Investigate or reassure? When to refer for infant gastrointestinal issues

Rosalyn Page

writer

Rosalyn Page

Rosalyn Page

 

Most infant gastrointestinal issues will resolve on their own—know the red flags to watch for

Functional gastrointestinal problems in infants are very common and usually resolve themselves without requiring tests to find an underlying cause, according to Dr Rupert Hinds, a paediatric gastroenterologist at Monash Medical Centre.

“A lot of these functional problems are the process of the gut needing to mature and learn what it’s supposed to do,” Dr Hinds says.

From birth, a baby’s system is adjusting to milk, then eating and digesting food. This can be a challenge for a young immune system. Symptoms of discomfort and crying from colic, constipation and reflux are predominantly caused by immaturity of the gut.

Colic usually resolves after around four or five months and reflux towards the end of the first year.

With reflux, babies can regurgitate small amounts after they’re fed due to having a slightly loose junction where the oesophagus meets the stomach. This can occur regardless of whether the baby is breastfed or bottle fed.

Over the course of the first year of life the oesophagus gradually improves its function and tightness, making reflux much less likely, Dr Hinds says.

Introducing solids can also present further challenges to the baby’s digestive system. Dr Hinds says it’s important that GPs advise parents to introduce solids at about six months of age, as recommended by the Australian guidelines. GPs can explain to parents that things will improve as the baby expands their repertoire of solids, drinks a bit more water and gets used to different textures in their gut.

“Many babies are transiently constipated with the introduction of solids and for the most part it’s a normal process that settles with time,” he says.

For GPs, the mainstay of treatment is reassurance and looking at what the baby is being fed, what type of formula, the quantities and the baby’s age.

Dr Hinds recommends against over investigating and over medicating, “but keeping an open mind and looking for those things that would be unusual functional symptoms”.

However, there are certain red flags that suggest a more serious problem.

Red flags that should be investigated include:

  • The baby seems to be experiencing pain or discomfort when they regurgitate
  • The regurgitation is stopping the baby from wanting to feed.
  • Evidence of blood or bile.
  • The baby vomits so much that they are not gaining weight or thriving
  • The baby is coughing or having breathing problems due to their vomiting.
  • The baby’s constipation starts very early in life, before solids have been introduced
  • Their stools have blood or mucus.

 

“After looking at the history of the baby and its feeding, with any potential red flag symptoms, GPs need to refer them to a paediatrician or paediatric gastroenterologist for further diagnosis and management,” Dr Hinds says.

Dr Rupert Hinds will be speaking on Functional gut disease in infants at the upcoming Healthed webcast on Tuesday, 7 March. Register here to attend and earn CPD.

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Rosalyn Page

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