Infant formulas for the treatment of functional gastrointestinal disorders: A position paper of the ESPGHAN Nutrition Committee

Identifier:  imarina:9369118

Handle: https://hdl.handle.net/20.500.11797/imarina9369118

Authors:  Haiden, N; Savino, F; Hill, S; Kivelae, L; De Koning, B; Köglmeier, J; Luque, V; Moltu, SJ; Norsa, L; De Pipaon, MS; Verduci, E; Bronsky, J

Abstract:
Functional gastrointestinal disorders (FGID), such as infant regurgitation, infant colic, and functional constipation, are common and typically physiological phenomena during the early months of an infant's life and account for frequent consultations with pediatricians. Various infant formulas are marketed for their management and are frequently given by parents to infants before a medical consultation. However, the evidence supporting their effectiveness is limited and some have altered nutritional compositions when compared to standard formulas. Thus, these products should only be used under medical supervision and upon medical advice. Marketing and over-the-counter sales do not ensure proper medical guidance and supervision. The aim of this position paper is to review the current evidence regarding the safety and efficacy of formulas specifically formulated for addressing regurgitation, colic, and constipation, recognized as FGID. The objective is to provide guidance for clinical management based on the highest quality of available evidence. A wide search using Pubmed, MEDLINE, EMBASE and Cochrane Database of Systematic Reviews was performed including the MESH terms infant formula, colic, constipation, regurgitation, reflux, palmitate, lactase, lactose, magnesium, hydrolyzed protein, prebiotics or probiotics. 752 papers were identified and screened. Finally, 72 papers were included in the paper. In the absence of evidence, recommendations reflect the authors' combined expert opinion. Final consensus was obtained by multiple e-mail exchange and meetings of the Nutrition Committee. (1) For breastfed infants experiencing FGID such as regurgitation, colic, or constipation, transitioning from breastfeeding to commercial formulas is not recommended. (2) In general, whether an infant is breastfed or formula-fed, it's crucial to reassure parents that FGIDs are normal and typically do not necessitate treatment or change to a special formula. (3) Thickened formulas, often termed anti-reflux formulas, may be considered in specific cases of regurgitation. (4) The usage of specialized formulas for infants with colic is not advised due to a lack of clinical evidence. (5) In the case of constipation in infants, the use of formulas enriched with high beta-palmitate and increased magnesium content may be considered to soften the stool. Generally, there is limited evidence supporting the use of specialized formulas for FGID. Breastfeeding should never be discontinued in favor of formula feeding. What is Known Functional gastrointestinal disorders, such as infant regurgitation, infant colic, and functional constipation, are common and typically physiological phenomena during the early months of an infant's life. The infant food industry provides a wide range of formulas designed for managing these mild functional gastrointestinal disorders. Despite the widespread use of these formulas, their effectiveness in treating mild functional gastrointestinal disorders remains uncertain.What is New Weaning from breastfeeding is not advised for infants experiencing any or several functional gastrointestinal disorders. In majority of formula-fed infants, no specific formulas are indicated. In breastfed infants with regurgitation, breast milk can be expressed and supplemented with thickening agents and in formula fed infants, industrially thickened infant formulas often referred to as "anti-reflux formulas," or formulas with appropriately added thickeners can be considered in special cases under medical guidance. Special anti-colic formulas do not usually benefit infants with colic. In cases of infant constipation, considering formulas with high beta-palmitate and an elevated magnesium content may be an option to soften stool consistency. It is generally not recommended to use formulas for combined functional gastrointestinal disorders.