A Narrative Review on the Update in the Prevalence of Infantile Colic, Regurgitation, and Constipation in Young Children: Implications of the ROME IV Criteria

Retrospective Study on the Association Between Climate Factors and Infant Colic in Beijing (2021-2022)

Purpose

To assess seasonal variations in infant colic (IC) prevalence and explore the association between climate factors, including temperature, air pollutants, and their interactions, with IC.

Methods

Medical records of 1955 infants aged 0-3 months from October 2021 to September 2022 were analyzed, with IC diagnosed according to Rome IV criteria. Seasonal differences in IC prevalence were compared using chi-square tests. Climate data, including weekly averages of temperature, PM2.5, PM10, NO2, CO, O3, and AQI, along with 1-, 2-, and 4-week lags, were collected via web scraping. Interaction terms between temperature and pollutants (including lagged variables) were created. Variance Inflation Factors (VIF) addressed multicollinearity. Pearson correlation assessed linear relationships, while Generalized Additive Models (GAM) evaluated non-linear associations.

Results

The overall IC prevalence was 38.62%. Demographic analysis showed no significant differences between infants with and without IC. Seasonal analysis revealed significant differences, with the highest IC prevalence in winter. After Bonferroni correction, spring (34.52%) and winter (43.60%) differed significantly (p < 0.0083). Linear correlation analysis indicated weak associations between temperature, pollutants, and their interactions with IC (correlation coefficients: -0.05 to 0.03). GAM confirmed these findings, with individual climate factors explaining only 0.002 of the deviance and their interactions explaining 0.007. No meaningful relationship between climate factors and IC prevalence was identified.

Conclusion

This study identified significant seasonal differences in IC prevalence, with the highest rates observed in winter. However, no significant linear or non-linear associations were found between IC and temperature, air pollutants, or their interactions. These findings underscore the need for future research to explore non-climatic factors.

Evaluating the influence of parental atopy on the effectiveness of a maternal dairy-free diet in alleviating infantile colic: a before-and-after study

BACKGROUND

Infantile Colic (IC) poses a significant challenge for parents as it manifests through repeated and extended episodes of fussiness, crying, or irritability occurring before the age of 5 months. The precise cause of IC is currently unknown. The association between IC, a family history of atopy, and the development of individual atopy in the future remains uncertain, given conflicting findings from prior studies.

OBJECTIVES

This study aimed to investigate the impact of parental atopy on IC severity and the effectiveness of the mother's hypoallergenic Dairy-Free Diet in alleviating pain in infants with colic.

METHODS

This non-randomized trial conducted at Amirkabir Hospital in Arak, Iran, from January 2023 to October 2023, involving 206 eligible IC patients non-randomly assigned to two groups based on parental atopy history. Breastfed infants were prescribed a dairy-free diet, involving the removal of dairy products from the mother's diet. Pain severity was assessed using the FLACC scale at baseline and after one-month of intervention.

RESULTS

The research initially involved 206 subjects with an average age of 28.77 ± 9.99 days, evenly distributed based on parental atopy history. However, there was a 28.6% loss to follow-up, resulting in a final analyzed population of 147 individuals. The intervention, a maternal dairy-free diet, demonstrated a significant reduction in pain symptoms within both groups and overall (P = 0.001), with no significant difference in efficacy between infants with and without parental atopy history (P = 0.219). Parental history of atopy did not exhibit a significant association with colic pain severity (P = 0.404). The study revealed that the impact of the diet on colic severity varied, with more pronounced effects observed in cases of severe and moderate colic compared to mild cases.

CONCLUSIONS

Adopting a Dairy-Free Diet significantly reduced colic symptoms, irrespective of parental atopy history. The severity of colic appears unrelated to parental atopy, and the observed improvement with a Dairy-Free diet is potentially attributed to milk intolerance rather than milk allergy.

