A recent study, published in BMJ Open, suggests that England spends £72.3m (of which approximately £50 million was National Health Service expenditure) a year managing infant functional gastrointestinal (GI) disorders, such as reflux, colic and constipation.
Yet a new international expert review on the current management recommendations for infant functional GI disorders has concluded that first-line management should focus on parental reassurance and nutritional advice. Published in Acta Paediatrica, the review also noted that, with the exception of functional constipation, medication is seldom required.
Around 50% per cent of infants will suffer with at least one functional GI Disorder before six months of age. These conditions are common and often the consequence of an infant’s maturing gut, but they can cause substantial distress to both babies and parents, who will often seek medical advice on managing them.
Indeed, a BMJ Open study calculated that a minimum of £6.3m is spent on consultations and prescriptions of medication for colic, with parents incurring a further £13.6m in costs through the purchase of over the counter (OTC) colic medicines - with no evidence to support their efficacy. In reality these figures are likely to be significantly higher.
GPs and other frontline healthcare professionals (HCPs), such as pharmacists and health visitors, are best placed to reduce these figures as they are the first port-of-call for concerned parents. A recent survey of UK parents commissioned on behalf of the multi-disciplinary expert group Gut Feelings, shows that infant reflux, colic and constipation were associated with high levels of anxiety with 50 per cent of parents surveyed. Two thirds of parents also believe a medicinal treatment is needed for colic.
Dr Arun Ghosh, GP and Gut Feelings spokesperson said, “I agree with the latest advice in the experts’ review, once red flags have been ruled out, parental reassurance and nutritional advice should be the cornerstone of management for infant colic, reflux and constipation. However, we must not underestimate how distressing this can be for parents, so it is important that we find a way to communicate a sense of reassurance and confidence to them.”
A parallel survey of HCPs showed that although a high proportion, (83%) of GPs understand that providing reassurance to parents is a priority, this is unfortunately not mirrored by parents' attitudes, with only 53% reporting feeling reassured. The survey also demonstrated that 90% of GPs are influenced by parental anxiety when making their treatment decision, rather than by treatment guidelines.
“The feeling of being reassured is subjective and it is often difficult to reassure worried parents. Parents want to be listened to and heard, so it is important that parental reassurance is provided effectively to alleviate their distress, build their confidence and empower them not to reach for medication, which has limited clinical evidence.” Dr Vanessa Bogle, Psychologist and Gut Feelings spokesperson.
To help support GPs in the management of Functional GI Disorders a new educational resource, developed by healthcare professionals, has been launched today on MIMS Learning, which summarises the guidelines for reflux, colic and constipation, and includes a psychology-based motivational interviewing section on how to give effective parental reassurance: www.mimslearning.co.uk/
A combination of better adherence to existing guidelines and responding to parental distress with more effective reassurance and advice on nutrition and practical approaches, rather than medication, could be the key to helping parents and reducing costs.