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Role of Maternology in Functional Gastrointestinal Disorders in Infant

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Role of Maternology in Functional Gastrointestinal Disorders in Infant GENERAL ARTICLES Ref: Ro J Pediatr. 2019;68(1) DOI: 10.37897/RJP.2019.1.2 ROLE OF MATERNOLOGY IN FUNCTIONAL GASTROINTESTINAL DISORDERS IN INFANT Daniela Marincas1,2, MD, PhD student, Simina Angelescu3, psychologist, Prof. Coriolan Ulmeanu1,4, MD, PhD 1“Carol Davila” University of Medicine and Pharmacy, Bucharest, Romania 2Stella Maris SRL, Family Medicine, Bucharest, Romania 3Angelescu Simina, privat psychology, Bucharest, Romania 4Departament of Pediatrics,“Grigore Alexandrescu” Emergency Children’s Hospital, Bucharest, Romania ABSTRACT The functional digestive pathology of the child in the first year of life is frequently encountered in the medical practice and is difficult to manage, diagnose and treat. The current general medical approach does not treat mother and child in the first year after birth as a biological unit, thus leaving out the perspective of the associa- tion of functional gastrointestinal disorders (FGID) with an impairment of maternal-child emotional relationship, resulting in uncertain therapeutic results. This perspective of the problem has been approached by maternolo- gy, a newer branch of medical sciences, which has been born on the assumption that most of the handicaps stem from a relational difficulty between the mother and her infant. Maternology integrates the child’s suffering from the perspective of the emotional relationship of the parent-child couple, emphasizing that the mother and the child is a biological unit that needs to be diagnosed and treated together, thus giving a new view in address- ing the baby’s functional sufferings. Keywords: functional gastrointestinal disorders in infant, maternology, mother-child emotional relationship INTRODUCTION It is mentioned in the literature that there is a link between parents’ psychological state (anxiety, The functional digestive pathology of the child depression) and abdominal symptomatology in in the first year of life is frequently encountered in children, and also that the management of the most medical practice. Functional gastrointestinal disor- common FGID, such as infantile colic and regurgi- ders (FGID) represent a group of disorders which tation, should focus on education and parent reas- are difficult to manage from a diagnosis and treat- surance, and nutritional advice, such as recommen- ment standpoint. dations on volume, frequency, feeding techniques FGID symptoms cause great discomfort for in- (1,5). fants and parents, increasing the number of unnec- However, some infants continue to suffer, which essary physician presentations and healthcare costs. certainly shows that there may be other issues that International expert committees meet periodically escape the current medical approach. at the Rome Foundation to establish the latest de- An important percentage of this type of pathol- velopments and changes in the symptom-based ogy is possibly influenced by the mother-child classification system of FGID. FGID results from emotional relationship in the peak vulnerability pe- complex and reciprocal interactions between bio- riod, which is the first year of life. There are mani- logical, psychological and social aspects (brain-gut festations described in psychology as psychoso- axis) (1,2,3,4). Corresponding author: Daniela Marincas, 84th Lt av Negel Gheorghe, Bucharest, Romania E-mail: [email protected] ROMANIAN JOURNAL OF PEDIATRICS – VOL. LXVIII, NO. 1, YEAR 2019 9 10 ROMANIAN JOURNAL OF PEDIATRICS – VOL. LXVIII, NO. 1, YEAR 2019 matic, and in maternology they are called “disorders The GI disorders in infants and young children of birth” (13,15). according to the Rome IV classification are: G.1. Infant regurgitation The current medical approach G.2. Infant rumination syndrome to the problem G.3. Cyclic vomiting syndrome The current general medical approach does not G.4. Infant colic treat mother and child as a biological unit in the G.5. Functional diarrhea first year after birth, thus neglecting the perspective G.6. Infant dyschezia of the FGID link with the emotional mother-child G.7. Functional constipation (7) relationship. Although there are many papers about the emotional plan, the parent, which in this case is The current state of knowledge the mother, is considered to be only a caregiver of It is known that during childhood, the structure the sick child, who needs encouragement and sup- and function of the gastrointestinal tract (GI), nerv- port for the concern that arises because of the ba- ous system and microbiota is still maturing and this by’s health issues, but it is not clear if there is a re- can cause signs and symptoms of GI that do not lationship between the mother’s condition and the have a clear structural