Exploring Community Perspectives on Functional Paediatric Habitual Constipation

(1) Background: Functional habitual constipation (FC) in children is a common gastrointestinal problem. This study aimed to explore the local community's view on this problem, emphasising the challenges that parents face in managing the condition and its impact on the child's quality of life. (2) Methods: A prospective, cross-sectional, community-based study was conducted between March and July 2023. The survey received 933 responses. The target population was adults over 18 years of age living in the Eastern Province of Saudi Arabia. An electronically distributed questionnaire was designed in the Arabic language. (3) Results: The mean knowledge scores were significantly higher in females than males, with t (931) = -2.701 and p = 0.007. The Bonferroni post hoc test results indicated that participants between 20 and 29 years exhibited significantly higher levels of knowledge scores compared to those between 30 and 39 years. Furthermore, the results revealed that those with three or more children had significantly higher knowledge scores compared to those with only one child. (4) Conclusions: This study demonstrated that parents in the local community have a good perceived knowledge of FC, but it needs to be linked with practice. They tended to report high levels of perception and demonstrated better practices. These results emphasise the importance of exploring the local community's view on constipation among children.

Diagnosis and management of food allergy-induced constipation in young children-An EAACI position paper

The recognition of constipation as a possible non-Immunoglobulin E (IgE)-mediated allergic condition is challenging because functional constipation (unrelated to food allergies) is a common health problem with a reported worldwide prevalence rate of up to 32.2% in children. However, many studies in children report challenge proven cow's milk allergy and constipation as a primary symptom and have found that between 28% and 78% of children improve on a cow's milk elimination diet. Due to the paucity of data and a focus on IgE-mediated allergy, not all food allergy guidelines list constipation as a symptom of food allergy. Yet, it is included in all cow's milk allergy guidelines available in English language. The Exploring Non-IgE-Mediated Allergy (ENIGMA) Task Force (TF) of the European Academy for Allergy and Clinical Immunology (EAACI) considers in this paper constipation in the context of failure of standard treatment and discuss the role of food allergens as culprit in constipation in children. This position paper used the Delphi approach in reaching consensus on both diagnosis and management, as currently published data are insufficient to support a systematic review.

Rome IV Clinical Criteria and Management of Functional Constipation: Indonesian Health Care Professionals' Perspective

Purpose

The updated ROME IV criteria for functional constipation (FC) in children were published in 2016. However, information on the use of these criteria is scarce. This study aimed to report the frequency of the use of the ROME IV criteria by Indonesian pediatricians and general practitioners (GPs) in FC management in infants and toddlers.

Methods

An anonymous cross-sectional online survey was conducted between November 2021 and March 2022.

Results

A total of 248 respondents (183 pediatricians and 65 GPs) from 24 Indonesian provinces completed the survey. Most respondents reported an estimated prevalence of FC to be less than 5% both in infants and toddlers. On average, only 64.6% of respondents frequently used the ROME IV criteria. Pediatricians used the ROME IV criteria more often than GPs did (p<0.001). The most frequently used criteria were painful or hard bowel movements (75.0%) and ≤2 defecations/week (71.4%). Lactulose as a laxative was the preferred treatment choice, followed by changing the standard formula to a specific nutritional formula. Most of the respondents carried out parenteral reassurance and education. Normal growth, as a marker of good digestion and absorption function, and normal stool consistency and frequency were the most reported indicators of gut health.

Conclusion

The ROME IV criteria for functional constipation are not extensively used by pediatricians and GPs in Indonesia. Laxatives and specific nutritional formulas were the most used management approaches in infants and toddlers. Medical education, especially for general practitioners, should be updated.

A narrative review on the diagnosis and management of constipation in infants

INTRODUCTION

Functional constipation is one of the common disorders of gut-brain interaction in infancy, and decreases the quality of life of infants and parents.

AREAS COVERED

Relevant articles up to November 2022 were reviewed. We searched in PubMed, Google Scholar, and MEDLINE for guidelines, position papers, reviews, and randomized controlled trials on infant constipation.

