Common infant feeding problems

Definitions

Functional GI disorders are divided into seven recognised categories¹:

Infant reflux — persistent regurgitation of stomach contents

Infant rumination syndrome — habitual regurgitation for the purpose of self-stimulation

Cyclic vomiting syndrome  — episodes of prolonged vomiting

Infant colic  — persistent crying

Functional diarrhoea  — frequent passing of unformed stools

Infant dyschezia  — painful straining and crying before successful or unsuccessful passage of soft stools

Functional constipation  — stool retention

Health and wellbeing impact

The signs and symptoms of functional GI disorders are distressing for child and parent alike. This can lead to considerable social consequences, as parents struggle to cope with their unhappy infant.

Research shows that children who experienced functional GI disorders as infants are more likely to suffer from abdominal pain throughout childhood^5-8, have sleeping or behavioural problems^7-11, and be perceived as fragile by their mothers¹².

Parents of children with functional GI disorders are more likely to have a poor quality of life^9-13 and suffer from tiredness, fatigue or postnatal depression^14-15. They are also more likely to give up breastfeeding at an earlier stage¹⁶ or make multiple changes to their child’s formula¹⁷.

Economic impact

As parents desperately seek some comfort for their distressed child, the costs inevitably mount up.

Home remedies, over-the-counter remedies, medical consultations, prescribed treatments and lost income due to time taken off work all contribute to a total economic impact that has been estimated at £72.3 million per year in England¹⁸.

This “conservative estimate” (outpatient costs were excluded, for example) includes around £50 million of costs to the NHS. Parents also spent £13.6 million on over-the-counter colic medicines with no evidence of efficacy¹⁸.

Earlier studies estimated that the NHS spends around £65m each year to help parents manage infant crying and sleeping problems in the first 12 weeks of life ¹⁹.

In the US the total national cost for emergency department visits due to constipation alone has been estimated at $1.6bn²⁰. Infants account for the highest proportion of these visits.

Key learnings

• Infant functional GI disorders is an umbrella term for the signs and symptoms of seven GI disorders, affecting young children.
• The most common functional GI disorders are infant reflux, infantile colic and functional constipation.
• Around 50% of infants will suffer at least one functional GI disorder or related sign or symptom before six months of age.
• Functional GI disorders have no obvious organic cause, but are thought to be due to changes in the infant’s GI system as it matures.
• Functional GI disorders are highly prevalent during the early months, cause significant distress and impose a considerable burden on the finances of concerned parents and overstretched healthcare systems.
• Managing infant functional GI disorders is estimated to cost at least £72.3m per year.
• Diagnostic criteria for the seven functional GI disorders have been internationally agreed.
• Functional GI disorders are best managed through a combination of parental guidance and nutritional advice.
• Nutritional advice should stress the benefits of continuing breastfeeding.
• In non-breastfed infants with common functional GI disorders, specialist formulas may be considered.
• Pharmacological management may be of use in functional constipation but is rarely appropriate in other common functional GI disorders.
• Patient-centred guidance and reassurance is likely to be more effective than the traditional “doctor-knows-best” approach.

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2. Vandenplas Y, Abkari A, Bellaiche M, Benninga M, Chouraqui JP, Çokura F, 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.
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4. Gut Feelings Survey of 600 parents of children under 2, who experienced FGIDs as infants and 110 HCPs (40 GPs, 40 HVs, 30 Community Pharmacists) across the UK. Conducted in December 2017. Data on file.
5. Partty A, Kalliomaki M, Salminen S, Isolauri E. Infant distress and development of functional gastrointestinal disorders in childhood: is there a connection? JAMA Pediatr 2013;167(10):977–8.
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18. Mahon J, Lifschitz C, Ludwig T, Thapar N, Glanville J, Miqdady M, et al. The costs of functional gastrointestinal disorders and related signs and symptoms in infants: a systematic literature review and cost calculation for England. BMJ Open 2017;7(11):e015594.
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