0
We're unable to sign you in at this time. Please try again in a few minutes.
Retry
We were able to sign you in, but your subscription(s) could not be found. Please try again in a few minutes.
Retry
There may be a problem with your account. Please contact the AMA Service Center to resolve this issue.
Contact the AMA Service Center:
Telephone: 1 (800) 262-2350 or 1 (312) 670-7827  *   Email: subscriptions@jamanetwork.com
Error Message ......
Research Letter |

Infant Distress and Development of Functional Gastrointestinal Disorders in Childhood:  Is There a Connection? FREE

Anna Partty, MD1; Marko Kalliomaki, MD, PhD1; Seppo Salminen, PhD2; Erika Isolauri, MD, PhD1
[+] Author Affiliations
1Department of Pediatrics, Turku University Hospital, Turku, Finland
2Functional Foods Forum, University of Turku, Turku, Finland
JAMA Pediatr. 2013;167(10):977-978. doi:10.1001/jamapediatrics.2013.99.
Text Size: A A A
Published online

One infant in 4 manifests with abundant crying, fussing, or colic cry and is brought for medical evaluation during the first months of life.1 Concomitantly, excessive antigen uptake and bacterial translocation ensue across the immature gut barrier.2 Not surprisingly, infant crying has been related to food allergy3 and aberrant gut microbiota composition4 and these have, in turn, been linked to functional gastrointestinal disorders (FGIDs).5 We hypothesized that colic crying is associated with FGIDs later in childhood.

The study was approved by the committees on ethical practice at Turku University Hospital and the Health Office of Turku. Written informed consent was obtained from the children and their parents.

The study population comprised children participating in an ongoing, randomized, double-blind, prospective follow-up study of probiotic intervention in the perinatal period and risk of allergic and inflammatory diseases later in life (clinicaltrials.gov/ct/gui/show/NCT00167700), described in detail elsewhere.4 In brief, mothers (n = 159) of these children were randomly assigned to receive placebo or Lactobacillus rhamnosus GG (ATCC 53103; Valio Ltd) daily for 4 weeks before expected delivery. After the delivery, the preparation was given either to the child, or continuously to the mother, if breast-feeding, for 6 months. During the seventh and 12th weeks of life, parents recorded their infants’ behavior patterns, vomit, stools, and skin condition, using a modified 24-hour Barr chart on 7 consecutive days as previously described.4 During the study visit at age 13 years, a clinical examination was carried out by A.P., who was not involved in the original study and was blinded for the randomization and the behavioral diaries.

The diagnosis of FGID was based on the modified Rome III Diagnostic Questionnaire for pediatric FGID.6 The questionnaire was translated from English into Finnish and it was completed by the children with parental help at home before the follow-up visit.

Comparisons between 2 continuous and categorical variables were made by unpaired t test and χ2 test or Fisher exact test, as appropriate, respectively. Univariate associations between FGID and continuous variables were studied by logistic regression analysis. Statistical analyses were made by SAS for Windows (version 9.2; SAS Institute Inc).

The 13-year follow-up was completed by 75 of the 132 invited children (56.8%) and the questionnaire by 74 (56.1%). Clinical characteristics are shown in the Table. Functional gastrointestinal disorder was diagnosed in 15 children (20.3%). Abdominal migraine and irritable bowel syndrome, being the most common diagnoses, were found in 7 (9.5%) and 4 children (5.4%), respectively.

Table Graphic Jump LocationTable.  Clinical Characteristics and Crying Profile of Children With and Without FGID

By the age of 13 years, 28% and 5.6% of the children with and without colic-type crying during the seventh week of life, respectively, developed FGID (P = .05). Likewise, children manifesting with FGID had had more colic-type crying than healthy children during the seventh week of life (mean [SD], 31 [26] and 10 [13] min/d, respectively [P = .005]). The same tendency was still observed during the 12th week of life (mean [SD], 14 [22] and 4 [8] min/d, respectively [P = .08]). Other modes of infant distress were comparable between the groups (Table). The early probiotic supplementation had no effect on the development of FGID (Table).