EXPERT OPINION

Randomized controlled trials in this specific age group are mostly limited to trials with infant formula. The prevalence of infant constipation in formula-fed infants is decreasing, and can be associated with adaptations in formula composition. While the supplementation of infant formula with pro-, pre- and/or synbiotics decreases the prevalence of constipation, their efficacy in constipated infants is disappointing. There is limited evidence to support the addition of magnesium to infant formula to treat constipation. The evidence for the efficacy and safety of polyethylene glycol in children < 2 years has expanded over the past years. The administration of lactulose or polyethylene glycol is the preferred medical management, in case nutritional management does result in insufficient improvement.

Effectiveness of a starch thickened infant formula with reduced lactose content, probiotics and prebiotics on quality of life and clinical outcome in infants with regurgitation and/or colic

Background

Regurgitation and colic are quite common in young infants, leading to a reduced quality of life (QoL) and to parental distress. Their management is challenging and aims to effectively reassure and relieve symptoms. This study aimed to assess the effectiveness over 30 days of a starch thickened formula with a reduced lactose content, Limosilactobacillus reuteri (Lactobacillus reuteri) DSM 17938 and FOS/GOS.

Methods

A real-world prospective multicenter experimental study was conducted in a before-after design within subject. Full term infants 0-5 months with regurgitation or colic or both symptoms and without intercurrent illness were included after parental informed consent and received the studied formula. The primary endpoint was the improvement in QoL using the QUALIN infant's questionnaire. Secondary endpoints were the symptoms outcome and the formula tolerance.

Results

Of the 101 infants included (age: 6.2 ± 4.3  weeks), 33 had regurgitation, 34 colic and 34 had both. At D30, the QoL score was improved in 75% of infants in per protocol analysis (n = 68; +8.2 ± 13.7; p < 0.001), more in those with colic or both symptoms. Meanwhile, in intention to treat analysis (all p < 0.001), the daily number of regurgitations decreased by 61% and the weekly number of days with colic by 63% while the daily cumulative duration of crying decreased by 82 ± 106 mn. These improvements were observed within the first week by 89 and 76% of parents, respectively.

Conclusion

The study formula associated with reassurance is shown to be quickly effective in the management of infant's regurgitation or/and colic in routine clinical practice.

Clinical trial registration

https://clinicaltrials.gov/, identifier NCT04462640.

Early-Life Gut Health Indicators and Reported Prevalence of Infant Functional Constipation by Healthcare Professionals

A healthy gut during early childhood is important. However, it seems that there are no standard indicators used to assess it. Healthcare professionals (HCPs) were asked via an electronic survey question about gut health indicators (GHIs) for infants and toddlers, in addition to an estimated prevalence of infant's functional constipation (FC) and its management. HCPs from eight countries participated in the survey (Russia (66.0%, 1449), Indonesia (11.0%, 242), Malaysia (6.0%, 132), Mexico (5.7%, 125), KSA (5.1%, 113), Turkey (3.0%, 66), Hong Kong (2.2%, 49), and Singapore (1.0%, 23)). The 2199 participating respondents were further classified into three continents (Asia (20.2%), Europe (68.8%), and others (11.0%)). Most of them were pediatricians (80.3%), followed by pediatric gastroenterologists (7.0%), general practitioners (6.4%), and others (6.3%). The top three preferred GHIs were similar for infants and toddlers: an absence of gastrointestinal (GI) symptoms, effective digestion/absorption as assessed by normal growth, and a general feeling of well-being. The absence of GI-related infection was the least preferred indicator. Most of the respondents reported the prevalence of FC among infants was less than 5%, with the peak incidence between the ages of 3 and 6 months. The reported choices of intervention to manage FC in infants were a change to a specific nutritional solution from a standard formula (40.2%), parental reassurance (31.7%), and lactulose (17.0%). Conclusion: The HCPs in the eight countries preferred the absence of GI symptoms, normal growth for effective digestion and absorption, and general well-being as the gut health indicators in infants and toddlers. The reported prevalence of FC in infants was less than 5%.

