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Middle East Consensus Statement on the Diagnosis and Management of Functional Gastrointestinal Disorders in <12
Yvan Vandenplas1, Muath Abdurrahman Alturaiki2, Wafaa Al-Qabandi3
1Department of Pediatrics, Universitair Ziekenhuis Brussel, Vrije Universiteit Brussel, Brussels, Belgium.
Insights
This study outlines infant feeding strategies for common gastrointestinal issues like regurgitation, constipation, and colic. Dietary interventions and specific formulas are recommended based on infant age and suspected allergies, avoiding unnecessary investigations.
Area of Science:
- Pediatric Gastroenterology
- Infant Nutrition
- Functional Gastrointestinal Disorders
Background:
- Infantile functional gastrointestinal disorders (FGIDs) are common, including regurgitation, constipation, and colic.
- Management strategies require evidence-based approaches tailored to specific symptoms and infant age.
- Probiotics show limited evidence for FGIDs, and diagnostic investigations are not typically needed without warning signs.
Approach:
- Review of current algorithms for managing infant regurgitation, constipation, and colic.
- Evaluation of dietary interventions, including specialized infant formulas (anti-regurgitation, partially hydrolyzed, extensively hydrolyzed) with prebiotics and β-palmitate.
- Assessment of pharmacological options like lactulose and macrogol (polyethylene glycol, PEG) for constipation.
Key Points:
- Anti-regurgitation formula for troublesome regurgitation; avoid investigations without warning signs.
- Partially hydrolyzed formula with prebiotics/β-palmitate for functional constipation; lactulose safe for <6 months, PEG preferred for >6 months.
- Specialized formulas and maternal diet modifications for infantile colic, especially if cow's milk protein allergy (CMPA) is suspected.
Conclusions:
- Breastfeeding should not be discontinued due to FGIDs.
- Dietary modifications and age-appropriate formula selection are key management strategies.
- Targeted interventions are effective for infant gastrointestinal issues, emphasizing safety and evidence-based practice.
Abstract:
This paper covers algorithms for the management of regurgitation, constipation and infantile colic in infants. Anti-regurgitation formula may be considered in infants with troublesome regurgitation, while diagnostic investigations or drug therapy are not indicated in the absence of warning signs. Although probiotics have shown some positive evidence for the management of functional gastrointestinal disorders (FGIDs), the evidence is not strong enough to make a recommendation. A partially hydrolyzed infant formula with prebiotics and β-palmitate may be considered as a dietary intervention for functional constipation in formula fed infants. Lactulose has been shown to be effective and safe in infants younger than 6 months that are constipated. Macrogol (polyethylene glycol, PEG) is not approved for use in infants less than 6 months of age. However, PEG is preferred over lactulose in infants >6 months of age. Limited data suggests that infant formula with a partial hydrolysate, galacto-oligosaccharides/fructo-oligosaccharides, added β-palmitate may be of benefit in reducing infantile colic in formula fed infants in cases where cow's milk protein allergy (CMPA) is not suspected. Evidence suggests that the use of extensively hydrolyzed infant formula for a formula-fed baby and a cow's milk free diet for a breastfeeding mother may be beneficial to decrease infantile colic if CMPA is suspected. None of the FGIDs is a reason to stop breastfeeding.
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