Our findings herein invite an intriguing theory that early bouts of unsoothable crying could actually represent an early manifestation of abdominal pain–related FGIDs. Thus, our results extend those of a previous study lacking rigorous crying diaries.7L rhamnosus GG did not affect the emergence of FGID later in childhood in our study, suggesting that different probiotics or probiotic combinations may be required. Alternatively, they may be more operative in the treatment of pediatric FGID.8 Limitations of our study include a rather small study population and a considerable rate of dropouts, while the prospective nature and 13 years of follow-up emphasize its strength. Thus, further search of long-term sequelae of infant distress behavior is warranted, not only to add understanding about their origins but also to find new remedial options.

Corresponding Author: Anna Partty, MD, Department of Pediatrics, Turku University Hospital, Kiinamyllynkatu 4-8, 20520 Turku, Finland (aklein@utu.fi).

Published Online: August 19, 2013. doi:10.1001/jamapediatrics.2013.99.

Author Contributions: The authors had full access to all of the data in the study and take responsibility for the integrity of the data and the accuracy of the data analysis.

Study concept and design: All authors.

Acquisition of data: Partty, Salminen, Isolauri.

Analysis and interpretation of data: All authors.

Drafting of the manuscript: Partty, Salminen, Isolauri.

Critical revision of the manuscript for important intellectual content: All authors.

Statistical analysis: Partty, Isolauri.

Obtained funding: Salminen, Isolauri.

Administrative, technical, or material support: Salminen, Isolauri.

Study supervision: Kalliomaki, Isolauri.

Conflict of Interest Disclosures: None reported.

Funding/Support: The study has been funded by the Foundation for Pediatric Research and an EVO grant from Turku University Hospital.

Trial Registration: clinicaltrials.gov Identifier: NCT00167700.

Additional Contributions: We thank the families participating in our study, Jaakko Matomaki, MSc, for statistical consultation, Robert MacGilleon, MA, for language review of the manuscript, and Johanna Hvitfelt-Koskelainen for help with the follow-up of participants.

Alvarez  M, St James-Roberts  I.  Infant fussing and crying patterns in the first year in an urban community in Denmark. Acta Paediatr. 1996;85(4):463-466.
PubMed   |  Link to Article
Walker  WA. Transmucosal passage of antigens. In: Schmidt  E, ed. Food Allergy. New York, NY: Vevey/Raven Press; 1998:15-32.
Lucassen  PL, Assendelft  WJ, Gubbels  JW, van Eijk  JTM, Douwes  AC.  Infantile colic: crying time reduction with a whey hydrolysate. a double-blind, randomized, placebo-controlled trial. Pediatrics. 2000;106(6):1349-1354.
PubMed   |  Link to Article
Pärtty  A, Kalliomäki  M, Endo  A, Salminen  S, Isolauri  E.  Compositional development of Bifidobacterium and Lactobacillus microbiota is linked with crying and fussing in early infancy. PLoS One. 2012;7(3):e32495.
PubMed   |  Link to Article
Saps  M, Lu  P, Bonilla  S.  Cow’s-milk allergy is a risk factor for the development of FGIDs in children. J Pediatr Gastroenterol Nutr. 2011;52(2):166-169.
PubMed   |  Link to Article
Helgeland  H, Flagstad  G, Grøtta  J, Vandvik  PO, Kristensen  H, Markestad  T.  Diagnosing pediatric functional abdominal pain in children (4-15 years old) according to the Rome III Criteria: results from a Norwegian prospective study. J Pediatr Gastroenterol Nutr. 2009;49(3):309-315.
PubMed   |  Link to Article
Savino  F, Castagno  E, Bretto  R, Brondello  C, Palumeri  E, Oggero  R.  A prospective 10-year study on children who had severe infantile colic. Acta Paediatr Suppl. 2005;94(449):129-132.
PubMed   |  Link to Article
Francavilla  R, Miniello  V, Magistà  AM,  et al.  A randomized controlled trial of Lactobacillus GG in children with functional abdominal pain. Pediatrics. 2010;126(6):e1445-e1452.
PubMed   |  Link to Article

