Pediatric Functional Gastrointestinal Disorders Benefit from Compounding Pharmacist Outreach
Kids and gastrointestinal complaints go hand-in-hand. Most of the time there’s an easy cure and they are back outside playing in no time—but for some kids, the complaints persist and become chronic. Parents may try to take care of the problem without a trip to the doctor, instead visiting the pharmacy in search of an OTC product. That’s when pharmacists have the chance to offer guidance. Don’t let this opportunity pass you by. Pharmacists can truly help these kids by giving parents tips on how to recognize pediatric functional gastrointestinal disorders and when it’s time to see the doctor.
Multiple Diagnoses Confound Functional Gastrointestinal Disorders
When it comes to children, functional gastrointestinal disorders (FGID) are relatively common. An estimated 13 to 38 percent of children and adolescents suffer from weekly abdominal pain and nearly 24 percent have symptoms lasting longer than two months.1 Irritable bowel syndrome is just as prevalent in adolescents as adults, with 17 percent of high school students and 8 percent of middle school students presenting with symptoms sufficient for a diagnosis.2
Parents often expect doctors to run a few tests and come up with a diagnosis, but that’s not how it happens when kids have functional gastrointestinal disorders. Functional problems aren’t related to structural abnormalities that show up on an x-ray or MRI. This type of health problem involves the gut-brain interaction, which means standard lab tests have little value. FGIDs arise from abnormalities in intestinal motility and nerve sensitivity, or the way the brain controls them. A short list of the most common FGID-related conditions includes:
- Functional abdominal pain syndrome
- Functional constipation
- Gastrointestinal reflux disease
- Functional dyspepsia
- Infant regurgitation
- Irritable bowel syndrome
- Abdominal migraine
- Cyclic vomiting syndrome
Help Parents Sort Through Symptoms
Attitudes are slowly changing, but Western medicine has historically given more credence to biomedical diseases with verifiable anatomic changes. As a result, kids’ GI symptoms may not be viewed as a “real” problem, which can make parents feel inadequate and can prevent kids from getting timely and sufficient treatment. The opinion that it’s just in their heads also creates a conundrum because pediatric FGID is associated with a higher prevalence of psychiatric disorders, especially anxiety and depression. As you have the opportunity to interact with these parents, remember that they may already be on the defensive, so be patient and prepared to talk about all aspects of treatment.
Pediatric FGIDs may manifest as common GI problems like stomach aches and diarrhea, but their chronic nature can interfere with school attendance and prevent kids from normal socialization. In fact, when they interfere with quality of life—whether the child’s or the family’s—it’s time to see the pediatrician. The trouble with assessing symptoms is that they’re a little different for each type of FGID. These classic symptoms may occur alone or in any combination:
- Problems in the passage of food
Key symptoms for a few common types of FGID include:3
- Functional abdominal pain – This FGID is characterized by weekly abdominal pain lasting at least two months. Children often have increased rectal sensitivity and feel more pain from normal rectal distension compared with controls. Prevalence ranges from 0.3 to 19 percent.
- Functional dyspepsia – Symptoms include persistent or recurrent pain localized to the upper abdomen and often occurring after eating. Prevalence is estimated at 5 to 16 percent.
- Irritable bowel syndrome – Defined as weekly symptoms of abdominal pain or discomfort accompanied by changes in bowel patterns, which may include changes in form or frequency. Visceral hypersensitivity stems from dysregulated communication between nerves in the intestine and central nervous system. The prevalence of IBS-associated abdominal pain is 8 to 17 percent in children and 13 to 38 percent in adolescents.4
The Rome III diagnostic criteria are becoming the gold standard, even for pediatric FGID.5 The Journal of Pediatric Gastroenterology and Nutrition published a study in June 2016 supporting the use of Rome III for facilitating symptom-based diagnosis. After studying 976 pediatric patients referred to a gastroenterology clinic, the researchers also found that 52 percent of patient aged four years or less and 75 percent of those older than four met Rome III diagnostic criteria for FGID.6
Multimodal Treatment Options
In addition to learning about abdominal pain symptoms, parents depend on pharmacists to help them sort through the overwhelming choices of treatments, whether OTC and prescription medications, supplements or alternative therapies. A treatment approach that combines medical and psychological treatment is often most effective for children and adolescents struggling with FGID. Depending on the diagnosis, options include:
Pharmaceutical treatments – A variety of drugs from any of the following categories may be needed to treat FGID. Children with GI symptoms may have a hard time taking meds, so talk to parents about compounding different forms or adding more palatable flavoring.
- Tricyclic antidepressants
- Chloride channel agonists
- Stool softeners
- Bulking agents
Psychological – One way to help parents understand the benefit of psychological therapy is to remind them about the nerve connections between the gut and brain, their child’s potential hypersensitivity and how they can learn to control it through cognitive behavioral therapy.7 Controlling stress and anxiety also relieves symptoms.
Alternative medicine – While hypnosis, biofeedback, relaxation techniques and acupuncture may not be appropriate for young children, adolescents can benefit from these options.
Dietary management – Certain foods may trigger FGID symptoms, but the specific foods that are problematic differs for each person. Parents can keep a diary, noting what their kids ate and when symptoms arise. Then they should eliminate foods one-by-one to see if symptoms improve. Otherwise, they can consult a registered dietitian to help them identify triggers and develop a diet plan.
Proactive Outreach for Parents Buying OTC Products
Parents may approach you with questions about OTC products, but they’ll also appreciate that someone notices when they buy pediatric GI products and asks whether they have any questions about their child’s symptoms and treatment. Remember that pediatric FGID can be tremendously stressful for parents and kids alike. Any encouragement and guidance you provide will make a positive impact.
Pharmaceutica North America provides prescription products, APIs, compounding kits and OTC supplements that can help treat children and adolescents with functional gastrointestinal disorders. Contact us today to talk about how we can support all your pharmaceutical needs.
- “How to Deal With Pediatric Functional Gastrointestinal Disorders,” September 2013, http://link.springer.com/article/10.1007/s40124-013-0018-4 ↩
- “Kids and Teens GI Disorders,” 2016, http://iffgd.org/kids-teens.html ↩
- “Pediatric Functional Gastrointestinal Disorders,” June 2008, http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2821593/ ↩
- “Irritable Bowel Syndrome in Children and Adolescents,” May 2015, https://www.uspharmacist.com/article/irritable-bowel-syndrome-in-children-and-adolescents ↩
- “Rome III Diagnostic Criteria for Functional Gastrointestinal Disorders,” 2006, http://www.romecriteria.org/assets/pdf/19_RomeIII_apA_885-898.pdf ↩
- “Diagnostic Criteria for Pediatric Functional Gastrointestinal Disorders,” June 2016, http://www.practiceupdate.com/journalscan/28313/2/9 ↩
- “Psychological Treatments in Functional Gastrointestinal Disorders: A Primer for the Gastroenterologist,” March 2014, http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3591464/ ↩