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. 1999 Sep;45(Suppl 2):II60–II68. doi: 10.1136/gut.45.2008.ii60

Childhood functional gastrointestinal disorders

A Rasquin-Weber, P Hyman, S Cucchiara, D Fleisher, J Hyams, P Milla, A Staiano
PMCID: PMC1766693  PMID: 10457047

Abstract

This is the first attempt at defining criteria for functional gastrointestinal disorders (FGIDs) in infancy, childhood, and adolescence. The decision-making process was as for adults and consisted of arriving at consensus, based on clinical experience. This paper is intended to be a quick reference. The classification system selected differs from the one used in the adult population in that it is organized according to main complaints instead of being organ-targeted. Because the child is still developing, some disorders such as toddler's diarrhea (or functional diarrhea) are linked to certain physiologic stages; others may result from behavioral responses to sphincter function acquisition such as fecal retention; others will only be recognizable after the child is cognitively mature enough to report the symptoms (e.g., dyspepsia). Infant regurgitation, rumination, and cyclic vomiting constitute the vomiting disorders. Abdominal pain disorders are classified as: functional dyspepsia, irritable bowel syndrome (IBS), functional abdominal pain, abdominal migraine, and aerophagia. Disorders of defecation include: infant dyschezia, functional constipation, functional fecal retention, and functional non-retentive fecal soiling. Some disorders, such as IBS and dyspepsia and functional abdominal pain, are exact replications of the adult criteria because there are enough data to confirm that they represent specific and similar disorders in pediatrics. Other disorders not included in the pediatric classification, such as functional biliary disorders, do occur in children; however, existing data are insufficient to warrant including them at the present time. For these disorders, it is suggested that, for the time being, clinicians refer to the criteria established for the adult population.


Keywords: infant vomiting; cyclic vomiting syndrome; functional dyspepsia in children; irritable bowel syndrome in children; functional abdominal pain in children; functional diarrhea in children; functional constipation in children; Rome II

