Functional Gastrointestinal Problems in Infants
A group of pediatric gastroenterologists met in Rome to try to produce a “diagnostic consensus” on a number of common conditions in infancy and early childhood, about which there is little agreement on how to diagnose them and what they look like clinically. The group produced the so-called Rome II criteria for these disorders. The article is quite valuable in that it covers a number of conditions that sometimes are baffling for clinicians, it helps to think about how to diagnose them and how they should be treated. It describes conditions of vomiting in infancy like infant regurgitation and the “infant rumination syndrome”, as well as the more rare relative “cyclic vomiting” which is thought to be an equivalent of migraine. For the somewhat older child, conditions like dyspepsia ( discomfort in the stomach), aerophagia (constant swallowing of air leading to abdominal discomfort and premature satiety during meals) as well as abdominal migraine. Finally, it also describes a condition in infants called “infant dyschezia”, which occurs in the very young infant, less than six months of age, who screams and cries before every bowel evacuation, which may lead to constipation if the child avoids defecating due to the fear of pain. This paper is worth reading and keeping around to review the diagnostic criteria and tests that might be useful when a puzzling diagnostic issue of this nature is seen in a very small child.
Rasquin-Weber, A., Hyman, P..E., Cucchiara, S., Fleischer, D.R., Hyams, J.S., Milla, P.J., Staiano, A. Childhood functional gastrointestinal disorders.Gut, 1999. Vol. 45. suppl. II. 11601168