Common gastrointestinal distress among infants: Role of optimal nutritional interventions

Abstract

The immature gastrointestinal (GI) tract makes infants vulnerable to transient disorders including colic, gastro-oesophageal reflux (GER) and constipation. These conditions cause a significant distress to infants and caregivers, and are among the most common reasons for the paediatrician referral. In addition, these conditions are associated with a significant morbidity, hospitalisations and high healthcare costs, adding to the burden of the disease. Although they are additions to the ongoing physiological development or arise from maladaptive behavioural responses, the evidence remains limited. The vague aetiology and the self-limiting nature, has devoid these conditions of robust clinical attention, both in the research and clinical practice. Frequent early-life intestinal insults may translate as a risk factor in the development of chronic GI disorders and psychological problems later in life. Emerging evidence suggests that providing an optimal nutritional intervention closer to the breast milk can be a path breaking approach to manage these frequently encountered conditions and aid the growth and development of infants.

Optimal nutrition in gastrointestinal distress among infants aged 6-8 weeks: An observational study in India

“…Calcium absorption of cow's milk is 20% less than that of human milk and the lactose content is also considerably lower (~3.7-5 g/100 g) than that in human milk (~6.9-7.5 g/100g); hence, cow's milk is a comparatively suboptimal energy source [22,23] . Whey/casein ratio in cow's milk is 20:80, which is very low compared with the optimal ratio of 60:40 in breast milk [17] . In addition, introduction of cow's milk in infant's feed can evoke an immunological response, resulting in cow's milk protein allergy and cow's milk propensity to lead to iron deficiency, which increases the risk of dehydration [24] .…”

“…Whenever breast milk is not available, ensuring nutritional intervention, which is comparable to breast milk, is necessary for optimal digestive health. It is recommended that optimal lactose content; whey/casein ratio; calcium/phosphate ratio; osmolality; and pro-and prebiotics should be considered to alleviate infantile GI distress [17] . In this regard, IF is considered as an alternative/adjuvant source of nutrition to breast milk in infants and toddlers [18] .…”

A significant cause of constipation and growth retardation: hirschsprung’s disease

“…Constipation, defined as difficult defecation ( less than 3 times per week and continued at least two weeks) is the most common gastroenterological complaint in the childhood, [13,[16][17][18]. Anamnesis and physical examination are the most important steps in the evaluation of the patient presenting with constipation [11,19]. It should first be decided whether the disease is organic or functional [2,4,19].…”

“…Anamnesis and physical examination are the most important steps in the evaluation of the patient presenting with constipation [11,19]. It should first be decided whether the disease is organic or functional [2,4,19]. Weight loss, growth retardation, bloody stool, constipation from early infant period; fever, accompanied by vomiting and other system findings should thought to have organic causes.…”

A cross sectional survey in paediatricians pertaining to management of functional gastrointestinal disorders in infants: Indian perspectives

“…2 These issues create psychological stress on parents and healthcare providers leading to a never-ending cycle of trying medications, dietary manipulations, behavioral strategies and complementary supplements. 3 This in turn have a significant impact on personal and public healthcare expenses, which include the costs of prescribed treatments in countries where residents pay for child healthcare, over the counter or home remedies, visits to healthcare professionals and loss of income when parents have to take time off work. 2 In Asian infants, the studies on epidemiology, etiology and management of FGIDs are scarce and mostly extend the understanding from global research.…”