Caring for kids

Leading pharmacist calls for more guidelines on colic, constipation and reflux in infants, as new survey shows 99% of pharmacists field questions on these disorders

A new survey has found nearly all community pharmacists speak with parents about infants with suspected symptoms of either colic, constipation or reflux.

The survey, undertaken by Edelman Intelligence and funded by a grant from Nutricia, interviewed 362 retail pharmacists.

About a third of the sample (34%) had between six and 10 years of experience in pharmacy, while a further 30% had between 11 and 20 years.

Just three percent had less than three years of experience.

Ninety-nine percent of the sample said they have conversations with parents about colic, constipation or reflux.

Nine in ten pharmacists (92%) discussed colic, constipation or reflux with parents at least once a week.

Infant constipation was most frequently discussed at least once a week (85%), followed by reflux (76%) and colic (76%).

Meanwhile one in seven pharmacists had conversations about infants with symptoms of constipation every day.

“These [conditions] are the ones pharmacists get asked most about,” says pharmacist John Bell, specialist practitioner/teacher in primary health care at the Graduate School of Health, University of Technology, Sydney and an advisor to the PSA.

“These are called functional gastrointestinal disorders,” he tells AJP, adding that they are “pretty common” in infants.

“Reflux, constipation and colic are more recurrent conditions that clearly concern parents, understandably, about which pharmacists are more likely to be looking for advice, information and guidelines as to how those conditions should be treated.

“The other one which we get asked about is infants with diarrhoea. Normally that’s an acute problem and pharmacists are pretty well knowledgeable about how to respond to that – with electrolyte replacement and so on.”

Mr Bell says based on the survey results, “it was clear that almost all pharmacists not only get asked about these conditions but are making recommendations”.

“Mostly it seems that recommendations are made for medicines, rather than say nutritional advice. However sometimes the recommendations tend to be neither nutrition related, nor medicine related. They’re things like, for constipation, increasing water consumption. For reflux, holding the baby upright for 30 mins after feeding. For colic, physical soothing rather than a medical or a nutritional recommendation. These are good recommendations, not saying they’re not.

“But I think what comes out of the survey is that pharmacists are looking for more information, and maybe more specific guidelines on what to recommend and when.

“What pharmacists are looking for, and what we should be providing now, are evidence-based guidelines. If we’re using medicines, what medicines are appropriate?

“We know for instance that traditionally various colic medicines have been used and really there’s no particular evidence that any of them work effectively. Would more likely nutritional advice or reassurance, soothing the baby, be more appropriate?” he says.

“That’s something that we can do in the profession. Another thing is that it appeared pharmacists like to get information from face-to-face seminars and symposiums.

“I know that at the PSA19 conference in late July, we’ve got some sessions on nutrition in infants, so I think that will be very valuable as well.”

The Edelman/Nutricia report was conducted to support key research that contributed to a peer-reviewed paper, which has just been accepted by the Journal of Paediatrics and Child Health, and there will be a presentation on the paper at the PSA conference in July.

Mr Bell says there is differentiation in the advice given by pharmacists based on their varying levels of experience.

“I think more experienced pharmacists feel more comfortable in giving advice,” he tells AJP.

“There’s more training now being given to undergraduate and postgraduate pharmacists. But our aim in our university courses is to make sure that the graduates also are confident and knowledgeable and have the evidence-based information to provide advice as well.”

He says long-term impacts of these functional gastrointestinal disorders are, to a large degree, emotional in nature.

“Parents and carers are always concerned if they see a baby in distress. Long-term conditions like reflux may lead to some more serious conditions affecting the gastrointestinal tract and oesophagus.

“It’s a matter I think of identifying when pharmacists can treat these conditions and when they should be referred on,” he says.

“Mostly for the vast majority of infants, because these things are so common, they can generally be treated with not just appropriate medication and nutritional advice, but also with reassurance – I think a lot of parents are looking for reassurance that these in most cases are not serious conditions.

“With simple remedies, support, not only reassurance for the parents but for the parents to give some kind of reassurance to the child as well, I think they can be pretty well managed.”

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