Nutrition as a method for managing functional gastrointestinal disorders in infants

Functional gastrointestinal disorders (FGIDs) are a common problem in paediatric practice. Symptoms of this disorder in infants account for 25 to 55%. Presence of these symptoms in children has significant impact on their quality of life and also, affects the parents’ quality of life. Functional GI disorders are characterized by pronounced clinical manifestations, despite the absence of organic GI pathology and metabolic disorders. The article presents the major types of functional disorders such as infantile colic, functional constipation and infantile regurgitation, as well as their prevalence, pathophysiological mechanisms and clinical presentation. Particular attention is paid to dietary recommendations that can help improve the health condition of children. Cow’s milk-based infant formulas are popular, while goat’s milk-based formulas are a newish alternative nutrition. It should, however, be noted that goat milk protein has a range of health benefits compared to cow’s milk protein, especially in terms of digestion, as it is more efficiently digested than proteins from cow milk. Recommendations for the management of patients with functional GI disorders on modern milk formulas in the absence of breastfeeding are presented using the example of a clinical report of a 2-month-old baby (K.) with his mother’s complaints about loud crying after eating, irregular bowel movements, regurgitation, short and restless sleep episodes. The CoMiSS (Cow’s Milk-related Symptom Score) scale showed that goat’s milk-based infant formula may be a promising alternative to cow’s milk-based infant formula for this baby.

1. Rumyantsev AG, Timakova MV. History and evolution of pediatrics. Clinical Practice in Pediatrics. 2013;8(2):59–65. (In Russ.) Available at: https://elibrary.ru/qajkgd.

2. Lim ML, Wallace MR. Infectious diarrhea in history. Infect Dis Clin North Am. 2004;18(2):261–274. https://doi.org/10.1016/j.idc.2004.01.006.

3. Ковнер С. Очерки истории медицины. Вып. третий (От Платона до Галена). Киев; 1888. 436 с. Режим доступа: https://commons.wikimedia. org/wiki/File:Ковнер_С._Г._-_Очерки_истории_медицины_%28вып_III%29_1888.pdf.

4. Zakharova IN, Lykina YeV. Consequences of improper infant feeding. Current Pediatrics. 2007;6(1):40–46. (In Russ.) Available at: https://vsp.spr-journal.ru/jour/article/view/995.

5. Darmon N, Drewnowski A. Does social class predict diet quality? Am J Clin Nutr. 2008;87(5):1107–1117. https://doi.org/10.1093/ajcn/87.5.1107.

6. Keefe DM. Agency Response Letter GRAS Notice No. GRN 000644, C.f.F.S.a.A. Nutrition, Editor; 2016. Available at: https://www.fda.gov/food/ gras-notice-inventory/agency-response-letter-gras-notice-no-grn-000644.

7. Agostoni C, Bresson JL, Fairweather-Tait S, Flynn A, Golly I, Korhonen H et al. Scientific Opinion on the suitability of goat milk protein as a source of protein in infant formulae and in follow-on formulae. EFSA J. 2012;10(3):2603. https://doi.org/10.2903/j.efsa.2012.2603.

8. Maathuis A, Havenaar R, He T, Bellmann S. Protein Digestion and Quality of Goat and Cow Milk Infant Formula and Human Milk Under Simulated Infant Conditions. J Pediatr Gastroenterol Nutr. 2017;65(6):661–666. https://doi.org/10.1097/MPG.0000000000001740.

9. Hodgkinson AJ, Wallace OAM, Boggs I, Broadhurst M, Prosser CG. Gastric digestion of cow and goat milk: Impact of infant and young child in vitro digestion conditions. Food Chem. 2018;245:275–281. https://doi.org/10.1016/j.foodchem.2017.10.028.

10. Bellaiche M, Oozeer R, Gerardi-Temporel G, Faure C, Vandenplas Y. Multiple functional gastrointestinal disorders are frequent in formula-fed infants and decrease their quality of life. Acta Paediatr. 2018;107(7):1276–1282. https://doi.org/10.1111/apa.14348.