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Selected References

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  1. APLEY J., NAISH N. Recurrent abdominal pains: a field survey of 1,000 school children. Arch Dis Child. 1958 Apr;33(168):165–170. doi: 10.1136/adc.33.168.165. [DOI] [PMC free article] [PubMed] [Google Scholar]
  2. Andersen J. M., Sugerman K. S., Lockhart J. R., Weinberg W. A. Effective prophylactic therapy for cyclic vomiting syndrome in children using amitriptyline or cyproheptadine. Pediatrics. 1997 Dec;100(6):977–981. doi: 10.1542/peds.100.6.977. [DOI] [PubMed] [Google Scholar]
  3. Benninga M. A., Büller H. A., Heymans H. S., Tytgat G. N., Taminiau J. A. Is encopresis always the result of constipation? Arch Dis Child. 1994 Sep;71(3):186–193. doi: 10.1136/adc.71.3.186. [DOI] [PMC free article] [PubMed] [Google Scholar]
  4. Boyce W. T., Barr R. G., Zeltzer L. K. Temperament and the psychobiology of childhood stress. Pediatrics. 1992 Sep;90(3 Pt 2):483–486. [PubMed] [Google Scholar]
  5. Carey W. B. "Colic"--primary excessive crying as an infant-environment interaction. Pediatr Clin North Am. 1984 Oct;31(5):993–1005. doi: 10.1016/s0031-3955(16)34681-8. [DOI] [PubMed] [Google Scholar]
  6. Fan L. L., Graham L. M. Radiological cases of the month. Lipoid pneumonia from mineral oil aspiration. Arch Pediatr Adolesc Med. 1994 Feb;148(2):205–206. doi: 10.1001/archpedi.1994.02170020091016. [DOI] [PubMed] [Google Scholar]
  7. Fenton T. R., Harries J. T., Milla P. J. Disordered small intestinal motility: a rational basis for toddlers' diarrhoea. Gut. 1983 Oct;24(10):897–903. doi: 10.1136/gut.24.10.897. [DOI] [PMC free article] [PubMed] [Google Scholar]
  8. Fleisher D. R. Functional vomiting disorders in infancy: innocent vomiting, nervous vomiting, and infant rumination syndrome. J Pediatr. 1994 Dec;125(6 Pt 2):S84–S94. doi: 10.1016/s0022-3476(05)82931-2. [DOI] [PubMed] [Google Scholar]
  9. Fleisher D. R. Infant rumination syndrome: report of a case and review of the literature. Am J Dis Child. 1979 Mar;133(3):266–269. [PubMed] [Google Scholar]
  10. Fleisher D. R. Management of cyclic vomiting syndrome. J Pediatr Gastroenterol Nutr. 1995;21 (Suppl 1):S52–S56. doi: 10.1097/00005176-199501001-00015. [DOI] [PubMed] [Google Scholar]
  11. Fleisher D. R., Matar M. The cyclic vomiting syndrome: a report of 71 cases and literature review. J Pediatr Gastroenterol Nutr. 1993 Nov;17(4):361–369. [PubMed] [Google Scholar]
  12. Forbes D., Withers G. Prophylactic therapy in cyclic vomiting syndrome. J Pediatr Gastroenterol Nutr. 1995;21 (Suppl 1):S57–S59. doi: 10.1097/00005176-199501001-00016. [DOI] [PubMed] [Google Scholar]
  13. Gauderer M. W., Halpin T. C., Jr, Izant R. J., Jr Pathologic childhood aerophagia: a recognizable clinical entity. J Pediatr Surg. 1981 Jun;16(3):301–305. doi: 10.1016/s0022-3468(81)80684-7. [DOI] [PubMed] [Google Scholar]
  14. Graham D. Y., Malaty H. M., Evans D. G., Evans D. J., Jr, Klein P. D., Adam E. Epidemiology of Helicobacter pylori in an asymptomatic population in the United States. Effect of age, race, and socioeconomic status. Gastroenterology. 1991 Jun;100(6):1495–1501. doi: 10.1016/0016-5085(91)90644-z. [DOI] [PubMed] [Google Scholar]
  15. Greenbaum D. S., Mayle J. E., Vanegeren L. E., Jerome J. A., Mayor J. W., Greenbaum R. B., Matson R. W., Stein G. E., Dean H. A., Halvorsen N. A. Effects of desipramine on irritable bowel syndrome compared with atropine and placebo. Dig Dis Sci. 1987 Mar;32(3):257–266. doi: 10.1007/BF01297051. [DOI] [PubMed] [Google Scholar]
  16. Hyams J. S., Burke G., Davis P. M., Rzepski B., Andrulonis P. A. Abdominal pain and irritable bowel syndrome in adolescents: a community-based study. J Pediatr. 1996 Aug;129(2):220–226. doi: 10.1016/s0022-3476(96)70246-9. [DOI] [PubMed] [Google Scholar]
  17. Hyams J. S., Treem W. R., Etienne N. L., Weinerman H., MacGilpin D., Hine P., Choy K., Burke G. Effect of infant formula on stool characteristics of young infants. Pediatrics. 1995 Jan;95(1):50–54. [PubMed] [Google Scholar]
  18. Levine M. D. Children with encopresis: A descriptive analysis. Pediatrics. 1975 Sep;56(3):412–416. [PubMed] [Google Scholar]