or biochemical cause. Diag- baby’s symptoms (6). The functional impairment nosis of a functional disorder virtually eliminates of the infant often persists despite any conventional organic disease as a cause of symptoms. Regurgita- treatment, without explanation, beyond the time tion, infantile colic and functional constipation are limits suggested in the scientific literature (7). the most common FGID in childhood, and it has Over the time, FGID have generated various di- been shown that more FGID can coexist often in agnostic and treatment problems for practitioners, the same child. Infant dyschezia, functional diar- as the diagnosis required the exclusion of organic rhea, infant rumination syndrome and cyclic vomit- and inflammatory pathologies. If initially FGID ing syndrome occur less frequently (4,5). were considered to be less scientifically explicable, G.1. Infant regurgitation less treatable, largely considered psychiatric, only Infant regurgitation is the most common FGID in the last three decades of the 20th century deep in the first year of life and may occur in healthy studies were carried out, these studies discovered infants between three weeks and one year of age. links between mind and body, making them parts Recognizing infant regurgitation can avoid fre- within a common system. Thus, the concept of the quent visits to physicians and unnecessary investi- biopsychosocial model of diseases (1977, George gations, as well as therapy for gastroesophageal Engel) was born. In the biopsychosocial model, reflux, a disease that can often be confused with gastrointestinal functional symptoms integrate: infant regurgitation. But we are also usually deal- motility disorders, increased visceral sensitivity, ing with an anxious mother, who frequently turns to under conditions of coordination between the brain a pediatrician, because she worries not only about and the gastrointestinal tract in the presence of in- the child’s condition but also about her own condi- fluences from psychosocial factors. tion, a state she certainly does not wish to talk about FGID are an important group of diseases, cur- (5). It has been noticed that interaction between rently accepted as self-contained medical entities, physician and the child’s mother/caregiver often both in practice and in medical research. helps to improve the latter’s condition. It is said Since 1992, international expert committees that parents are concerned about the condition of have been set up to clarify the FGID and have be- their child, the identification of the sources of phys- gun developing a common international classifica- ical and emotional suffering, and the plans to elim- tion of FGID using the symptom-based classifica- inate stressful conditions (5). tion system. The Rome Foundation is the current G.2. Rumination international organization that sets out the criteria Rumination is the regular regurgitation of stom- for diagnosing and classifying FGID based on ach contents in the mouth for self-stimulation. In- symptoms (7). The Rome IV consensus on diag- fant rumination syndrome is a disorder which is nostics and classification criteria for digestive rarely described in literature. Maternal behavior as- functional disorders for the pediatric side has main- sociated with this syndrome can either be negligent tained the two major categories: neonatal and in- or extremely attentive, but there seems to be a lack fant disorders and disorders of older children and of pleasure in holding the baby or the lack sensitiv- adolescents. ity to the child’s needs for comfort and satisfaction ROMANIAN JOURNAL OF PEDIATRICS – VOL. LXVIII, NO. 1, YEAR 2019 11 (5,7,18). The treatment aims to help parents ad- short- and long-term health consequences, shorten- dress their feelings about the child, and improve ing the duration of exclusive breastfeeding, fre- their ability to recognize and respond to children’s quent medical consultations and care, raising the physical and emotional needs (5). costs unreasonably. G.3. Cyclic vomiting syndrome A more recent review of the literature has shown Data on clinical evolution in infants and young that there is a clear impact of FGID symptoms on children are rare, epidemiological studies report family life and on short-term and long-term well- that they may occur before the age of three (5). being, studies have reported that inconsolable cry- G.4. Infant colic ing and baby colic in the first three months of life Understanding colic in infants requires an ap- are associated with lack of sleep and fatigue in preciation of the child’s development, the diadic mothers or even postpartum depressive symptoms. relationship of the caregiver with the child, and the There has also been observed an inadequate moth- family and social environment in which they exist er-child interaction, a mother-insecure child attach- (7). Infant
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