Epidemiology of functional gastrointestinal disorders in infants and toddlers: A systematic review

Table 1 Classification of functional gastrointestinal disorders in infants and toddlers

	Rome III nomenclature	Age	Frequency	Duration	Synonym or approximate terms
G1	Infant regurgitation	3 wk-12 mo	≥ 2 regurgitations/d	≥ 3 wk	Gastroesophageal reflux
G2	Infant rumination syndrome	3-8 mo1		≥ 3 mo	Childhood feeding and eating disorders2
G3	Cyclic vomiting syndrome		≥ 2 vomiting episodes	hours - days	Periodic vomiting
G4	Infant colic	0-4 mo	≥ 3 d/wk for ≥ 1 wk	≥ 3 h/d	Infantile colic; abdominal pain syndrome
					Wessel’s criteria: irritability, fussing or crying
G5	Functional diarrhea	6-36 mo1	≥ 3 painless stools/d	≥ 4 wk	Infantile diarrhea
G6	Infant dyschezia	< 6 mo	≥ 10 min straining		Straining and crying
G7	Functional constipation	≤ 4 yr	≤ 2 defecations/wk	≥ 4 wk	Classic Iowa criteria
			≥ 1 incontinence/wk		Functional defecation disorder
					Functional fecal retention3

¹Onset of symptoms;

²International Classification of Disease and Diagnostic and Statistical Manual systems;

³Rome II nomenclature.

Table 2 Prevalence or frequency of functional gastrointestinal disorders: Eating and feeding problems in infants and toddlers

Author, year, country	Study design, setting	Sample size (participation %)	Age bracket	Case definition	Case ascertainment	Score	FGID prevalence %
							Regurgitation	Rumination	Cyclic vomiting
Van Tilburg, 2015, United States	Cross-sectional, community	264 (82.5)	0-3 yr	Rome III	Online panel w/mothers	2	25.9	4.3	3.4
					QPGS-RIII
					PedsQL4.0
Rouster, 2015, United States	Cross-sectional, specialty care	332 (91.0)	0-4 yr	Rome III	Parental interviews	4	13.2	3.0	10.2
					QPGS-RIII
Liu, 2009, China	Cross-sectional, community	5030 (99.4)	0-2 yr	Rome III	Parental interviews	6	17.9
					Parental questionnaire on GI symptoms
Primavera, 2009, Italy	Cross-sectional, primary care	9291 (NR)	0-14 yr	Rome II	Interviews w/parents and children	4	0.44
					FGID questionnaire
Campanozzi, 2009, Italy	Cross-sectional, primary care	2642 (NR)	1-12 mo	Rome II	Interviews w/parents and children	4	12.0
					I-GERQ
Miele, 2004, Italy	Cross-sectional, primary care	9660 (NR)	1-12 mo	Rome II	Interviews w/parents and children	4	0.74
					FGID questionnaires

Score = Methodological strength of study (maximum 8) by Loney’s criteria. PedsQL4.0: Pediatric Quality of Life version Inventory 4.0; I-GERQ: Infant Gastroesophageal Reflux Questionnaire; QPGS-RIII: Questionnaire on Pediatric Gastrointestinal Symptoms - Rome III; FGD: Functional gastrointestinal disorders; NR: Not reported; w: With; GI: Gastrointestinal.

Table 3 Prevalence or frequency of functional gastrointestinal disorders: Colic and defecation problems in infants and toddlers

Author, year, country	Study design, setting	Sample size (participation %)	Age bracket	Case definition	Case ascertainment	Score	FGID prevalence %
							Colic	Diarrhea	Dyschezia	Constipation
Tharner, 2015, the Netherlands	Population-based birth-cohort, community	4823 (61)	2-4 yr	Rome II	Interviews w/parents and children, CEBQ - parental	7				2 yr: 11.2
										3 yr: 15.7
										4 yr: 14.2
Van Tilburg, 2015, United States	Cross-sectional, community	264 (82)	0-3 yr	Rome III	Online panel w/mothers	2	5.9	8.8	2.4	14.1
					QPGS-RIII
					PedsQL4.0
Kramer, 2015, the Netherlands	Prospective cohort, well-baby clinics	1292 (87)	1-9 mo	Rome III	Interviews w/parents and children Parental questionnaire	6			1 mo: 3.9/17.31
				M-Rome III					3 mo: 0.9/6.51
Rouster, 2015, United States	Cross-sectional, specialty care	332 (91)	0–4 yr	Rome III	Parental interviews	4	4.2	0.3	3.3	29.2
					QPGS-RIII
Osakatul, 2014, Thailand	Cross-sectional, hospital’s catchment area	3010 (97.1)	4 mo-5 yr	Rome II	Parental interviews	7				1.9 (Rome II)
				Rome III	Laboratory exams					1.6 (Rome III)
Turco, 2014, Italy	Prospective birth-cohort, university-based hospitals	402 (86.4)	0-12 mo	Rome III	Telephone interview w/parents	4				3 mo: 11.6
										6 mo: 13.7
										12 mo: 10.7
Mota, 2012, Brazil	Population-based birth-cohort, community	3799 (92)	0-4 yr	M-Rome II	Interviews w/mothers	7				2 yr: 27.31
										4 yr: 31.01
Liu, 2009, China	Cross-sectional, community	5030 (99.4)	0-2 yr	Rome III	Parental interviews	6	1.4	12.3		13.7
					Parental questionnaire on GI symptoms
Aydoğdu, 2009, Turkey	Cross-sectional (retrospective), university-based hospital and specialty care unit	193 (NR)	0-5 yr	Rome II	Medical records	3				51.9
				Iowa criteria	Laboratory exams
Miele, 2004, Italy	Cross-sectional, primary care	9660 (NR)	1-12 mo	Rome II	Interviews w/parents and children	4		0.07		0.68
					FGID questionnaires
Voskuijl, 2004, the Netherlands	Cross-sectional, tertiary care	45 (65.7)	≤ 6 yr	Rome II	Patient diary	3				64.0
				Iowa criteria	Medical interviews w/ parents and children
					Physical examination

Score = Methodological strength of study (maximum 8) by Loney’s criteria. CEBQ: Child Eating Behavior Questionnaire; QPGS-RIII: Questionnaire on Pediatric Gastrointestinal Symptoms - Rome III; PedsQL4.0 Pediatric Quality of Life version Inventory 4.0; I-GERQ: Infant Gastroesophageal Reflux Questionnaire; NR: Not reported; w: With; M-Rome: Modified Rome criteria.