Indonesian pediatricians’ knowledge of Rome IV criteria and their therapeutic approach to infantile colic

  • Agus Tini Sridevi FKUI
  • Hubert Jonathan Faculty of Medicine, Universitas Indonesia, Jakarta
  • Brahmantyo Ardhi Wicaksono Faculty of Medicine, Universitas Indonesia, Jakarta
  • Badriul Hegar Department of Child Health, Universitas Indonesia/Cipto Mangunkusumo Hospital, Jakarta
Keywords: Infant Colic, Rome IV, Indonesian Pediatricians, Knowledge, Behaviour, Therapeutic approach

Abstract

Background Infantile colic is a functional gastrointestinal disorder (FGID) that occurs in approximately 20% of infants under 6 months. Even though this condition is self-limiting, inappropriate therapy affects the baby’s future quality of life. Therefore, it is essential for physicians, especially pediatricians, to employ a correct diagnosis based on the currently accepted Rome IV criteria and an appropriate therapeutic approach.

Objective To assess the gaps in Indonesian pediatricians’ understanding of infantile colic according to Rome IV criteria, their therapeutic approach in managing the condition, and associated factors.

Methods We randomly selected 131 pediatricians from the Jakarta Chapter of the Indonesian Pediatric Society to complete a questionnaire aimed at assessing their knowledge on the diagnosis of and therapeutic approach to infantile colic. The questionnaire was scored on a scale of 0 to 20. We evaluated the association between questionnaire scores and their association with several variables, including years of clinical experience, accreditation of pediatric residency institution, type of hospital, and guidelines used.

Results Out of the 131 pediatricians selected, 75 (57.3%) had used the Rome IV criteria. The mean knowledge score of those participants was 14.24 (SD 3.32) out of 20. Mean therapeutic approach score of all participants was 11.50 (SD 2.80) out of 16 points. There was no significant association between either knowledge or therapeutic approach score with length of clinical experience, accreditation of pediatric residency institution, hospital type, or guidelines used.

Conclusions Most surveyed pediatricians who have used the Rome IV criteria have fairly good knowledge of infantile colic. Overall, pediatricians also have a fairly sound therapeutic approach to infantile colic. However, with mean scores of approximately 70% of the maximum score, education is needed to improve on these areas. Knowledge of and therapeutic approach to infantile colic are not associated with length of clinical experience, accreditation of pediatric residency institution, hospital type, or guidelines used.

Author Biography

Hubert Jonathan, Faculty of Medicine, Universitas Indonesia, Jakarta

 

