Management of FGID’s

what is gastrointestinal immaturity?

Initially, a baby with an immature GI tract will have feeding intolerances. These include vomiting food, stomach bile, or both; abdominal distension, where the baby’s belly appears abnormally large; reduced or absent bowel sounds; and reduced or absent stool. In some cases, the baby will also appear generally unwell.

At what age is the digestive system fully developed?

At birth, your baby’s digestive system is still developing and maturing. At this point, he is not ready to accept other types of food except breast milk. At about six months, your baby’s digestive system is mature enough to digest more complex and solid food substances, like starch, protein, and fat in a non-milk diet.

Management of FGIDs.

Parents of infants with FGIDs are understandably keen to find a quick and easy solution and will often opt for medication hoping for rapid relief from symptoms. The new era of social media-induced parental expectations for instant solutions have placed healthcare professionals under high pressure (often unneeded), given importance to investigations or recommended pharmacological treatments which are likely to bring little benefit in the absence of disease with possible adverse effects. There is widespread overuse of medication in the management of FGIDs such as regurgitation and infantile colic. The cornerstone of the management of FGIDs in infants is parental reassurance, anticipatory guidance, education on natural evolution and different contributing factors, and adequacy of nutrition. Nutritional advice (feeding technique, volume and frequency, and change in the formula) can also be considered and should always stress the benefits of breastfeeding and offer appropriate support to continue breastfeeding. Overfeeding, especially in formula-fed infants, is a frequent cause of infant distress.

Management of infantile colic.

Frequent and extensive auto-medication by parents of infants with colic has been reported. Consequently, management should focus on sustaining parents to cope with their child’s excessive crying and distressed behaviour by informing them that in general, crying peaks at about 4 to 6 weeks after birth, may last up to three hours per day in otherwise normal infants and steadily diminishes from 12 weeks onwards [2,9,30]. Physical examination and history should focus on the most important warning signs, such as severe vomiting, back-arching, Sandifer syndrome, gastrointestinal bleeding, failure to thrive, abdominal distention, bloating, and any other signs of further organic causes

Management of functional constipation.

Constipation is seldom in exclusively breastfed infants although some of them defecate less than once a week. Constipation is different from dyschezia. Dyschezia refers to a condition in infants presenting with severe distress and discomfort when defecating, but produce stools with normal consistency. The goal of treatment of functional constipation is to restore a regular defecation pattern and prevent relapses. In the absence of suspicion of an organic condition such as anorectal malformations, Hirschsprung’s disease or cystic fibrosis, and in the absence of warning signs such as failure to thrive, intermittent diarrhoea or abdominal distension, parental reassurance is required, which should eventually be endorsed by a nutritional intervention 

CONCLUSION.

Symptoms and signs of FGIDs represent a frequent and important burden to infants and parents and have a negative impact on their quality of life. The cornerstone of optimal management of FGIDs in infancy is based on parental education and reassurance, which can be accompanied by appropriate nutritional recommendations. FGIDs are not an indication to stop breastfeeding, but it should be supported actively. In formula-fed infants, special formulas may be considered if reassurance and advice on nutrition based on appropriate volume and frequency of milk intake does not lead to sufficient improvement. In the absence of organic disease, it is unlikely that any pharmacological intervention will be helpful. Moreover, medication may cause adverse effects. FGIDs often lead to a vicious cascade of distressed infants, concerned parents, increased medical consultation, over-prescription and use of over-the-counter medications resulting in an escalation in healthcare costs.

It is hypothesized that appropriate management will contribute towards disruption of the cascade of parental anxiousness accompanied with a negative impact on the family’s life and will alleviate the distress in infants. Nutritional guidance is essential with some evidence regarding efficacy as it is devoid of the risks of inducing adverse effects.

Article courtesy of  US National library of Medicine