Pharmacy Unscripted - Baby Health: Digestion

Question 1

What can functional gastrointestinal disorders (FGIDs) be described as?

Answer 1

Defined as conditions where the gastrointestinal system is not working properly, but there is no physical or biochemical cause. Where x-rays, blood tests and endoscopies will all come back as normal.

Question 2

Are FGIDs psychological?

Answer 2

No, although stress can make it worse.

Question 3

What are three examples of FGIDs?

Answer 3

• Regurgitation
• Colic
• Functional Constipation

Question 4

What is Regurgitation also known as?

Answer 4

Also known as reflux, posseting and spitting up of feeds in infants.

Question 5

When does regurgitation usually start?

Answer 5

starts before the baby is eight weeks old, becomes less frequent with time and, in 90 per cent of cases, resolves by the age of 12 months.

Question 6

What is the first step in managing regurgitation in babies?

Answer 6

First step is to reassure the parent, as it can be distressing for them. In most cases no further action is required and the issue will resolve with time, but there are some steps parents can take if they are worried or their baby is distressed.

Question 7

What advice can be given to mothers breastfeeding who’s baby is regurgitating feeds?

Answer 7

In breastfed babies it might be useful to have a feeding assessment with a trained breastfeeding advisor. If this does not improve the situation, they should be referred to their GP or health visitor.* It’s important to encourage continued breastfeeding wherever possible as it is best for baby.

Question 8

hat advice can be given to mothers for formula fed babies who are regurgitating feeds?

Answer 8

If the volume of milk at each feed is excessive for the weight of the baby, advise reducing the amount of feed; the recommended feed volume found on the formula packaging can be used as a guide
Recommend trialling smaller, more frequent feeds (while maintaining an appropriate total daily amount of milk)
Suggest a 14 day trial of thickened formula (for example, containing rice starch, corn starch, locust bean gum or carob bean gum).

If the baby is still showing signs of distress, they should be referred to a Health Visitor or GP.

Question 9

What is colic?

Answer 9

Colic is when a baby cries a lot but there’s no obvious cause. It’s a common problem, affecting about 20 per cent of babies.

Question 10

When does colic usually start and stop - what ages?

Answer 10

It can start when a baby is a few weeks old and usually stops by the time they are six months old.

Question 11

What are the possible signs that could indicate colic?

Answer 11

A baby may have colic if they cry for more than three hours a day, 3 days a week for at least a week.

They may cry more in the afternoon and evening. Other signs of colic include:

• It’s hard to settle or soothe the baby
• They clench their fists
• They go red in the face
• They bring their knees up to their tummy or arch their back
• Their tummy rumbles or they are very wind

Question 12

Is it known in what causes colic?

Answer 12

It is not known exactly what causes colic, but it may be caused by a developing GI system and gut microbiome or the baby not being able to digest milk proteins properly

Question 13

Is there a cure for colic?

Answer 13

There is no cure for colic,

Question 14

How can you advise parents on ways to soothe their baby?

Answer 14

• Hold or cuddle the baby when they’re crying a lot
• Gently rock the baby over the shoulder
• Gently rock the baby in their Moses basket or crib, or push them in their pram
• Bathe your baby in a warm bath
• Have some gentle white noise like the radio or TV in the background to distract them

Breastfed babies should continue to be fed as normal. Parents of formula fed babies might wish to try specialist anti-colic bottles and teats. They could also consider, under the advice of a healthcare professional, a 14 day trial of a formula milk formulated to help colic

Question 15

Is constipation in babies more common in babies than regurgitation and colic?

Answer 15

Constipation in babies is less common than regurgitation and colic, affecting about 15 per cent of babies.

Question 16

What are the symptoms of constipation in babies?

Answer 16

Symptoms of constipation include passing less than two stools per week or passing hard or large stools.

Question 17

Is constipation more common in exclusively breastfed babies?

Answer 17

No, it is less common

Question 18

What can you advise parents to do to help with constipation in babies?

Answer 18

advise parents to try gently moving their baby’s legs in a bicycling motion, or carefully and gently massage their tummy to help stimulate their bowels. Warm baths can also encourage bowel movements.

Question 19

To deal with constipation in babies, what can you do to check in formula fed babies?

Answer 19

If the baby is formula fed, check that the bottles are being made up correctly as per the instructions on the container. If the baby has moved onto solids, fibre can be increased by offering more fruit and vegetables.

Question 20

For constipation in babies, if dehydration is a possible what can the parent do?

Answer 20

Feeds can be supplemented with bottles of boiled cooled water.

Question 21

What are the red flag symptoms of FGIDs in babies?

Answer 21

These require a referral to GP:

• baby stops gaining or loses wieght
• Vomiting forcefully or retching
• Breathing difficulties
• Abnormal body spasms
• Fever
• Body becomes stiff or floppy
• Unresponsive, difficult to keep awake or not wanting to feed
• Blood or yellow liquid in their vomit
• Blood in stools
• Sudden swelling or a puffy face
• Pale/mottled/ashen/blue skin
• A rash that doesn’t fade when pressed with a glass
• underlying medical conditions/ being treated for another illness
• suspected cows’ milk allergy or lactose intolerance

Question 22

What does FSMPs stand for?

Answer 22

Foods for special medical purposes (FSMPs)

Question 23

What are FSMPs?

Answer 23

they are not medicines or medical devices, and are covered by food legislation.

Question 24

What can FSMPs be defined as?

Answer 24

They can be defined as foods:

Which have been specially processed or formulated for their intended use

Used under medical supervision by a healthcare professional; this can include a pharmacist

For people who have an impaired ability to take, digest, absorb, metabolise or excrete ordinary food, certain nutrients or metabolites

For the dietary management of patients, including infants

Which may be intended for the partial or exclusive feeding of patients.

Question 25

Can some baby formulas be defined as FSMPs?

Answer 25

Some baby formulas are defined as FSMPs and should only be used on the recommendation of the pharmacist or another healthcare professional. These include milks specifically formulated for babies with digestive problems such as colic, regurgitation and constipation.

Question 26

What is good about Aptamil ANTI-REFLUX?

Answer 26

• formula thickened with carob bean gum,
  shown to be effective in reducing infant regurgitation episodes by up to 78%,
  it is nutritionally complete,
  suitable from birth to one year.

Question 27

What are some important notes for the two previous mentioned milk formulas?

Answer 27

They are food for special medical purposes for the dietary management of frequent reflux and regurgitation. They should only be used under medical supervision, after full consideration of the feeding options available including breastfeeding. Suitable for use as the sole source of nutrition for infants from birth and as part of a balanced diet from 6-12 months. These products should not be used in combination with antacids or other thickeners and are not suitable for premature infants.