References

1. Barr R, St. James Roberts I, Keefe M, editors. Behavioural treatment of prolonged infant crying: evaluation, methods, and a proposal. In: New evidence on unexplained early infant crying: its origins, nature and management. Skillman, NJ: Johnson & Johnson Pediatric Institute; 2001. p. 187–208. ISBN 9780931562211.
2. Benninga MA, Nurko S, Faure C, Hyman PE, St James Roberts I, Schechter NL. Childhood functional gastrointestinal disorders: neonate/toddler. Gastroenterology. 2016;150:1443-1455.e2. DOI: https://doi.org/10.1053/j.gastro.2016.02.016.
3. Zeevenhooven J, Koppen IJN, Benninga MA. The new Rome IV criteria for functional gastrointestinal disorders in infants and toddlers. Pediatr Gastroenterol Hepatol Nutr. 2017;20:1–13. DOI: https://doi.org/10.5223/pghn.2017.20.1.1.
4. Vandenplas Y, Abkari A, Bellaiche M, Beningga M, Chouraqui J, Harb T, et al. Prevalence and health outcomes of functional gastrointestinal symptoms in infants from birth to 12 months of age. J Pediatr Gastroenterol Nutr. 2015;61:531–7. DOI: https://doi.org/10.1097/MPG.0000000000000949.
5. Wessel M, Cobb J, Jackson E, Harris G, Detwiler AC. Paroxysmal fussing in infancy, sometimes called colic. Pediatrics. 1954;14:421–35. PMID: 13214956.
6. Barr R. Excessive crying. In: Sameroff A, Lewis M, Miller S, editors. Handbook of developmental psycopathology. 2nd ed. New York: Kluwer Academic/Plenum Publishers; 2000. p. 327–50. PMID: 25873690.
7. Murray L, Cooper P. The impact of irritable infant behavior on maternal mental state: a longitudinal study and a treatment trial. In: Barr R, St James-Roberts I, Keefe M, editors. New evidence on unexplained early infant crying: its origins, nature and management. Skillman, NJ: Johnson & Johnson Pediatric Institute; 2001. p. 149–64.
8. van Tilburg M, Hyman P, Walker L, Rouster A, Palsson O, Kim S, et al. Prevalence of functional gastrointestinal disorders in infants and toddlers. J Pediatr. 2015;166:684–9. DOI: https://doi.org/10.1016/j.jpeds.2014.11.039.
9. Scherer LD, Zikmund-Fisher BJ, Fagerlin A, Tarini BA. Influence of “GERD” label on parents’ decision to medicate infants. Pediatrics. 2013;131:839–45. DOI: https://doi.org/10.1542/peds.2012-3070.
10. Fujiwara T, Barr R, Brant R, Barr M. Infant distress at five weeks of age and caregiver frustration. J Pediatr. 2011;159:425-30.e.1-2. DOI: https://doi.org/10.1016/j.ped.2016.01.004.
11. Barr R, Trent R, Cross J. Age-related incidence curve of hospitalized shaken baby syndrome cases: convergent evidence for crying as a trigger to shaking. Child Abus Negl. 2006;30:7–16. PMID: 16406023.
12. Reijneveld S, van der Wal M, Brugman E, Sing RA, Verloove-Vanhorick SP. Infant crying and abuse. Lancet. 2004;364:1340–2. DOI: https://doi.org/10.1016/S014-6736(04)17191-2.
13. Gelfand AA. Infant colic. Semin Pediatr Neurol. 2016;23:79–82. DOI: https://doi.org/10.1016/j.spen.2015.08.003.
14. Meyer E, Coll C, Lester B, Boukydis C, McDonough S, Oh W. Family-based intervention improves maternal psychological well-being and feeding interaction of preterm infants. Pediatrics. 1994;93:241–6. PMID: 8121735.
15. Schei E, Fuks A, Boudreau JD. Reflection in medical education: intellectual humility, discovery, and know-how. Med Health Care Philos. 2019;22:167–78. DOI: https://doi.org/10.1007/s11019-018-9878-2.
16. Drossman D. Functional gastrointestinal disorders: history, pathophysiology, clinical features and Rome IV. Gastroenterology. 2016;150:1262-79.e2. DOI: https://doi.org/10.1053/j.gastro.2016.02.032.
17. St James-Roberts I. The origins, prevention and treatment of infant crying and sleeping problems: an evidence-based guide for healthcare professionals and the families they support. London & New York: Routledge; 2012. DOI: https://doi.org/10.1007/s00787-012-0315-4.
18. Barr R. The normal crying curve: what do we really know? Dev Med Child Neurol. 1990;32:356–62. DOI: https://doi.org/10.1111/j.1469-8749.1990.tb16949.x.
19. Treem WR. Infant colic. A pediatric gastroenterologist's perspective. Pediatr Clin North Am. 1994;41:1121–38. DOI: https://doi.org/10.1016/s0031-3955(16)38848-4.
20. Johnson J, Cocker K. Infantile colic: recognition and treatment. Am Fam Physician. 2015;92:577–82. PMID: 26447441.
