How to treat digestive disorders affecting babies

For several years now, the paradigm of thefirst thousand daysina child'slife has become firmly established, highlighting the importance of this period, which comprises the 270 days of gestation and the 365 days ofthe baby'sfirst and second years oflife, asa key stage for their future development. During this period,adequate nutritionis one of the fundamental pillars for strengthening the child's human potential.

But what happens when babies cry inconsolably due tocolic, regurgitation, constipation, or diarrhea? These gastrointestinal symptoms are called "functional digestive disorders" (FDOs), and from birth to approximately six months of age,about 1 in 2 babies develop at least one functional disorder orrelated signs and symptoms, which represents a significant impact on a very large number of families.

Although these conditions do not originate from a specific organic disease, they are disorders that affect the health and quality of life of the baby, causing anxiety in families, poor quality of life, reduced duration of exclusive breastfeeding, and numerous changes in formula milk, among other issues, which are more pronounced in infants with more than one of these symptoms.

Gastrointestinal symptoms in newborns and children under 4 years of age are one of the main reasons for consulting a pediatrician, presenting a functional disorder or related signs and symptoms, such as colic, regurgitation, constipation, diarrhea, and dyschezia, the latter defined as a defecation disorder consisting of difficult bowel movements and often leading to chronic constipation.

Regurgitation isthe effortless return of food from the stomach and occurs in around 30% of children at this stage of life. Meanwhile, colic causes severe abdominal pain, which manifests itself in an acute, intermittent, and spasmodic manner: it affects 1 in 5 babies and causes inconsolable crying. Constipation is defined as when a child has restricted bowel movements and experiences significant general discomfort. It is estimated to affect 20% of infants.

The symptoms of functional disorders can be very distressing for babies and their families; in fact, inconsolable crying is a frequent reason for visits to the emergency room, often in the middle of the night, causing a great deal of stress for the family.

Diarrhea is largely attributed to digestive immaturity in the first months of life, where the gut microbiota, the set of microorganisms that inhabit our intestines, also plays an important role. The balance between healthy microorganisms and those that could potentially make us sick is key to intestinal and overall health.

Bacterial colonization begins during intrauterine life and continues throughout the first two years of life. During pregnancy, the baby's microbiota is influenced by the mother's health and nutrition, while at birth, the type of delivery also plays an important role, with natural childbirth being ideal, as the baby acquires beneficial bacteria from the mother as it passes through the birth canal.

Immediate skin-to-skin contact and exclusive breastfeeding until 6 months of age, continuing for 2 years or more, are also important. All of these factors are determinants of a healthy microbiota that will impact the newborn's health throughout their life.

Recommendations for the treatment of functional digestive disorders

First and foremost, it is important to reassure families and provide them with appropriate nutritional recommendations. These include:

– Always maintain breastfeedingand allow time during consultations to support families in these clinical situations.

– Ensure that drug treatment is NOT the first option for children with TDFs.

– For those who receive formula milk, choose those specially designed for the treatment of these digestive disorders, which are covered because they are considered medicinal formulas (Law No. 27,305).

This regulation, also known as the 'medicinal milk law', was enacted in 2016 and stipulates that all health insurance providers and, in the case of families without social security, the State, must cover 100% of the cost of medicinal milk for all children who '...suffer from cow's milk protein allergy (CMPA), as well as those suffering from gastrointestinal disorders, diseases, or disorders and metabolic diseases...'.

Pediatricians will never tire of recommending, insisting, and reiterating thatbreastfeeding is always the best option. For children who are fed formula, there are formulas specially designed for their treatment, which help reduce the frequency of regurgitation, decrease the intensity of colic, or soften stools if constipation is the problem. At the same time, specific exercises and postures are often recommended to improve the situation.

In the first person

Leandro Desplats is a lawyer and new father. Below is his personal experience,recounted in the first person. We eagerly and joyfully awaited Luca's arrival. We never imagined or anticipated that the first few months would be so difficult due to the problems that arose from his feeding disorders. At the time of his birth in August 2021, he was a healthy baby, but at around a month and a half old, he began to suffer from severe stomach pains with inconsolable crying, intense colic, constipation, persistent diarrhea with consequent dermatitis in the area, flatulence, loud noises in his stomach, and vomiting with severe gastric reflux.

It goes without saying that our son experiences difficulties when these symptoms affect him, even preventing him from falling asleep, and that rest is very important at this stage of his development.

It took us two months to obtain an accurate diagnosis due to the difficulty in getting an urgent appointment with a pediatric gastroenterologist. In the meantime, Luca suffered daily, and so did we, managing with his regular pediatrician.

It was very difficult for us to find a medicated formula that would alleviate his symptoms, until we found it. We did the first tests and our son, almost magically, immediately stopped having symptoms.

In light of these facts and our enormous concern as parents, we went to the health insurance company with the relevant documentation, diagnoses, and prescriptions to request coverage. However, despite our insistence, they systematically rejected our request, even under the terms of current Law 27,305, which requires health insurance providers and private health insurance companies to cover 100% of the cost of special medical milk, based on the Mandatory Medical Plan (PMO) and the Maternal and Child Plan (PMI).

Faced with the refusal of the health insurance company, the pediatrician recommended new formulas to test his tolerance, but the attempts were in vain. We made a great financial effort while we went to court, requesting a precautionary measure.

The story has a happy ending, because Luca finally got the benefit he was entitled to, but unfortunately he had to take legal action to get it. I am "lucky" enough to have the necessary tools to claim what my son is entitled to by law, and that is what we did.

Based on this difficulty we experienced with Luca, we began to become aware of and learn about the difficulties faced by many families who do not have the necessary information or sufficient resources to deal with this process. That is why, in February, we started a solidarity project, together with other parents who had experienced similar situations, In this project, we basically provide advice and file complaints regarding the rejection and limitations of medical milk benefits in a timely manner and through the appropriate legal channels, helping all parents who find themselves in the same situation with their babies.

* Dr. Carmen Vecchiarelli (MN 66.176) is a pediatric neonatologist and deputy head of the Neonatology Department at the Medical Center in Buenos Aires.

Source: Infobae