of continuing breastfeeding and consider the use of special formulas for non-breastfed infants. However, these guidelines are often ignored.

“Despite the lack of drug benefits and emphasis on parental and nutritional support in the guidelines, there is still widespread overuse of medical management in [functional GI disorders] such as regurgitation and infantile colic,” write the researchers.

They express particular concern at the use of proton pump inhibitors in infants.

“Gastric acid inhibitors or prokinetic drugs have been shown to have side effects, such as increased rate of infection and have been demonstrated to be mostly ineffective in the management of infantile colic and regurgitation,” they say. The researchers urge a more pragmatic approach to the management of functional GI disorders in children.

This should focus on parental reassurance and nutritional advice including the promotion of breastfeeding, guidance on feeding technique, volume and frequency.

“It is unlikely that any pharmacological intervention will be necessary once an organic cause of the symptoms has been excluded,” say the researchers.

The researchers warn that functional GI disorders often lead to a “vicious cascade” of distressed infants, concerned parents, increased medical consultation, over-prescribing and use of over the counter medication resulting in escalating healthcare costs.

“By offering appropriate advice and reassurance healthcare professionals can help disrupt this cascade, convert to a virtuous cycle, reduce infants’ distress, alleviate parental anxiety and improve quality of life for the family while protecting healthcare budgets.”

Our careline

The information above is designed to help healthcare professionals support parents, but if you still need assistance, at Nutricia Early Life Nutrition we have two carelines with two dedicated phone numbers; one for your patients to call directly, and the other specifically for healthcare professionals. The Nutricia Early Life Nutrition healthcare professional helpline is staffed by people who understand what it’s like to be on the frontline of healthcare. Our team has over a hundred and fifty years’ cumulative experience, including hands-on experience in midwifery, as well as paediatric and neonatal nursing.

Our free healthcare professional helpline is open from 8am to 8pm, Monday to Friday. Just phone 0800 996 1234 for expert advice on infant feeding and nutrition, including common infant feeding problems such as cows’ milk allergy, colic, constipation and reflux.

IMPORTANT NOTICE: Breastfeeding is best for babies. Infant formula is suitable from birth when babies are not breastfed. Follow-on milk is only for babies over 6 months, as part of a mixed diet and should not be used as a breastmilk substitute before 6 months. We advise that all formula milks including the decision to start weaning should be made on the advice of a doctor, midwife, health visitor, public health nurse, dietitian, pharmacist or other professional responsible for maternal and child care. Foods for special medical purposes should only be used under medical supervision. May be suitable for use as the sole source of nutrition for infants from birth, and/or as part of a balanced diet from 6–12 months. Refer to label for details.

  1. Salvatore S, Abdelhak A, Wei Cai, et al. Acta Paediatr. 208; doi:10.1111/apa. 14378