Functional GI disorders in infants
Regurgitation (possetting)
Passive process (not vomiting mechanism) due to higher pressure in stomach than esophagus and immaturity of sphincter
Useful comparative: if adult drank same adjusted milk volume (7L) and lay around all day they would likely get similar
Red flags – failure to thrive/gain weight, blood in vomit, apnoea, etc
Management
– reassurance and explanation regarding natural history (resolution 6-9 months in majority)
– ensure feed volume not excessive/smaller feeds more often/posture
– thickener
– trial on extensively hydrolysed formula
– PPI and H2A shouldn’t be used unless evidence of erosive esophagitis
‘Colic’
Primary goal is to rule out organic causes – is baby acutely unwell/feverish/not interested in feeding
May be due to developmental of baby rather than pain
Trial baby massage and ensure social supports in place
Avoid medication
Constipation
Check red flags – meconium passed > 24hr delay, Hirshprung, inperforate anus, spinal (sacral dimple – gluteal fold deviation, hemangioma)
Dyschezia is different entity – difficulty passing normal (not hard) stool – occurs in 5% of infants under 9 months – developmental issue (co-ordinating muscles) – do not use laxatives
Lactulose < 6 months
Macrogol > 6 months
+/- glycerol suppository
Consider trial on hydrolyzed formula