No need to treat most functional gastric disorders in infants

Most functional gastrointestinal problems in infants can be managed without drug treatment, according to a review of international guidelines published in Acta Paediatrica.

Regurgitation, infantile colic and functional constipation are common functional gastrointestinal disorders during infancy. | iStock/Userba011d64_201
Regurgitation, infantile colic and functional constipation are common functional gastrointestinal disorders during infancy. | iStock/Userba011d64_201

GPs can reduce the inappropriate use of medication or dietary interventions to treat infants with reflux, colic or constipation simply by reassuring and educating parents, the review shows.

The reviewers examined national and international guidelines and expert reviews on the management of regurgitation, infantile colic and functional constipation.

They found that drug treatment is rarely recommended for infantile colic and regurgitation, which are temporary problems during the first months of life and usually resolve spontaneously. Treatment with gastric acid inhibitors or prokinetic drugs has side-effects, such as an increased rate of infection, and is mostly ineffective for these conditions.

First-line management of these conditions should be parental education, reassurance and nutritional advice that stresses the benefits of continuing breastfeeding. Advice on feeding techniques, volume and frequency is also recommended as overfeeding may exacerbate symptoms and should be avoided.

Special infant formulas may be considered for non-breastfed infants with common functional gastrointestinal disorders. A thickened anti-regurgitation infant formula may reduce persistent regurgitation in non-exclusively-breastfed infants and help to reassure parents.

Functional constipation is rare in breastfed infants and alternative causes of constipation should be considered. Some breastfed infants defaecate less than once a week. However, for non-exclusively-breastfed infants with functional constipation, nutritional advice may not be sufficient and laxatives may be required as the first-line treatment.

Parental reassurance

GP Dr Arun Ghosh said, 'I agree with the latest advice in the experts’ review; once red flags have been ruled out, parental reassurance and nutritional advice should be the cornerstone of management for infant colic, reflux and constipation. However, we must not underestimate how distressing this can be for parents, so it is important that we find a way to communicate a sense of reassurance and confidence to them.'

A study published in BMJ Open in 2017 calculated that a minimum of £6.3 million is spent on consultations and prescriptions of medication for colic, with parents incurring a further £13.6 million in costs through the purchase of OTC colic medicines with no evidence of efficacy. 

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