HCM CITY- The latest diagnostic criteria for infant and toddler functional gastrointestinal disorders (FGIDs) were updated for paediatricians at conferences held in HCM City and Hà Nội on August 12 and 13.

These are designed to help paediatricians diagnose the disorders without tests and improve children’s digestive systems, according to experts.

Prof Dr Nguyễn Gia Khánh, chairman of the Việt Nam Paediatric Association, told the conferences that FGIDs do not seriously affect infants and toddlers’ growth or cause serious complications, but reduce the quality of their life.

Prof Marc Benninga, pediatric gastroenterologist at Emma Children’s Hospital in the Netherlands, said infant and toddler FGIDs include a variable combination of often age-dependent, chronic or recurrent symptoms not explained by structural or bio-chemical abnormalities.

Functional symptoms during childhood sometimes accompany normal development – for example, infant regurgitation -- and could arise from maladaptive behavioural responses to internal or external stimuli like retention of feces in the rectum, which often results from an experience with painful def­ecation, he said.

Childhood FGIDs are not dangerous when the symptoms and caregiver’s concerns are addressed and contained, he said.

“Con­versely, failed diagnosis and inappropriate treatments of functional symptoms may be the cause of needless physical and emotional suffering.”

In 2006 a consensus on FGIDs in infants and toddlers was arrived at. But at that time little evidence regarding epidemiology, pathophysiology, diagnostic work-up, treatment strategies and follow-up was available. 

Consequently, the criteria for the clinical entities were more experience than evidence based. In the past decade new insights have been gained into various FGIDs in these age groups. Based on those, further revisions have been made to the criteria.

Benninga said when infants and toddlers get constipation, which is considered one of the symptoms of FGIDs, parents should not change their formula milk.

Khánh of the Việt Nam Paediatrics Association said many studies showed that the digestive tract cannot adapt to frequent changes in milk, affecting infants and toddlers’ growth.

Benninga advised that infants and toddlers with constipation should not eat high-fibre food or drink a lot of fluids.

It is best to visit doctors and take medicines that induce bowel movements or soften or loosen up the stool, he said.

Moreover, parents are often stressed, angry and worried when infants and toddlers with FGIDs cry a lot, and they usually forcefully and violently shake the child to try and stop it from crying, he said.

Such shaking can affect babies’ development, he warned.

Parents should take their children to doctors when they cry for many days, he said.

The causes of digestive disorders in infants and toddlers were discussed at the conferences.

Paediatricians said that changes in the structure of proteins in milk are to blame for the disorders.

High temperatures while processing milk causes the changes, and the changed proteins are indigestible for babies, leading to dyspepsia, abdominal pain and constipation, they said.

Parents should choose naturally high protein food to help their children digest easily, they said.

Children aged more than two need a lot of proteins for developing muscles, skin, hair, nervous and immunity systems and others, they added.

The conferences on ROME IV - new criteria in diagnosis and treatment of infants and toddlers’ FGIDs were held by the Việt Nam Paediatric Association in co-operation with FrieslandCampina Việt Nam’s Friso brand.

LockNutri_­^TM technology, which best protects the structure of natural proteins in milk and is used to produce the Friso brand of milk, was referred to at the conference. –VNS