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Case study : Infant colic and constipation, what recommendations ?

The rapid development of the infant’s digestive system may promote the development of functional gastrointestinal disorders such as colic or constipation1. Worried, parents are looking for an effective solution to quickly relieve their baby. Study a practical case about an infant with FGIDs* and discover the latest international recommendations.

Prevalence of Gastrointestinal Disorders

According to the results of the GASEL observatory, the most encountered FGIDs* in Africa are2:  

  • Infant colic (58%)
  • Gas and bloating (43%)
  • Constipation (31%)
  • Regurgitations (40%)

Almost 1 in 2 infants has at least one FGID* or associated symptom1.  More than half of these disorders are associated: 53% of infants included in the GASEL study suffer from several digestive disorders2.

PRACTICAL CASE

You meet 4-month-old Asma** and her parents in consultation. She is a healthy baby with no history, who is breastfed and has not undergone any dietary changes. However, for the past few days, she cried often and for a long time. Her parents, very worried, ask you for a quick and effective solution:
In your opinion, Asma’s** colic may have an impact on:
  • Her sleep quality
  • Her behaviour (agitation and irritability)
  • Her future health (functional gastrointestinal disorders, risks of allergies, behavioral disorders…)
  • The quality of family life: guilt, discouragement, anxiety, depression

FGIDs* have a significant impact on: the quality of infant life, parental anxiety and the child’s future health (sleep, behavioral disorders…) .

What would be your first-line management about Asma’s** colic?
  • Listen to parents, reassure and guide them by explaining the functional disorder in question
  • Encourage continued breastfeeding or provide adapted nutritional solutions if Asma** is no longer breastfed
  • Prescribing medications

In cases of infant colic, medication is rarely necessary, without benefit to the child and can cause serious adverse reactions. It is important to focus on parenting education and reinsurance, as well as nutritional advice.

INTERNATIONAL RECOMMENDATIONS


The latest international recommendations on the FGIDs’ management are 5-8: 

  • Reassure and explain to parents with appropriate terms
  • Measure the quality of infant’s life to better assess the severity of the disorder concerned
  • Remind them the benefits of breastmilk that is best suited to the infant’ specific needs and the prevention of certain infectious diseases
  • With the help of nutritional management (change of milk) that contributes to the improvement of the various digestive disorders
  • For non-breastfed children, provide nutritional management (specific adapted milk) that helps to improve the various digestive disorders      

With the exception of functional constipation, medication is rarely required and never in cases of infant colic5.

To learn more about FGIDs’* management, listen to an expert in paediatrics gastroenterology, Dr Marc Bellaïche.


References

*FGID: Functional Gastrointestinal Disorders

**Fictional case and character invented as part of the article

  1. Vandenplas et al. Prevalence and health outcomes of functionnal gastrointestinal symptoms in infants from birth to 12 months of age. JPGN volume 61, number 5, november 2015
  2. Bellaiche, Marc, et al. « A large‐scale study to describe the prevalence, characteristics and management of functional gastrointestinal disorders in African infants. » Acta Paediatrica (2020).
  3. https://www.gfhgnp.org/wordpress/wp-content/uploads/kdocuments/5-sept-18Fiche-recommandations-COLIQUE.pdf 27/08/2020
  4. https://www.sfpediatrie.com/sites/www.sfpediatrie.com/files/documents/BrochurePatients/pleurs.pdf 27/08/2020
  5. Salvatore, S., Abkari, A., Cai, W., et al. « Review shows that parental reassurance and nutritional advice help to optimize the management of functional gastrointestinal disorders in infants. » Acta Paediatr. Avril 2018.
  6. Manificat S, Dazord A, Langue J et al., Evaluation de la qualité de vie du nourrisson et du très jeune enfant : validation d’un questionnaire. Etude multicentrique européenne, Arch Pédiatr, 2000 ; 7 : 605-14.
  7. WHO 2009 Infant and young child feeding – model chapter for texbooks, Session 2 : The physiological basis of breastfeeding, p9-17.
  8. Bellaïche M, Oozeer R, Gerardi-Temporel G and al, Multiple functional gastrointestinal disorders are frequent in formul-fed infants and decrease their quality of life, Acta Paediatr, 2018 Mar 31 ; doi : 10.1111/apa.14348.

BA20-635

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