21. Shamir R. Infant colic and functional gastrointestinal disorders: is there more than a “gut feeling”? J Pediatr Gastroenterol Nutr. 2013;57:S1–2. DOI: https://doi.org/10.1097/MPG.0b013e3182a154ff.
22. Heidelbaugh J. Childhood functional GI disorders. In: Hungin P, Heidelbaugh J, editors. Functional gastrointestional disorders for primary care and non-GI clinicians. 1st ed. Raleigh: Edwards Brothers Malloy; 2016. p. 80–98. DOI: https://doi.org/10.1053/j.gastro.2016.02.015.
23. Barr R, Young S, Wright J, Gravel R, Alkawaf R. Differential calming responses to sucrose taste in crying infants with and without colic. Pediatrics. 1999;103:e68. PMID: 10224212.
24. Scarpato E, Quitadamo P, Roman E, Jojkic-Pavkov D, Kolacek S, Papadopoulou A, et al. Functional gastrointestinal disorders in children: a survey on clinical approach in the Mediterranean area. J Pediatr Gastroenterol Nutr. 2017;64:e142–6. PMID: 28541259.
25. Salvatore S, Barberi S, Borrelli O, Castellazzi A, Di Mauro D, Di Mauro G, et al. Pharmacological interventions on early functional gastrointestinal disorders. Ital J Pediatr. 2016;42:68. PMID: 27423188.
26. Magongwa N, Matsaung B, Motubatse J, Schellack N. An overview of gastrointestional illness in children. S Afr Pharm J. 2018;85:52–9.
27. Chogle A, Velasco-Benitez C, Koppen I, Moreno J, Ramirez Hernandez C, Saps M. A population-based study on the epidemiology of functional gastrointestinal disorders in young children. J Pediatr. 2016;179:139-41.e1. PMID: 27726867.
28. Milidou I, Sondergaard C, Jenses M, Olsen J, Henriksen T. Gestational age, small for gestational age, and infantile colic. Pediatr Perinat Epidemiol. 2014;28:138–45. PMID: 24261325.
29. Ferreira-Maia A, Matijasevich A, Wang Y. Epidemiology of functional gastrointestinal disorders in infants and toddlers: a systematic review. World J Gastroenterol. 2016;22:6547–58. PMID: 27605889.
30. Wolke D. Behavioural treatment of prolonged infant crying: evaluation, methods, and a proposal. In: Barr R, St James-Roberts I, Keefe M, editors. New evidence on unexplained early infant crying: its origins, nature and management. Skillman, NJ; 2001. p. 187–208.
31. de Weerth C, Fuentes S, Puylaert P, de Vos W. Intestinal microbiota of infants with colic: development and specific signatures. Pediatrics. 2013;131:e550-8. PMID: 23319531.
32. Shamir R, St James-Roberts I, Di Lorenzo C, Burns A, Thapar N, Indrio F, et al. Infant crying, colic, and gastrointestinal discomfort in early childhood: a review of the evidence and most plausible mechanisms. J Pediatr Gastroenterol Nutr. 2013;57 Suppl 1:S1–45. PMID: 24356023
33. Sung V. Infantile colic. Aust Prescr. 2018;41:105–10. PMID: 30116077.
34. Chau K, Lau E, Greenberg S, Jacobson S, Yazdani-Brojeni P, Verma N, et al. Probiotics for infantile colic: a randomized, double-blind, placebo-controlled trial investigating Lactobacillus reuteri DSM 17938. J Pediatr. 2015;166:74–8. PMID: 25444531.
35. Savino F, Cordisco L, Tarasco V, Palumeri E, Calabrese R, Oggero R, et al. Lactobacillus reuteri DSM 17938 in infantile colic: a randomized, double-blind, placebo-controlled trial. Pediatrics. 2010;126:e526-33. PMID: 20713478
36. Anabrees J, Indrio F, Paes B, Alfaleh K. Probiotics for infantile colic: a systematic review. BMC Pediatr. 2013;13:186. DOI; https://doi.org/10.1186/1471-2431-13-186.
37. Sung V, Collett S, de Gooyer T, Hiscock H, Tang M, Wake M. Probiotics to prevent or treat excessive infant crying: systematic review and meta-analysis. JAMA Pediatr. 2013;167:1150–7. PMID: 24100440.
38. de Weerth C, Fuentes S, de Vos W. Crying in infants: on the possible role of intestinal microbiota in the development of colic. Gut Microbes. 2013;4:416-21. PMID: 23941920.
39. Metcalf T, Irons T, Sher L, Young P. Simethicone in the treatment of infant colic: a randomized, placebo-controlled, multicenter trial. Pediatrics. 1994;94:29-34. PMID: 8008533.
40. Danielsson B, Hwang C. Treatment of infantile colic with surface active substance (simethicone). Acta Paediatr Scand. 1985;74:446–50. PMID: 3890465.