Reported Prevalence and Nutritional Management of Functional Constipation among Young Children from Healthcare Professionals in Eight Countries across Asia, Europe and Latin America

Background: The prevalence of functional constipation (FC) among children varies widely. A survey among healthcare professionals (HCPs) was conducted to better understand the HCP-reported prevalence and (nutritional) management of FC in children 12−36 months old. Methods: An anonymous e-survey using SurveyMonkey was disseminated via emails or WhatsApp among HCPs in eight countries/regions. Results: Data from 2199 respondents were analyzed. The majority of the respondents (65.9%) were from Russia, followed by other countries (Indonesia (11.0%), Malaysia (6.0%)), Mexico, KSA (5.1% (5.7%), Turkey (3.0%), Hong Kong (2.2%), Singapore (1.1%)). In total, 80% of the respondents (n = 1759) were pediatricians. The prevalence of FC in toddlers was reported at less than 5% by 43% of the respondents. Overall, 40% of the respondents reported using ROME IV criteria in > 70% of the cases to diagnose FC, while 11% never uses Rome IV. History of painful defecation and defecations < 2 x/week are the two most important criteria for diagnosing FC. In total, 33% of the respondents reported changing the standard formula to a specific nutritional solution, accompanied by parental reassurance. Conclusion: The most reported prevalence of FC in toddlers in this survey was less than five percent. ROME IV criteria are frequently used for establishing the diagnosis. Nutritional management is preferred over pharmacological treatment in managing FC.

A population-based study on prevalence and predisposing risk factors of infant functional gastrointestinal disorders in a single center in Southern Fujian

BACKGROUND AND AIM

The prevalence of infant functional gastrointestinal disorders (FGIDs) varies across different areas but is largely unknown in southern Fujian. The aim of this study is to evaluate the prevalence of infant FGIDs in southern Fujian according to Rome IV diagnostic criteria.

METHODS

A cross-sectional prospective questionnaire-based survey was conducted among healthy infants between 0 and 3 months of age in southern Fujian. A total of 1,006 infants who received a physical examination from October 2017 to October 2018 were recruited in this study. Parents or caregivers provided demographic information and completed the questionnaire on gastrointestinal symptoms for infants. Infants with FGIDs were diagnosed using the Rome IV criteria.

RESULTS

Based on the Rome IV criteria, the prevalence of having a FGID in infants is 58.3% (586/1,006). The most common FGIDs in infants were regurgitation (45.7%, 460/1,006), followed by difficult defecation (3.6%, 36/1,006), functional constipation (3.2%, 32/1,006), and colic (2.4%, 24/1,006). No infants fulfilled diagnostic criteria for rumination syndrome and cyclic vomiting syndrome. Among the infants with FGIDs, 457 cases (78.0%, 457/586) were found with single FGID. Combined FGIDs were diagnosed in 129 (22.0%, 129/586) infants; of whom, 21.2% (124/586) had double disorders and 0.9% (5/586) had triple disorders. The most common combined FGIDs were regurgitation and difficult defecation (12.8%), followed by regurgitation and colic (2.4%). Risk factor analysis revealed that younger paternal age (B = 0.424, P = 0.004), paternal history of FGIDs (B = 0.821, P = 0.000), maternal history of FGIDs (B = 0.427, P = 0.012), and probiotics received in infant (B = 0.324, P = 0.032) were associated with an increased risk of infant FGIDs, whereas vitamin D supplementation after birth (B = -0.690, P = 0.000) can reduce the risk of developing FGIDs.

CONCLUSION

FGIDs are common in infants living in southern Fujian according to Rome IV diagnostic criteria. The most common FGIDs in infants were regurgitation, difficult defecation, and functional constipation. Factors including younger paternal age, parental history of FGIDs, and the probiotic supplementation in infant showed a significant association with infant FGIDs. Whereas, vitamin D supplementation in infant was found to be a protective factor against FGIDs.