Management of gut-related symptoms in the paediatric population can be challenging. Many factors need to be taken into consideration including psychological, behavioural and other family members as well as growth and developmental requirements.
The most common complaint in infants, particularly the first 3 months of life, is colic. Although the aetiology of infantile colic is not known, it is often suggested that it is gut-related. The Wessel Criteria define infantile colic as ‘paroxysms of crying-fussing episodes, lasting for more than 3 hours per day, for three or more days per week and for three or more weeks’. Infants with colic also present with excessive flatulence, back arching, drawing up of the knees, are red-faced with clenched fists and wrinkled brows. Breastfeeding mothers tend to change their diet to relieve colic symptoms, however, the evidence to support such practice is poor. Anecdotally avoiding dairy products and ‘windy’ foods (onions or cabbage) appears to be the most common strategy despite the lack of evidence. In formula-fed infants, switching from a standard cow’s milk formula to a partially- or extensively-hydrolysed formula has shown to be effective.
Functional gastrointestinal disorders (FGID) in children are thought to account for 50% of consultations by paediatric gastroenterologists. However, the prevalence of FGID in children is not fully understood. It has been suggested that irritable bowel syndrome (IBS), a FGID, affects up to 20% of school-aged children in the U.S. The evidence supporting dietary therapies in children with IBS suggests that a reduction of single or multiple dietary sugars such as, lactose, sorbitol or fructose is effective and more recently the low FODMAP diet was shown to have efficacy. While research evidence to support the use of a low FODMAP diet in the paediatric population is currently limited, interest in using this novel diet strategy is gaining momentum.