41. Willliams J, Watkins-Jones R. Dicyclomine: worrying symptoms associated with its use in some small babies. Br Med J (Clin Res Ed). 1984;288:901. PMID: 6423135.
42. Moore D, Tao B, Lines D, Hirte C, Heddle ML, Davidson GP. Double-blind placebo-controlled trial of omeprazole in irritable infants with gastroesophageal reflux. J Pediatr. 2003;143:219–23. PMID: 12970637.
43. Dobson D, Lucassen P, Miller J, Vlieger AM, Prescott P, Lewith G. Manipulative therapies for infantile colic. Cochrane Database Syst Rev. 2012;12:CD004796. PMID: 23235617.
44. Sheidaei A, Abadi A, Zayeri F, Nahidi F, Gazerani N, Mansouri A. The effectiveness of massage therapy in the treatment of infantile colic symptoms: a randomized controlled trial. Med J Islam Repub Iran. 2016;30:351. PMID: 27453882.
45. Salvatore S, Abkari A, Cai W, Catto-Smith A, Cruchet S, Gottrand F, et al. Review shows that parental reassurance and nutritional advice help to optimise the management of functional gastrointestinal disorders in infants. Acta Paediatr. 2018;107:1512-20. PMID: 29710375.
46. Bai Y, Wang S, Yin X, Bai J, Gong Y, Lu Z. Factors associated with doctors’ knowledge on antibiotic use in China. Sci Rep. 2016;6:23429. PMID: 27010107.
47. Kamuhabwa AAR, Kisoma S. Factors influencing prescribing practices of medical practitioners in public and private health facilities in Dar es Salaam , Tanzania. Trop J Pharm Res. 2015;14:2107–13. DOI: https://doi.org/10.4314/tjpr.v14i11.22.
48. Davari M, Khorasani E, Tigabu BM. Factors influencing prescribing decisions of physicians: a review. Ethiop J Health Sci. 2018;28:795–804. PMID: 30607097.
49. Carthy P, Harvey I, Brawn R, Watkins C. A study of factors associated with cost and variation in prescribing among GPs. Fam Pract. 2000;17:36–41. PMID: 10673486.
50. Novack L, Jotkowitz A, Knyazer B, Novack V. Evidence-based medicine: assessment of knowledge of basic epidemiological and research methods among medical doctors. Postgrad Med J. 2006;82:817–22. PMID: 17148706.
51. Beasley BW, Scrase DR, Schultz HJ. Determining the predictors of internal medicine residency accreditation: what they do (not what they say). Acad Med. 2002;77:238–46. PMID: 11891164.
52. Barzansky B, Hunt D, Moineau G, Ahn D, Lai CW, Humphrey H, et al. Continuous quality improvement in an accreditation system for undergraduate medical education: benefits and challenges. Med Teach. 2015;37:1032–8. PMID: 25897708.
53. Choudhry NK, Fletcher RH, Soumerai SB. Systematic review: the relationship between clinical experience and quality of health care. Ann Intern Med. 2005;142:260–73. PMID: 15710959.
54. Sargeant J, Curran V, Jarvis-Selinger S, Ferrier S, Allen M, Kirby F, et al. Interactive on-line continuing medical education: physicians’ perceptions and experiences. J Contin Educ Health Prof. 2004;24:227–36. PMID: 15709562.
55. Fordis M, King JE, Ballantyne CM, Jones PH, Schneider KH, Spann SJ, et al. Comparison of the instructional efficacy of Internet-based CME with live interactive CME workshops: a randomized controlled trial. JAMA. 2005;294:1043-51. DOI: https://doi.org/10.1001/jama.294.9.1043.
56. Gutiérrez-Castrellón P, Indrio F, Bolio-Galvis A, Jiménez-Gutiérrez C, Jimenez-Escobar I, López-Velázquez G. Efficacy of Lactobacillus reuteri DSM 17938 for infantile colic: systematic review with network meta-analysis. Medicine (Baltimore). 2017;96:e9375. PMID: 29390535.
57. Sung V, D’Amico F, Cabana MD, Chau K, Koren G, Savino F, et al. Lactobacillus reuteri to treat infant colic: a meta-analysis. Pediatrics. 2018;141:e20171811. DOI: https://doi.org/10.1542/peds.2017-1811.
58. Iacovou M, Ralston RA, Muir J, Walker KZ, Truby H. Dietary management of infantile colic: a systematic review. Matern Child Health J. 2012;16:1319–31. PMID: 21710185.
Published
2022-06-30
How to Cite
1.
Sridevi A, Jonathan H, Wicaksono B, Hegar B. Indonesian pediatricians’ knowledge of Rome IV criteria and their therapeutic approach to infantile colic. PI [Internet]. 30Jun.2022 [cited 21Jun.2024];62(3):156-4. Available from: https://paediatricaindonesiana.org/index.php/paediatrica-indonesiana/article/view/2620
Section
Pediatric Gastrohepatology
Received 2021-03-15
Accepted 2022-06-30
Published 2022-06-30