Figures

Tables

Table Graphic Jump LocationTable.  Clinical Characteristics and Crying Profile of Children With and Without FGID

References

Alvarez  M, St James-Roberts  I.  Infant fussing and crying patterns in the first year in an urban community in Denmark. Acta Paediatr. 1996;85(4):463-466.
PubMed   |  Link to Article
Walker  WA. Transmucosal passage of antigens. In: Schmidt  E, ed. Food Allergy. New York, NY: Vevey/Raven Press; 1998:15-32.
Lucassen  PL, Assendelft  WJ, Gubbels  JW, van Eijk  JTM, Douwes  AC.  Infantile colic: crying time reduction with a whey hydrolysate. a double-blind, randomized, placebo-controlled trial. Pediatrics. 2000;106(6):1349-1354.
PubMed   |  Link to Article
Pärtty  A, Kalliomäki  M, Endo  A, Salminen  S, Isolauri  E.  Compositional development of Bifidobacterium and Lactobacillus microbiota is linked with crying and fussing in early infancy. PLoS One. 2012;7(3):e32495.
PubMed   |  Link to Article
Saps  M, Lu  P, Bonilla  S.  Cow’s-milk allergy is a risk factor for the development of FGIDs in children. J Pediatr Gastroenterol Nutr. 2011;52(2):166-169.
PubMed   |  Link to Article
Helgeland  H, Flagstad  G, Grøtta  J, Vandvik  PO, Kristensen  H, Markestad  T.  Diagnosing pediatric functional abdominal pain in children (4-15 years old) according to the Rome III Criteria: results from a Norwegian prospective study. J Pediatr Gastroenterol Nutr. 2009;49(3):309-315.
PubMed   |  Link to Article
Savino  F, Castagno  E, Bretto  R, Brondello  C, Palumeri  E, Oggero  R.  A prospective 10-year study on children who had severe infantile colic. Acta Paediatr Suppl. 2005;94(449):129-132.
PubMed   |  Link to Article
Francavilla  R, Miniello  V, Magistà  AM,  et al.  A randomized controlled trial of Lactobacillus GG in children with functional abdominal pain. Pediatrics. 2010;126(6):e1445-e1452.
PubMed   |  Link to Article

Correspondence

CME
Also Meets CME requirements for:
Browse CME for all U.S. States
Accreditation Information
The American Medical Association is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians. The AMA designates this journal-based CME activity for a maximum of 1 AMA PRA Category 1 CreditTM per course. Physicians should claim only the credit commensurate with the extent of their participation in the activity. Physicians who complete the CME course and score at least 80% correct on the quiz are eligible for AMA PRA Category 1 CreditTM.
Note: You must get at least of the answers correct to pass this quiz.
Your answers have been saved for later.
You have not filled in all the answers to complete this quiz
The following questions were not answered:
Sorry, you have unsuccessfully completed this CME quiz with a score of
The following questions were not answered correctly:
Commitment to Change (optional):
Indicate what change(s) you will implement in your practice, if any, based on this CME course.
Your quiz results:
The filled radio buttons indicate your responses. The preferred responses are highlighted
For CME Course: A Proposed Model for Initial Assessment and Management of Acute Heart Failure Syndromes
Indicate what changes(s) you will implement in your practice, if any, based on this CME course.
Submit a Comment

Multimedia

Some tools below are only available to our subscribers or users with an online account.

Related Content

Customize your page view by dragging & repositioning the boxes below.

Articles Related By Topic
Related Collections
PubMed Articles