  19. Liu D., Diorio J., Tannenbaum B., Caldji C., Francis D., Freedman A., Sharma S., Pearson D., Plotsky P. M., Meaney M. J. Maternal care, hippocampal glucocorticoid receptors, and hypothalamic-pituitary-adrenal responses to stress. Science. 1997 Sep 12;277(5332):1659–1662. doi: 10.1126/science.277.5332.1659. [DOI] [PubMed] [Google Scholar]
  20. Lloyd-Still J. D. Chronic diarrhea of childhood and the misuse of elimination diets. J Pediatr. 1979 Jul;95(1):10–13. doi: 10.1016/s0022-3476(79)80074-8. [DOI] [PubMed] [Google Scholar]
  21. Loening-Baucke V. Chronic constipation in children. Gastroenterology. 1993 Nov;105(5):1557–1564. doi: 10.1016/0016-5085(93)90166-a. [DOI] [PubMed] [Google Scholar]
  22. Meyers W. F., Herbst J. J. Effectiveness of positioning therapy for gastroesophageal reflux. Pediatrics. 1982 Jun;69(6):768–772. [PubMed] [Google Scholar]
  23. Molnar D., Taitz L. S., Urwin O. M., Wales J. K. Anorectal manometry results in defecation disorders. Arch Dis Child. 1983 Apr;58(4):257–261. doi: 10.1136/adc.58.4.257. [DOI] [PMC free article] [PubMed] [Google Scholar]
  24. Mortimer M. J., Kay J., Jaron A. Clinical epidemiology of childhood abdominal migraine in an urban general practice. Dev Med Child Neurol. 1993 Mar;35(3):243–248. doi: 10.1111/j.1469-8749.1993.tb11629.x. [DOI] [PubMed] [Google Scholar]
  25. Orenstein S. R., Magill H. L., Brooks P. Thickening of infant feedings for therapy of gastroesophageal reflux. J Pediatr. 1987 Feb;110(2):181–186. doi: 10.1016/s0022-3476(87)80150-6. [DOI] [PubMed] [Google Scholar]
  26. Partin J. C., Hamill S. K., Fischel J. E., Partin J. S. Painful defecation and fecal soiling in children. Pediatrics. 1992 Jun;89(6 Pt 1):1007–1009. [PubMed] [Google Scholar]
  27. Pilowsky I., Barrow C. G. A controlled study of psychotherapy and amitriptyline used individually and in combination in the treatment of chronic intractable, 'psychogenic' pain. Pain. 1990 Jan;40(1):3–19. doi: 10.1016/0304-3959(90)91045-K. [DOI] [PubMed] [Google Scholar]
  28. Sauvage D., Leddet I., Hameury L., Barthélémy C. Infantile rumination. Diagnosis and follow-up study of twenty cases. J Am Acad Child Psychiatry. 1985 Mar;24(2):197–203. doi: 10.1016/s0002-7138(09)60448-9. [DOI] [PubMed] [Google Scholar]
  29. Schor E., Starfield B., Stidley C., Hankin J. Family health. Utilization and effects of family membership. Med Care. 1987 Jul;25(7):616–626. [PubMed] [Google Scholar]
  30. Scott R. B., Ferreira C., Smith L., Jones A. B., Machida H., Lohoues M. J., Roy C. C. Cisapride in pediatric gastroesophageal reflux. J Pediatr Gastroenterol Nutr. 1997 Nov;25(5):499–506. doi: 10.1097/00005176-199711000-00003. [DOI] [PubMed] [Google Scholar]
  31. Sigurdsson L., Flores A., Putnam P. E., Hyman P. E., Di Lorenzo C. Postviral gastroparesis: presentation, treatment, and outcome. J Pediatr. 1997 Nov;131(5):751–754. doi: 10.1016/s0022-3476(97)70106-9. [DOI] [PubMed] [Google Scholar]
  32. Sutphen J., Borowitz S., Ling W., Cox D. J., Kovatchev B. Anorectal manometric examination in encopretic-constipated children. Dis Colon Rectum. 1997 Sep;40(9):1051–1055. doi: 10.1007/BF02050928. [DOI] [PubMed] [Google Scholar]
  33. Swenson O., Sherman J. O., Fisher J. H. Diagnosis of congenital megacolon: an analysis of 501 patients. J Pediatr Surg. 1973 Oct;8(5):587–594. doi: 10.1016/0022-3468(73)90395-3. [DOI] [PubMed] [Google Scholar]
  34. Symon D. N., Russell G. Abdominal migraine: a childhood syndrome defined. Cephalalgia. 1986 Dec;6(4):223–228. doi: 10.1046/j.1468-2982.1986.0604223.x. [DOI] [PubMed] [Google Scholar]
  35. Symon D. N., Russell G. Double blind placebo controlled trial of pizotifen syrup in the treatment of abdominal migraine. Arch Dis Child. 1995 Jan;72(1):48–50. doi: 10.1136/adc.72.1.48. [DOI] [PMC free article] [PubMed] [Google Scholar]
  36. Walker L. S., Garber J., Greene J. W. Psychosocial correlates of recurrent childhood pain: a comparison of pediatric patients with recurrent abdominal pain, organic illness, and psychiatric disorders. J Abnorm Psychol. 1993 May;102(2):248–258. doi: 10.1037//0021-843x.102.2.248. [DOI] [PubMed] [Google Scholar]
  37. Weaver L. T. Bowel habit from birth to old age. J Pediatr Gastroenterol Nutr. 1988 Sep-Oct;7(5):637–640. doi: 10.1097/00005176-198809000-00002. [DOI] [PubMed] [Google Scholar]

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