The role of pharmacists in managing gastrointestinal disorders in infants

An estimated 50% of infants suffer from colic, constipation, reflux, or a combination of these disorders.¹ These functional gastrointestinal disorders (FGIDs) are one of the most frequent causes of concern for parents of infants under four months of age,² often leading to discussions with their pharmacist.

FGIDs refer to a diverse group of chronic and recurrent symptoms, which can include feeding problems.³ Common FGIDs include:

• Infantile colic, defined as recurrent and prolonged periods of infant crying, fussing or irritability that occur without obvious cause and cannot be prevented or resolved.⁴
• Functional constipation, which results from painful, hard stools that are difficult for the infant to pass.⁵ Constipation is defined as including at least two of the following for at least one month: two or fewer bowel motions per week; history of excessive stool retention; history of painful or hard bowel motions; history of large-diameter stools; or presence of a large faecal mass in the rectum.⁶
• Infant reflux (or gastro-oesophageal reflux [GOR]) which refers to the passage of refluxed stomach contents into the pharynx and expelled from the mouth.^6,7 Regurgitation (when the reflux is visible) is defined as two or more regurgitation episodes per day for three or more weeks and does not present with retching, haematemesis, aspiration, apnoea, failure to thrive, feeding or swallowing difficulties or abnormal posturing.⁴

FGIDs are a frequent and relevant burden in infancy, and their symptoms are often extremely distressing for the infant and parents, resulting in a physical, social and emotional impact.^8,9 Pharmacists are often the first point of contact for concerned parents.

Pharmacist, John Bell told Australian Pharmacist: ‘Diagnosis can be difficult, and pharmacists have an important role to play in helping to resolve symptoms and providing parents with peace of mind.’

‘The longer these symptoms remain undiagnosed, and subsequently unmanaged, the bigger the toll. It can cause parental anxiety,^9,10 and is known to affect the relationship between the parents and their baby.’¹¹

‘Finding the right solution is important, with parents frequently seeking a quick fix rather than investigating the underlying cause. Pharmacists have an opportunity to have a conversation with parents and help resolve the issue before it escalates,’ says Mr Bell.

For more information on FGIDs, visit the Nutricia website here.

References

1. Vandenplas Y et al. JPGN. 2015; 61(5):531-537
2. Salvatore S et al., Acta Paediatrica. 2018; 107:1512-1520
3. Hyman PE et al. Childhood functional gastrointestinal disorders: Neonate/toddler. Gastroenterol 2006;130:1519–1526
4. Benninga MA et al. Gastroenterology. 2016; 150:1443-1455
5. NICE. CG99. Constipation in children and young people. 2010. Available at: http://publications.nice.org.uk/constipation-in-children-and-young-people-cg99 (accessed September 2015)
6. Poets CF & Brockmann PE. Myth: Gastroesophageal reflux is a pathological entity in the preterm infant. Semin Fetal Neonatal Med 2011; 16:259–263
7. NICE. NG1. Gastro-oesophageal reflux disease: recognition, diagnosis and management in children and young people. 2015. Available at: https://www.nice.org.uk/guidance/ng1/resources/gastrooesophageal-reflux-disease-recognition-diagnosis-and-management-in-children-andyoung-people-51035086789 (accessed September 2015)
8. Iacono G et al. Gastrointestinal symptoms in infancy: a population-based prospective study. Dig Liver Dis 2005; 37(6): 432–438
9. Thapar N. Novel perspectives on functional gastrointestinal problems in infancy. Satellite symposium during the 46th Annual Meeting of ESPGHAN 2015
10. van Tilburg MA et al. Prevalence of functional gastrointestinal disorders in infants and toddlers. J Pediatr 2015; 166: 684–689
11. Waddel L. Management of infantile colic: an update. J Fam Health Care 2013; 23(3): 17–22