1. Infantile colic |
Rome III Criteria (2006):2525 Hyman PE, Milla PJ, Benninga MA, Davidson GP, Fleisher DF, Taminiau J. Childhood functional gastrointestinal disorders: neonate/toddler. Gastroenterology. 2006;130:1519-26. all of the following characteristics from birth to 4 months of age: 1. episodes of paroxysms of irritability, fussing, or crying that starts and stops without obvious causes; 2. episodes lasting three or more hours/day for three days/week for at least one week; no failure to thrive. |
2. Infant regurgitation ("physiological reflux") |
Rome III Criteria (2006):2525 Hyman PE, Milla PJ, Benninga MA, Davidson GP, Fleisher DF, Taminiau J. Childhood functional gastrointestinal disorders: neonate/toddler. Gastroenterology. 2006;130:1519-26. All of the following characteristics in otherwise healthy infants: 1. two or more regurgitations per day for three or more weeks; no retching, hematemesis, aspiration, apnea, failure to thrive, feeding or swallowing difficulties, or abnormal posture. |
3. Functional intestinal constipation |
Rome III Criteria (2006)2525 Hyman PE, Milla PJ, Benninga MA, Davidson GP, Fleisher DF, Taminiau J. Childhood functional gastrointestinal disorders: neonate/toddler. Gastroenterology. 2006;130:1519-26. and ESPGHAN/NASPGHAN guideline (2014):3030 Tabbers MM, DiLorenzo C, Berger MY, Faure C, Langendam MW, Nurko S, et al. Evaluation and treatment of functional constipation in infants and children: evidence-based recommendations from Espghan and Naspghan. J Pediatr Gastroenterol Nutr. 2014;58:258-74. duration of at least on month of two or more of the following characteristics: 1. fewer than three bowel movements a week; 2. at least one weekly episode of fecal incontinence after sphincter control; 3. history of excessive retention of feces; 4. history of pain and/or difficulty in bowel movements; 5. presence of large fecal mass in the rectum; 6. history of elimination of large-diameter feces that can clog the toilet. Additional symptoms: irritability, decreased appetite, and early satiety. These symptoms disappear after elimination of large amounts of feces. |
4. Functional diarrhea ("irritable bowel syndrome") |
Rome III Criteria (2006):2525 Hyman PE, Milla PJ, Benninga MA, Davidson GP, Fleisher DF, Taminiau J. Childhood functional gastrointestinal disorders: neonate/toddler. Gastroenterology. 2006;130:1519-26. all of the following characteristics: 1. daily painless, recurrent passage of three or more large, unformed stools; 2. duration longer than 4 weeks; 3. onset between 6 and 36 months of age; 4. passage of stools during waking hours; 5. No failure to thrive if caloric intake is adequate. |
5. Infantile dyschezia |
Roma III Criteria (2006):2525 Hyman PE, Milla PJ, Benninga MA, Davidson GP, Fleisher DF, Taminiau J. Childhood functional gastrointestinal disorders: neonate/toddler. Gastroenterology. 2006;130:1519-26. It should include the two following characteristics in infants younger than 6 months: 1. at least 10 min of straining and crying before successful passage of soft stools; 2. no other health problems. |
6. Gastroesophageal reflux disease (GERD) |
NASPGHAN/ESPGHAN Guideline (2009):2626 Vandenplas Y, Rudolph CD, Di Lorenzo C, Hassall E, Liptak G, Mazur L, et al. Pediatric gastroesophageal reflux clinical practice guidelines: joint recommendations of the North American Society for Pediatric Gastroenterology, Hepatology, and Nutrition (Naspghan) and the European Society for Pediatric Gastroenterology, Hepatology, and Nutrition (Espghan). J Pediatr Gastroenterol Nutr. 2009;49:498-547. It is present when gastroesophageal reflux causes symptoms that are uncomfortable and/or complications. Clinical manifestations suggestive of GERD before 18 months: recurrent regurgitations and/or vomiting accompanied by failure to thrive; stressed behavior or crying without explanation. |
7. Allergy to cow's milk protein |
Brazilian Consensus (2007)3131 Sociedade Brasileira de Pediatria e Associação Brasileira de Alergia e Imunopatologia. Consenso brasileiro sobre alergia alimentar: 2007. Rev Bras Alerg Imunopatol. 2008;31:64-89. and ESPGHAN Guideline (2012):2727 Koletzko S, Niggemann B, Arato A, Dias JA, Heuschkel R, Husby S, et al. Diagnostic approach and management of cow’ milk protein allergy in infants and children: Espghan GI Committee Practical Guidelines. J Pediatr Gastroenterol Nutr. 2012;55:221-229. adverse reaction, reproducible, caused by an immune reaction triggered by antigen(s) of certain food(s). In infants, it is often a delayed reaction (non-IgE-mediated). In a group of 159 infants with suspected allergy to cow's milk protein, the following gastrointestinal signs and symptoms were found (each infant could have more than one clinical manifestation): regurgitation and vomiting in 53.5%; colic in 34.0%; diarrhea in 25.2%, of which approximately 30% with blood; blood in the stool in 14.5%; and constipation in 15.7%. Weight and length deficit were commonly observed.3232 Vieira MC, Morais MB, Spolidoro JV, Toporovski MS, Cardoso AL, Araujo GT, et al. A survey on clinical presentation and nutritional status of infants with suspected cow’ milk allergy. BMC Pediatrics. 2010;10:25.
In most cases, the diagnosis must be confirmed by challenge test with the suspected food, to be performed four to 12 weeks after the start of the elimination diet when the symptoms have already been controlled.2727 Koletzko S, Niggemann B, Arato A, Dias JA, Heuschkel R, Husby S, et al. Diagnostic approach and management of cow’ milk protein allergy in infants and children: Espghan GI Committee Practical Guidelines. J Pediatr Gastroenterol Nutr. 2012;55:221-229.,3131 Sociedade Brasileira de Pediatria e Associação Brasileira de Alergia e Imunopatologia. Consenso brasileiro sobre alergia alimentar: 2007. Rev Bras Alerg Imunopatol. 2008;31:64-89.
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