11. Iacono G, Merolla R, D’Amico D, Bonci E, Cavataio F, Di Prima L et al. Gastrointestinal symptoms in infancy: a population-based prospective study. Dig Liver Dis. 2005;37(6):432–438. https://doi.org/10.1016/j.dld.2005.01.009.

12. Steutel NF, Zeevenhooven J, Scarpato E, Vandenplas Y, Tabbers MM, Staiano A, Benninga MA. Prevalence of Functional Gastrointestinal Disorders in European Infants and Toddlers. J Pediatr. 2020;221:107–114. https://doi.org/10.1016/j.jpeds.2020.02.076.

13. Vernon-Roberts A, Safe M, Day AS. Editorial: Pediatric Functional Gastrointestinal Disorders: Challenges in Diagnosis and Treatment. Gastrointest Disord. 2024;6(1):308–312. https://doi.org/10.3390/gidisord6010021.

14. Drossman DA. The functional gastrointestinal disorders and the Rome II process. Gut. 1999;45(Suppl. 2):II1–II5. https://doi.org/10.1136/gut.45.2008.ii1.

15. Kolesnikov DB, Rapoport SI, Voznesenskaya LA. Current views of psychosomatic diseases. Clinical Medicine (Russian Journal). 2014;92(7):12–18. (In Russ.) Available at: https://elibrary.ru/smyapf.

16. Drossman DA. Functional Gastrointestinal Disorders: History, Pathophysiology, Clinical Features and Rome IV. Gastroenterology. 2016;150(6):1262–1279.e2. https://doi.org/10.1053/j.gastro.2016.02.032.

17. Zeng XL, Zhu LJ, Yang XD. Exploration of the complex origins of primary constipation. World J Clin Cases. 2024;12(24):5476–5482. https://doi.org/10.12998/wjcc.v12.i24.5476.

18. Simanenkov VI, Maev IV, Tkacheva ON, Alekseenko SA, Andreev DN, Bordin DS et al. Syndrome of increased epithelial permeability in clinical practice. Multidisciplinary national Consensus. Cardiovascular Therapy and Prevention (Russian Federation). 2021;20(1):2758. (In Russ.) https://doi.org/10.15829/ 1728-8800-2021-2758.

19. Aydemir Y, Aydemir O, Dinleyici M, Saglik AC, Cam D, Kaya TB, Canpolat FE. Screening for functional gastrointestinal disorders in preterm infants up to 12 months of corrected age: a prospective cohort study. Eur J Pediatr. 2024;183(5):2091–2099. https://doi.org/10.1007/s00431-024-05451-4.

20. Vernon-Roberts A, Alexander I, Day AS. Systematic Review of Pediatric Functional Gastrointestinal Disorders (Rome IV Criteria). J Clin Med. 2021;10(21):5087. https://doi.org/10.3390/jcm10215087.

21. Indrio F, Enninger A, Aldekhail W, Al-Ghanem G, Al-Hussaini A, Al-Hussaini B et al. Management of the Most Common Functional Gastrointestinal Disorders in Infancy: The Middle East Expert Consensus. Pediatr Gastroenterol Hepatol Nutr. 2021;24(4):325–336. https://doi.org/10.5223/pghn.2021.24.4.325.

22. Benninga MA, Faure C, Hyman PE, St James Roberts I, Schechter NL, Nurko S. Childhood Functional Gastrointestinal Disorders: Neonate/Toddler. Gastroenterology. 2016;150(6):1443–1455.e2. https://doi.org/10.1053/j.gastro.2016.02.016.

23. Deeb MT, Mohsen YM, Nehal ES. Diagnostic Outcome of Rome IV Criteria in Infant Regurgitation. QJM. 2024;117(Suppl. 1):hcae070.494. https://doi.org/10.1093/qjmed/hcae070.494.

24. Zakharova IN, Sugyan NG, Berezhnaya IV. Functional gastrointestinal disorders in the infants: diagnostics criteria and approaches to the dietary therapy. Russian Bulletin of Perinatology and Pediatrics. 2018;63(1):113–121. (In Russ.) https://doi.org/10.21508/1027-4065-2018-63-1-113-121.

