A cross sectional survey in paediatricians pertaining to management of functional gastrointestinal disorders in infants: Indian perspectives
Keywords:Breastfeed, Functional gastrointestinal disorders, Infants, Paediatricians, Partially hydrolysed protein formula, Quality of life
Background: Functional gastrointestinal disorders (FGIDs) in infants and toddlers possess extensive burden to the parents and healthcare professionals. Guidelines addressing the practices in diagnosis and management of FGIDs in infants in Indian subcontinent is unavailable. Hence this study assessed current knowledge, attitude and practice of pediatricians in diagnosis and treatment of FGIDs.
Methods: A cross-sectional survey based on a structured questionnaire assessed pediatrician’s knowledge about prevalence and profile of most common GI disorders in pediatric age groups (birth to 12 months), association of FGIDs with different feeding practices, impact of FGID on quality of life, various management options and physician preferred method of treatment.
Results: Colic was rated as the most common GI disorder, followed by gassiness/fussiness, regurgitation and constipation. About 59% pediatricians come across FGIDs more in formula-fed infants compared to breastfed infants (4.2%) and 93.9% pediatricians affirm that FGIDs affect quality of life. Approximately 91% pediatricians believed reassurance and education was the best management option, which was also reported as the preferred mode of management by about 89% pediatricians, whereas pharmacological therapies were the least preferred (1.6%). For breastfed infants suffering with regurgitation, colic or constipation, majority pediatricians opted for switching to 100% whey partially hydrolysed protein formula; sequentially followed by use of pre/probiotics and switch to extensively hydrolyzed protein formula.
Conclusions: Parental education and reassurance offer an ideal mode of management of FGIDs. Partially hydrolysed protein formula may be considered one of the best management options irrespective of the FGID condition in infants who are breastfeed.
Zeevenhooven J, Koppen IJN, Benninga MA. The new Rome IV criteria for functional gastrointestinal disorders in infants and toddlers. Pediatr Gastroenterol Hepatol Nutr. 2017;20(1):1-13.
Salvatore S, Abkari A, Cai W, Catto-Smith A, Cruchet S, Gottrand F, et al. Review shows that parental reassurance and nutritional advice help to optimise the management of functional gastrointestinal disorders in infants. Acta Paediatr. 2018;107(9):1512-20.
Kesavelu D, Sethi G, Bangale N, Anwar F, Rao S. Common gastrointestinal distress among infants: Role of optimal nutritional interventions. Clinic Epidemio Glob Heal. 2018;6(1):5-9.
Cai W, Bharadia L, Juffrie M, Cheah FC, Quak SH, Titapant V, et al. Prevalence and management of functional gastrointestinal disorders in infants: An Asian perspective. Pediatr Gastroenterol Hepatol Nutr. 2018;21(1):76-7.
Robin GS, Keller C, Zwiener R, Hyman PE, Nurko S, Saps M, et al. Prevalence of pediatric functional gastrointestinal disorders utilizing the Rome IV criteria. J Pediatr. 2018;195:134-9.
Vandenplas Y, Munasir Z, Hegar B, Kumarawati D, Suryawan A, Kadim M, et al. A perspective on partially hydrolyzed protein infant formula in nonexclusively breastfed infants. Kore J Pediatr. 2019;62(5):149-54.
Indrio F, Riezzo G, Giordano P, Ficarella M, Miolla MP, Martini S, et al. Effect of a partially hydrolysed whey infant formula supplemented with starch and Lactobacillus reuteri DSM 17938 on regurgitation and gastric motility. Nutrien. 2017;9(11):1181.
Vandenplas Y, Cruchet S, Faure C, Lee H, Di Lorenzo C, Staiano A, et al. When should we use partially hydrolysed formulae for frequent gastrointestinal symptoms and allergy prevention? Acta Paediatr. 2014;103(7):689-95.
Di Costanzo M, Nocerino R, Cosenza L, Di Scala C. Efficacy of a partially hydrolyzed whey formula on infant colic: A randomized controlled trial. Int J Nutr Sci Foo Tech. 2018;4(6):37-44.
Vandenplas Y, Abkari A, Bellaiche M, Benninga M, ChouraquiJP,Cokura F-C, et al. Prevalence and health outcomes of functional gastrointestinal symptoms in infants from birth to 12 months of age. J Pediatr Gastroenterol Nutr 2015;61(5):531-7.
Barr RG. Colic and crying syndromes in infants. Pediatri. 1998;102(5E):1282-6.
Indrio F, Miqdady M, Al Aql F, Haddad J, Karima B, Khatami K, et al. Knowledge, attitudes, and practices of pediatricians on infantile colic in the Middle East and North Africa region. Bi Me Centr Pediatri. 2017;17(1):187.
Koopman JS, Turkish VJ, Monto AS. Infant formulas and gastrointestinal illness. Americ J Publ Heal. 1985;75(5):477-80.
Chien PF, Howie PW. Breast milk and the risk of opportunistic infection in infancy in industrialized and non-industrialized settings. Adv Nutr Res. 2001;10:69-104.
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;107(7):1276-82.
Vandenplas Y, Alturaiki MA, Al-Qabandi W, AlRefaee F, Bassil Z, Eid B, et al. Middle East consensus statement on the diagnosis and management of functional gastrointestinal disorders in <12 months old infants. Pediatr Gastroenterol Hepatol Nutr. 2016;19(3):153-61.
Yachha SK, Srivastava A, Mohan N, Bharadia L, Sarma MS. Management of childhood functional constipation: Consensus practice guidelines of Indian Society of Pediatric Gastroenterology, Hepatology and Nutrition and Pediatric Gastroenterology Chapter of Indian Academy of Pediatrics. Indi Pediatr. 2018;55(10):885-92.