Gastro Intestinal Motility Immaturity What is it? When we eat food we swallow which is a voluntary response, that means we aware of it at the time and we make a conscious decision to swallow, everything after that moment is involuntary, which means our body does it automatically without us thinking about it. Our muscles work in a wave like motion to force food through various parts of the digestive system until everything is digested. These wave like motions of muscles are called perstalsis. Various parts of the digestive system have pressure receptors and valves. Put simply when food passes or fills an area, these receptors trigger the opening and closure of valves (sphincters), and perstalsis, allows the food to enter or leave the next part of the digestive system. So every time we eat perstalsis is being triggered throughout the whole digestive system. Sometimes this peristalsis is uncoordinated, or the wave like motions are two weak to move the food effectively, other times they can spasm, all of which can lead to discomfort, pain and related problems such as constipation. This immaturity can occur by itself in infants or it can occur alongside other immaturities such as reflux or food intolerance. In either case like it is generally a temporary disorder that infants grow out of while their digestive system matures. Reflux and Gastro Intestinal Motility Immaturity Reflux simply occurs when the stomach valve opens when it shouldn’t, however sometimes it occurs with an associated Gastro Intestinal Motility Immaturity. When this occurs, food re- enters our throat (esophagus) from the stomach, because of a faulty stomach valve, then the pressure receptors in our throat do one of two things. The first is to trigger perstalsis in an effort to propel the food back into the stomach, or alternatively out of our mouths. However when this occurs in infants with Reflux that have an associated Gastrointestinal Motility Immaturity, the muscles in the throat either don’t trigger peristalsis, or trigger peristalsis that is uncoordinated, or too weak, allowing the food now mixed with stomach acid to sit for longer, burning the throat. As the pain associated with reflux is determined by two factors, the first factor being the amount of acid in the feed, as food refluxed on ingestion would contain less acid, than food that has sat in the stomach for some time before being refluxed, and a second factor, which is how long the food sits in the esophagus or throat, an associated intestinal motility disorder would worsen the effects of the reflux. This is one of the many reasons why you get some infants with reflux who don’t vomit yet have obvious pain and discomfort, others that do vomit with apparent pain, and a third group who vomit without two much discomfort at all. The potential dangers that present themselves in infants with reflux and an associated gastro intestinal motility immaturity, are then the risk of the throat lining becoming inflamed and damaged, depending on how often and how long the food sits in the throat, and how acidic it is at the time. This is called oesophagitis, and this is generally why gastro scopes are performed on infants presenting with distress due to reflux, particularly if standard management techniques and drug therapies have failed. When Silent reflux infants become reflux infants Some mothers report that their silent reflux babies literally overnight become chuckers, or alternatively that some foods appear to make their silent reflux infants vomit. In the first instance there are many possible reasons for this one of which may be that the child is growing out of their gastro intestinal immaturity before their reflux, so their peristalsis is becoming stronger or more coordinated, even though their stomach valve continues to work sporadically. This may also explain why some infants may simply scream for a month or two then improve when they start vomiting. However in instances where it is linked to food it could be either of two things, it could be because the food is easier to reflux, i.e. often silent reflux infants on going onto Neocate will start vomiting as the formula is so thin and more easily refluxed than the previous formula. The infant still reflux’s the same; it’s just that now it is more visible. Please note that it is important to understand this, as the fact that an infant appears to vomit more may be a good thing, as thickeners or heavier food although they appear to make the reflux better, in that they lessen the amount of times the food is refluxed into the oesophagus, it may actually worsen the discomfort associated with reflux, as it can simply make it harder for the throat muscles to clear the feed from the oesophagus once refluxed, resulting in more pain for the infant. Also thicker textures foods or chunky foods can be harder for the peristalsis to propel along the throat, especially if the wavelike motions are still maturing, resulting in more apparent distress to the child, or more vomiting as the throat muscles tries to clear it from the oesophagus. For this reason many mums report that certain textures or thickeners just appear to make their infants vomit or scream more. Although introducing different textures in foods is important, with reflux infants their digestive systems often require a longer time than others before they are ready to handle these foods, so introduce textures carefully and don’t be dismayed if you have to puree everything for a little while longer, it will get better. Please be reassured that we deal with many mums whose infants had extremely limited diets for well over twelve months who eat anything and everything when their digestive system matures. Lastly children with any immaturity may have other immaturities such as a food intolerance, so vomiting or distress on introducing a new food or formula may thus indicate an intolerance or allergy. Take into consideration the texture and thickness of the food, however if it seems to linked to a particular type of food then hold off and try again in six to eight weeks. Gastro Intestinal Motility Immaturity and Diarrhea / Constipation If the peristalsis in the large intestine is uncoordinated or spasmodic, it can result in diahorrhea, or apparent difficulty in passing bowel motions, with associated pain due to spasming or cramping muscular contractions. A Gastro Intestinal Motility Immaturity can also cause the anal sphincter to not work effectively, as although the passing of bowel motions is voluntary in adults in infants it’s involuntary However Diarrhea and constipation are also indicators of a range of other conditions so it is worthwhile getting this checked out by a medical professional, to exclude other causes. Gastro Intestinal Motility Immaturity and the Immune System Many parents of infants a Gastro Intestinal Motility Immaturity comment that there child appears to be ill more often or more severely than other infants. There are many reasons for this. The first possible explanation, is that any immaturity will generally worsen if the immune system is compromised, making the infant appear ‘sicker,’ as their child not only suffers the effect of the virus but also from the effects of the immaturity. The second possible explanation in that the effects of the Gastro Motility Immaturity can be aggravated, and in turn aggravate or worsen the effects of the virus. For example a cold virus which inflames the throat lining, can create spasming of the peristaltic waves, which in turns aggravates reflux, which in turn further inflames the throat lining, creating a vicious cycle that remains long after the virus has run its course. So that child is sicker for longer. Gastro Intestinal Motility Immaturity and treatments Management strategies based on warmth for all other Gastro Intestinal Motility immaturities are worth considering, as the warmth from a warm bath etc helps relax muscles that may be spasming. Please refer to our kit for a list of these in various topics. For most infants this will be all that is required and although it won’t solve the problem it will ease their discomfort until they grow out of their distress. Drug therapy for Gastro Intestinal Motility immaturity may be trialed depending on the severity of the symptoms displayed, and the area affected. Although as Prepulsid is a motility drug, which works by helping to strengthen and coordinate the perstalsis and other involuntary muscular contractions of the body, this is a general drug therapy used for infants presenting with a Gastro Intestinal Motility disorder. Donalix colic mixture or like mixtures may also be trailed in an attempt to slow down the peristalsis and other involuntary muscular contractions of the body, as they are Anti spasmodic in that they work by having a drying effect on the glands of the digestive tract that secretes mucus. These glands that secrete mucus, aid the wave like contractions of the digestive system (peristalsis) in propelling food along the digestive tract. So reducing the secretion of mucus, results in slowing down the peristalsis of the digestive tract. For infants where the GIM immaturity creating concern involves constipation, the only drug therapies we are aware of paraffin oil type substances like Parachoc, to help ease apparent constipation, although in most instances parents are asked to preserve while the infants system matures. Enema’s etc are often not considered as they interfere with the workings of the bowel, and as this will get better with time, they tend to be a drug reserved for a last alternative scenario. In extreme circumstances of infants or children presenting with a Gastro Intestinal Motility immaturity / disorder, tube feeding, intravenous feeding or surgery may be considered. Surgery remains a last resort treatment usually not considered until the infant has been given sufficient time for them to grow out of it, unless it is posing to be life threatening.
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