25. Indrio F, Dargenio VN, Francavilla R, Szajewska H, Vandenplas Y. Infantile Colic and Long-Term Outcomes in Childhood: A Narrative Synthesis of the Evidence. Nutrients. 2023;15(3):615. https://doi.org/10.3390/nu15030615.

26. Muhardi L, Aw MM, Hasosah M, Ng RT, Chong SY, Hegar B et al. A Narrative Review on the Update in the Prevalence of Infantile Colic, Regurgitation, and Constipation in Young Children: Implications of the ROME IV Criteria. Front Pediatr. 2022;9:778747. https://doi.org/10.3389/fped.2021.778747.

27. Despriee ÅW, Mägi CO, Småstuen MC, Glavin K, Nordhagen L, Jonassen CM et al. Prevalence and perinatal risk factors of parent-reported colic, abdominal pain and other pain or discomforts in infants until 3 months of age – A prospective cohort study in PreventADALL. J Clin Nurs. 2022;31(19-20):2784–2796. https://doi.org/10.1111/jocn.16097.

28. Haiden N, Savino F, Hill S, Kivelä L, De Koning B, Kӧglmeier J et al. Infant formulas for the treatment of functional gastrointestinal disorders: A position paper of the ESPGHAN Nutrition Committee. J Pediatr Gastroenterol Nutr. 2024;79(1):168–180. https://doi.org/10.1002/jpn3.12240.

29. Walter AW, Hovenkamp A, Devanarayana NM, Solanga R, Rajindrajith S, Benninga MA. Functional constipation in infancy and early childhood: epidemiology, risk factors, and healthcare consultation. BMC Pediatr. 2019;19(1):285. https://doi.org/10.1186/s12887-019-1652-y.

30. Tran DL, Sintusek P. Functional constipation in children: What physicians should know. World J Gastroenterol. 2023;29(8):1261–1288. https://doi.org/10.3748/wjg.v29.i8.1261.

31. Diaz S, Bittar K, Hashmi MF, Mendez MD. Constipation. In: StatPearls. Treasure Island (FL): StatPearls Publishing; 2023. Available at: https://pubmed.ncbi.nlm.nih.gov/30020663/.

32. Zakharova IN, Berezhnaya IV, Kasyanova AN, Sugyan NG, Lazareva SI, Dedikova OV et al. Functional disorders of the gastrointestinal tract in young children – modern view on traditional problems in babies. Pediatrics. Consilium Medicum. 2018;(3):24–29. (In Russ.) Available at: https://www.kabrita.ru/assets/assets_vracham/pdf/nauchnye-publikatsii/Consilium%20Medicum%2C%202018%20%20%E2%84%963.pdf.

33. Zeevenhooven J, Koppen IJ, Benninga MA. The New Rome IV Criteria for Functional Gastrointestinal Disorders in Infants and Toddlers. Pediatr Gastroenterol Hepatol Nutr. 2017;20(1):1–13. https://doi.org/10.5223/pghn.2017.20.1.1.

34. Switkowski KM, Oken E, Simonin EM, Nadeau KC, Rifas-Shiman SL, Lightdale JR. Early-life risk factors for both infant colic and excessive crying without colic. Pediatr Res. 2024. https://doi.org/10.1038/s41390024-03518-4.

35. Vandenplas Y, Bajerova K, Dupont C, Eigenmann P, Kuitunen M, Meyer R et al. The Cow’s Milk Related Symptom Score: The 2022 Update. Nutrients. 2022;14(13):2682. https://doi.org/10.3390/nu14132682.

36. Vandenplas Y. Algorithms for Common Gastrointestinal Disorders. J Pediatr Gastroenterol Nutr. 2016;63(Suppl. 1):S38–S40. https://doi.org/10.1097/MPG.0000000000001220.

37. Verruck S, Dantas A, Prudencio ES. Functionality of the components from goat’s milk, recent advances for functional dairy products development and its implications on human health. J Funct Foods. 2019;52:243–257. https://doi.org/10.1016/j.jff.2018.11.017.

