Gastroenterology

Gastroenterology

Volume 130, Issue 5, April 2006, Pages 1519-1526
Gastroenterology

Introduction
Childhood Functional Gastrointestinal Disorders: Neonate/Toddler

https://doi.org/10.1053/j.gastro.2005.11.065Get rights and content

Recognizing the importance of childhood functional gastrointestinal disorders in understanding adult functional gastrointestinal disorders, and encouraging clinical and research interest, the Rome Coordinating Committee added a pediatric working team to Rome II in 1999. For Rome III, there was an increase from 1 to 2 pediatric working teams. This report summarizes the current consensus concerning functional disorders in infants and toddlers. Another report covers disorders diagnosed more often in school-aged children and adolescents. The symptoms from functional gastrointestinal disorders in children younger than 5 years depend on maturational factors in anatomy, gastrointestinal physiology, and intellectual and affective functioning. There has been little or no change for infant regurgitation, infant rumination syndrome, or infant dyschezia. Cyclic vomiting syndrome may be diagnosed after 2 rather than 3 episodes. The description of infant colic has been expanded, although there was consensus that infant colic does not reflect gastrointestinal malfunction. The greatest change was in functional constipation. Functional constipation and functional fecal retention in the 1999 report were merged into a single entity: functional constipation. Data-driven changes in diagnostic criteria for functional constipation appear to be less rigid and more inclusive than previous criteria.

Section snippets

G1. Infant Regurgitation

Regurgitation of stomach contents into the esophagus and mouth is common and normal in infants. Uncomplicated regurgitation in otherwise healthy infants is a developmental issue, not a disease. Regurgitation is the involuntary return of previously swallowed food or secretions into or out of the mouth. Regurgitation is distinguished from vomiting, which is defined by a central nervous system reflex involving both autonomic and skeletal muscles in which gastric contents are forcefully expelled

G2. Infant Rumination Syndrome

Infant rumination syndrome is a rare disorder characterized by voluntary, habitual regurgitation of stomach contents into the mouth for self-stimulation. Rumination is regurgitation of recently swallowed food, rechewing, and either reswallowing or spitting out the food. Although rumination is a functional symptom, infant rumination syndrome is a life-threatening psychiatric disorder caused by social deprivation. Rumination in healthy older children and adults is discussed in other reports in

G3. Cyclic Vomiting Syndrome

Cyclic vomiting syndrome (CVS) consists of recurrent, stereotypic episodes of intense nausea and vomiting lasting hours to days that are separated by symptom-free intervals lasting weeks to months.9 The frequency of episodes ranges from 1 to 70 per year and averages 12 per year. Attacks occur at regular intervals or sporadically. Typically, episodes begin at the same time of day, most commonly during night or morning. Episode duration tends to be the same in each patient. CVS reaches its

G4. Infant Colic

The term “colic” implies abdominal pain caused by obstruction to flow from the kidney, gallbladder, or intestine. In contrast, “infant colic” is a behavioral syndrome of early infancy involving long crying bouts and hard-to-soothe behavior. Infant colic was defined as “paroxysms of irritability, fussing or crying lasting >3 hours per day and occurring >3 days each week.”13 There is no proof that crying in infant colic is caused by pain in the abdomen or any other body part. Nevertheless,

G5. Functional Diarrhea

Functional diarrhea is defined by daily painless, recurrent passage of 3 or more large, unformed stools for 4 or more weeks with onset in infancy or preschool years. There is no evidence for failure to thrive if the diet has adequate calories. The child seems unperturbed by the loose stools, and the symptom resolves spontaneously by school age.

G5. Diagnostic Criteria for Functional Diarrhea

Must include all of the following:

  • 1

    Daily painless, recurrent passage of 3 or more large, unformed stools

  • 2

Disorders of Defecation

Defecation frequency in healthy infants and children decreases with age.22 Breast-fed infants may defecate as frequently as 12 times per day or as infrequently as once in 3 or 4 weeks. Firm stools may occur from the first weeks of life in formula-fed infants. These infants may experience painful defecation and so have a predisposition toward developing functional constipation (see following text).

There is a decline in stool frequency from an average of more than 4 stools daily in the first week

G6. Infant Dyschezia

Parents describe infants with dyschezia as straining for many minutes, screaming, crying, and turning red or purple in the face with effort. The symptoms persist for 10–20 minutes, until there is passage of soft or liquid stool. Stools pass several times daily. The symptoms begin in the first months of life and resolve spontaneously after a few weeks.

G6. Diagnostic Criteria for Infant Dyschezia

Must include both of the following in an infant younger than 6 months of age:

  • 1

    At least 10 minutes of

G7. Functional Constipation

Constipation represents the chief complaint in 3% of pediatric outpatient visits. Approximately 40% of children with functional constipation develop symptoms during the first year of life.27, 28 Sixteen percent of parents of 22-month-old children reported constipation.29

G7. Diagnostic Criteria for Functional Constipation

Must include 1 month of at least 2 of the following in infants up to 4 years of age:

  • 1

    Two or fewer defecations per week

  • 2

    At least 1 episode per week of incontinence after the

Recommendations for Future Research

  • 1

    Validating the diagnostic criteria for the childhood functional gastrointestinal disorders will be an important goal for the next decade. Epidemiologic community-based studies and studies of populations believed to be at risk (eg, children of patients with functional gastrointestinal disorders, female child abuse victims) are needed to determine the applicability of the diagnostic criteria, which were arrived at by consensus rather than by data analysis.

  • 2

    Clinical trials measuring symptom change

References (38)

  • B. Bourke et al.

    Cochrane’s epitaph for cisapride in childhood gastrooesophageal reflux

    Arch Dis Child

    (2002)
  • D.R. Fleisher

    Infant rumination syndrome

    Am J Dis Child

    (1979)
  • Li BUK (guest ed). Cyclic vomiting syndrome: proceedings of the international scientific symposium on CVS. J Pediatr...
  • D.R. Fleisher et al.

    The cyclic vomiting syndromea report of 71 cases and a literature review

    J Pediatr Gastroenterol Nutr

    (1993)
  • I. Anderson et al.

    Effective prophylactic therapy for cyclic vomiting syndrome in children using amitriplytine or cyproheptadine

    Pediatrics

    (1997)
  • R. Gokhale et al.

    Use of barbituates in the treatment of cyclic vomiting during childhood

    J Pediatr Gastroenterol Nutr

    (1997)
  • M.A. Wessel et al.

    Paroxysmal fussing in infancy, sometimes called colic

    Pediatrics

    (1954)
  • D.R. Fleisher

    Coping with colic

    Contemp Pediatr

    (1998)
  • L. Lothe et al.

    Cow’s milk whey protein elicits symptoms of infant colic in colicky formula-fed infantsa double blind cross-over study

    Pediatrics

    (1989)
  • Cited by (508)

    View all citing articles on Scopus
    View full text