Criteria

Rome IV diagnostic criteria for functional gastrointestinal disorders[62]

Developed for irritable bowel syndrome, the Rome III criteria provide a system for diagnosing functional gastrointestinal disorders by symptoms. Not all of the criteria are applicable to infants.

G1. Infant regurgitation (must include both of the following in otherwise healthy infants 3 weeks to 12 months of age):

  • Regurgitation ≥2 times per day for ≥3 weeks

  • No retching, haematemesis, aspiration, apnoea, failure to thrive, feeding or swallowing difficulties, or abnormal posturing.

G4. Infant colic (for clinical purposes, must include all of the following):

  • An infant who is aged <5 months when the symptoms start and stop

  • Recurrent and prolonged periods of infant crying, fussing, or irritability reported by carers that occur without obvious cause and cannot be prevented or resolved by carers

  • No evidence of infant failure to thrive, fever, or illness.

A unifying diagnostic term of ‘pediatric feeding disorders’ has been proposed, using the framework of the World Health Organization international classification of functioning, disability, and health.[1] This classification describes the effect of a feeding disorder on a child’s function, unifying medical, nutritional, feeding skills, and psychosocial concerns associated with the disorder and prompting assessment of both the underlying condition and functional limitations to direct optimal care plans.

The proposed criteria are:[1] 

A. A disturbance in oral intake of nutrients, inappropriate for age, lasting at least 2 weeks and associated with 1 or more of the following:

  1. Medical dysfunction, as evidenced by any of the following:

    1. Cardiorespiratory compromise during oral feeding

    2. Aspiration or recurrent aspiration pneumonitis

  2. Nutritional dysfunction, as evidenced by any of the following:

    1. Malnutrition

    2. Specific nutrient deficiency or significantly restricted intake of one or more nutrients resulting from decreased dietary diversity

    3. Reliance on enteral feeds or oral supplements to sustain nutrition and/or hydration

  3. Feeding skill dysfunction, as evidenced by any of the following:

    1. Need for texture modification of liquid or food

    2. Use of modified feeding position or equipment

    3. Use of modified feeding strategies

  4. Psychosocial dysfunction, as evidenced by any of the following:

    1. Active or passive avoidance behaviours by child when feeding or being fed

    2. Inappropriate carer management of child's feeding and/or nutrition needs

    3. Disruption of social functioning within a feeding context

    4. Disruption of carer-child relationship associated with feeding

B. Absence of the cognitive processes consistent with eating disorders and pattern of oral intake is not due to a lack of food or congruent with cultural norms.

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