Gastro-intestinal disorders

Regurgitations are the effortless returns of gastric contents through the esophagus and out of the mouth. Gastro-esophageal reflux (GER) is defined as the passage of gastric content into the esophagus with or without regurgitation and vomiting¹. This may cause acid exposure, at the origin of burning sensations.

In literature, the prevalence of regurgitations in infants younger than 12 months varies from 3 % to 87%², this large range being probably due to differences across studies in their design, their setting, and the diagnosis criteria used.  According to a recent study using the Rome IV criteria as definition for regurgitations, the reported prevalence was of 24.1%³. In a French cross-selectional study, the estimated prevalence of GER in infants aged from 0 to 23 months was 24.4%, and that in children aged from 2 to 11 years was 7.2%⁴.

Regurgitations can be physiologic and can be aggravated through several factors: lying position, abdominal compression, important volume of feeding, liquid foods. They can also be a symptom of another disease such as cow’s milk allergy⁵.

When GER leads to more severe symptoms that affect daily functioning and/or complications, it is called GER Disease (GERD). High volumes of regurgitations returned with force may lead to other important issues like feeding difficulties, growth disorders, etc¹.

Experts recommend thickened feed for treating visible regurgitation/vomiting, including infants with GERD¹.

Prevalence of functional constipation in the 1^st year of life varies between 0.05% to 39.3%¹, this large range being probably due to differences across studies in their design, their setting, and the diagnosis criteria used and 17.6% of all infants below 6 months suffer from constipation².Constipation mainly occurs when the infant experiences a painful defecation: by the infant: he/she then voluntarily retains passing his stools, causing prolonged fecal stasis in the colon, and resulting in fluid reabsorption as well as an increse size and consistency of stools³.

After several days without bowel movements, the most common symptoms are irritability, abdominal distension, cramps and decreased food intake³.

Causes of constipation in babies are numerous: change of rhythm or environment, immaturity of the digestive system, diet (such as low fiber, unadapted diet to the needs of the infant, or poor dilution of powdered infant formula) but also toilet training, stressful events, undercurrent diseases are factors which may favor constipation.

If nothing is done to break down the vicious circle of constipation, it can lead to fecal incontinence, loss of rectal sensation and ultimately loss of normal urge to defecate⁴. Therefore, it is necessary to treat the problem of constipation in children and to comfort both children and parents.

Up to 73% of all infants are affected by colics in their first months of life¹.

The signs of colics are agitation, intense and frequent tears, baby's fists getting tense and legs folding up on his belly. They are furthermore associated with frequent gas and flatus. Infants are inconsolable and seem to have abdominal pain.

Colics are paroxysms of irritability, fussing or crying that last up to 2/3 hours or more per day and that occur more than 3 days per week for at least 3 weeks². These criteria are commonly referred to as “the rule of threes” (3 hours per day, 3 days per weeks for at least 3 weeks). In the recent Rome IV definition of colic, any reference to precise time (duration of crying per day, time of occurrence of the symptoms…) has been omitted to keep only the idea of “recurrent and prolonged periods of crying that have no obvious cause and that [caregivers] cannot prevent or resolve³”.

The etiology of colics is not fully understood and several factors may contribute to their development (such as a stressful environment, diet…) Although colics are benign, they negatively impact the baby’s (and the family’s) quality of life and may have long term consequences by disturbing the interaction of the infant with his/her parents but also by causing him/her migraines, recurrent abdominal pain⁴, etc.

On average, a child will suffer from 0.5 to 1.9 episodes of diarrhea each year in his/her first 3 years of life¹. Diarrhea is defined as having at least 3 loose or watery stools per day but this definition does not take into account factors such as age so that a decrease in the consistency of stools (loose or liquid) and/or an increase in the frequency of evacuations may be considered as a diarrhea¹ . The main causes for diarrhea are: infection, intolerances to nutrients, drugs, improper feeding...

Acute diarrhea is characterized by significant losses of fluids and electrolytes in the stools, and by a decreased energetic efficiency of ingested foods.

The main risk of diarrhea to infants is dehydration. Diarrhea can be extremely dangerous in infants as dehydration can occur quickly. That is why it is recommended to parents to always get advice from a healthcare professional about their baby’s situation.