Infant functional gastrointestinal disorders (FGID) or "disorders of gut-brain interaction" is an umbrella term for a number of disorders that are not based on an underlying structural or biochemical abnormality. These include infantile colic (→), diarrhoea (→), vomiting (→), regurgitation and reflux (→). The symptoms can accompany the normal development of a child or arise from maladaptive behaviour. FGID are in general not dangerous, yet the caregivers should be reassured and their concerns addressed with compassion (Benninga et al., 2016, Zeevenhooven et al., 2017).
The Rome foundation (→) aims to "improve the lives of people with functional gastrointestinal disorders". Their Rome IV collection offers particularly valuable guidelines for the diagnosis and management of each FGID, which comprise symptom-based diagnosis criteria (Zeevenhooven et al., 2017). Several of the chapters are focussed on paediatric FGID offering diagnosis algorithms and questionnaires for gastroenterologists and general practitioners. These are available as webbased interactive toolkit. The Rome V release is anticipated 10 years after Rome IV release i.e. in 2026 (Rome Foundation, 19.10.2020).
Gastrointestinal symptoms are often caused by the immaturity of the infants gastrointestinal tract, nervous system and gut microbiome. Symptoms can be rather mild but also very distressing leading to parental anxiety and decreased quality of life for the parents and the child (Salvatore et al., 2018).
First line management should include parental reassurance, education and nutritional advice. The recommendation is to continue with breastfeeding. For formula-fed infants, specialised formulas could be considered. Special formulas including thickening agents (like starch), pre- and/or probiotics, ß-palmitate as well as hydrolysed or lactose-reduced formulas may be useful in managing FGID. The management aim is to limit the use of unnecessary pharmacological treatment, to prevent early breastfeeding cessation and reduce frequent unnecessary changes of formula types. Pharmagolocial management of FGID is considered unneccessary in most cases bearing the risk of adverse events, except for constipation where for example laxatives seem a viable management option (→) (Salvatore et al., 2018).
The Rome IV toolkit and questionnaires can be found here: https://theromefoundation.org/programs-projects/education-program/gi-genius-interactive-clinical-decision-toolkit/ and https://theromefoundation.org/rome-iv/rome-iv-questionnaire/
Benninga MA, Faure C, Hyman PE, St James Roberts I, Schechter NL, Nurko S. Childhood Functional Gastrointestinal Disorders: Neonate/Toddler: in Rome IV. Functional gastrointestinal disorders: Disorders of gut-brain interaction [SECTION II: FGID: Diagnostic groups _15]. Gastroenterology 2016; 150(6):1443–55. at: pubmed.ncbi.nlm.nih.gov/27144631
Salvatore S, Abkari A, Cai W, Catto-Smith A, Cruchet S, Gottrand F, Hegar B, Lifschitz C, Ludwig T, Shah N, Staiano A, Szajewska H, Treepongkaruna S, Vandenplas Y. Review shows that parental reassurance and nutritional advice help to optimise the management of functional gastrointestinal disorders in infants. Acta paediatrica (Oslo, Norway : 1992) 2018; 107(9):1512–20. at: pubmed.ncbi.nlm.nih.gov/29710375
Zeevenhooven J, Koppen IJN, Benninga MA. The New Rome IV Criteria for Functional Gastrointestinal Disorders in Infants and Toddlers. Pediatric gastroenterology, hepatology & nutrition 2017; 20(1):1–13. at: pubmed.ncbi.nlm.nih.gov/28401050back