38. Gan J, Bornhorst GM, Henrick BM, German JB. Protein Digestion of Baby Foods: Study Approaches and Implications for Infant Health. Mol Nutr Food Res. 2018;62(1):1700231. https://doi.org/10.1002/mnfr.201700231.

39. Muñoz-Salinas F, Andrade-Montemayor HM, De la Torre-Carbot K, Duarte-Vázquez MÁ, Silva-Jarquin JC. Comparative Analysis of the Protein Composition of Goat Milk from French Alpine, Nubian, and Creole Breeds and Holstein Friesian Cow Milk: Implications for Early Infant Nutrition. Animals. 2022;12(17):2236. https://doi.org/10.3390/ani12172236.

40. Hodgkinson AJ, Wallace OAM, Smolenski G, Prosser CG. Gastric digestion of cow and goat milk: Peptides derived from simulated conditions of infant digestion. Food Chem. 2019;276:619–625. https://doi.org/10.1016/j.foodchem.2018.10.065.

41. Lara-Villoslada F, Olivares M, Jiménez J, Boza J, Xaus J. Goat milk is less immunogenic than cow milk in a murine model of atopy. J Pediatr Gastroenterol Nutr. 2004;39(4):354–360. https://doi.org/10.1097/00005176200410000-00010.

42. Infante D, Prosser C, Tormo R. Constipated Patients Fed Goat Milk Protein Formula: A Case Series Study. J Nutr Health Sci. 2018;5(2):203. https://doi.org/10.15744/2393-9060.5.203.

43. Maximino P, van Lee L, Meijer-Krommenhoek YN, van der Zee L, da Costa Ribeiro Junior H. Common gastrointestinal symptoms in healthy infants receiving goat milk-based formula or cow’s milk-based formula: a double-blind, randomized, controlled trial. BMC Pediatr. 2024;24(1):753. https://doi.org/10.1186/s12887-024-05214-y.

44. Grant C, Rotherham B, Sharpe S, Scragg R, Thompson J, Andrews J et al. Randomized, double-blind comparison of growth in infants receiving goat milk formula versus cow milk infant formula. J Paediatr Child Health. 2005;41(11):564–568. https://doi.org/10.1111/j.1440-1754.2005.00722.x.

45. Salsberg A. Goat Milk Toddler Formula Reduces Symptoms Associated With Cow Milk Consumption. J Acad Nutr Dietetics. 2016;116(9):A100. https://doi.org/10.1016/J.JAND.2016.06.363.

46. Kompan D, Komprej A. The Effect of Fatty Acids in Goat Milk on Health. In: Chaiyabutr N (ed.). Milk Production – An Up-to-Date Overview of Animal Nutrition, Management and Health. InTech; 2012. https://doi.org/10.5772/50769.

47. Chen Q, Yin Q, Xie Q, Liu S, Guo Z, Li B. Elucidating gut microbiota and metabolite patterns shaped by goat milk-based infant formula feeding in mice colonized by healthy infant feces. Food Chem. 2023;410:135413. https://doi.org/10.1016/j.foodchem.2023.135413.

48. Leong A, Liu Z, Almshawit H, Zisu B, Pillidge C, Rochfort S, Gill H. Oligosaccharides in goats’ milk-based infant formula and their prebiotic and anti-infection properties. Br J Nutr. 2019;122(4):441–449. https://doi.org/10.1017/S000711451900134X.

49. Chen K, Zhang G, Xie H, You L, Li H, Zhang Y et al. Efficacy of Bifidobacterium animalis subsp. lactis, BB-12® on infant colic –a randomised, doubleblinded, placebo-controlled study. Benef Microbes. 2021;12(6):531–540. https://doi.org/10.3920/BM2020.0233.

50. van Lee L, Meijer-Krommenhoek Y, He T, van der Zee L, Verkade H. Sleep duration among breastfed, goat milk-based or cow’s milk-based infant formula-fed infants: Post hoc analyses from a double-blind RCT. J Pediatr Gastroenterol Nutr. 2025;80(3):482–489. https://doi.org/10.1002/jpn3.12436.