So many health fads, and just as many questions about their effectiveness.
I am all about natural health and wellness. However, I am also kind of a skeptic.
I tend to employ more of a "skeptic until proven effective" point-of-view.
Years ago, I dug into the research on probiotics for kids hoping to find a solution for my daughter's eczema. Spoiler alert. Probiotics can't treat eczema.
During my dig, however, I found some research that convinced me to begin giving a daily probiotic to my kids!
Whether you want to understand the benefits of probiotics for kids, are considering adding a daily probiotic for your child's overall health, or are searching for the best kids probiotics for certain ailments, you're in the right spot.
Summary
Please Note: This article contains affiliate links. As an Amazon Associate, I will receive a small commission on the sale of items linked to Amazon. However, the price is the same for you. I am not personally affiliated with any of the brands I recommend. I only promote products that I love and believe you will love. Thank you for supporting my small business.
Also Note: My intent with this information is absolutely not to provide medical advice, diagnosis, or treatment. I urge you to speak with your child's pediatrician or a trusted health care professional before starting any supplements for your child. I do believe that knowledge is power, and parent resources like these can help you prepare for your visit with your child's pediatrician to discuss health care concerns.
What Are Probiotics?
Nerd alert. When I am trying to understand something scientific, I like real scientific information.
The good news for you, I have reviewed the research, you get enjoy the summary.
Here we go.
What Are Probiotics?
Probiotics are defined by the World Health Organization as “live microorganisms which, when administered in adequate amounts, confer a health benefit on the host”.
Simple enough. Take away for me is that they must be given in an amount that creates a health benefit.
A little history.
The concept of probiotics is relatively new.
In the early 1900s, a French pediatrician noticed that children with diarrhea had a low number of Y-shaped bacteria in their stools. These y-shaped bacteria were, however, abundant in healthy children. He suggested that these bacteria could be administered to patients with diarrhea to help restore a healthy gut bacteria.
The first actual observation of the positive role played by some bacteria came in 1907, when a Russian Nobel Prize winner (Ellie Metchnikoff) suggested that, because the bacteria in our gut depend on food, we may be able to change what we eat in order to get rid of harmful bacteria and replace them with healthy bacteria. (4)
Smart.
What Are Prebiotics?
Prebiotics (like fiber!) have essentially the same aim as probiotics, which is to improve host health by controlling the gut bacteria by helping probiotics and healthy bacteria grow.
It is thought that by combining some probiotics and prebiotics, they work together, thus making them even more impactful. (4)
Do Probiotics Provide Health Benefits for Kids?
After almost an entire century filled with mostly mixed scientific reviews and anecdotal evidence, it wasn't until about 1980 that scientists were able to show health benefits of probiotics.
Although we have studies showing health benefits of probiotics, they have not been reproduced successfully using rigorous clinical trials.
Where does that leave us?
We still have a long way to go when it comes to understanding exactly what probiotics are beneficial, who and what they benefit, and how to achieve the benefit.
Benefits Of Probiotics For Kids
My goal is to provide you with evidence-based information.
As mentioned above, studies showing health benefits of probiotics have not been reproduced successfully using rigorous clinical trials.
Does this mean probiotics aren't beneficial to health? No.
Increasing evidence suggests that we are on to something.
However, there are still factors that we do not understand. Therefore, in most situations, it is not possible for health care professionals to make strong, evidence based recommendations on use of probiotics.
However, I am going to share with you some findings that we do have. I think you may find it helpful.
A quick summary of possible benefits of probiotics for kids
prevent eczema in children at risk for allergic conditions (eczema, asthma, seasonal allergies), including possible long term prevention
prevent and shorten length of common cold and ear infections
prevent antibiotic-associated diarrhea in children when taken with antibiotics
reduce diarrhea in children with gastroenteritis
reduce crying time in babies with colic
reduce pain in children with IBS
Eczema and Probiotics
Let's get the bad news out of the way. Unfortunately, probiotics are not a solution for treating eczema (2).
However, use of probiotics may be an effective method to prevent eczema in children at risk for allergic conditions (eczema, asthma, seasonal allergies), including possible long term prevention. (5)
Check it out.
Background: Eczema and Probiotics
The intestinal bacteria of children with allergic conditions (eczema, asthma, seasonal allergies) is different than that of children without allergic conditions.
Because of this, it has been thought that giving probiotics to children at risk of developing allergic conditions could potentially be beneficial.
In a double-blinded randomized controlled trial (the gold standard for scientific research), a probiotic called lactobacillus rhamnosus or a placebo was given to women during the final 4 weeks of pregnancy. If the infant was at high risk of allergic conditions, the treatment was continued for 6 months after birth in both the lactating woman and her infant.
Eczema was diagnosed in 35% of all children in the study by 2 years of age. Of those who received the placebo, 46% developed eczema, versus 23% who received the probiotic. By 4 years of age, the results remained about the same (46% of children in placebo group had eczema vs 26% in group treated with probiotics)
The number of mother-infant pairs required to be treated with the probiotics to prevent 1 case of chronic recurrent eczema was 4.5. An interesting way to think about it.
These results support a preventive effect for giving a probiotic to mothers late in pregnancy and to both mothers and infants during the first 6 months of lactation for the prevention of eczema in infants who are at risk of allergic conditions.
Seems like great news, right?
Despite the encouraging results of studies like these, other studies have not shown the same protective benefits.
Therefore, there is insufficient evidence to warrant the routine supplementation of probiotics to either pregnant women or infants to prevent allergic diseases in childhood.
Why do some studies show protective benefits and others don't?
It is thought that mother/child's genetic susceptibility, environmental factors such as geographic region and diet, and study variables including probiotic strains and doses used all play a factor in the variable results. (6)
Recommendations: Probiotic and Eczema
There is likely benefit from using probiotics for the prevention of eczema when probiotics are taken by:
pregnant women at high risk for having an allergic child
by women who breastfeed infants at high risk of developing allergy
by infants at high risk of developing allergy
These recommendations by the World Allergy Organization only apply to these specific scenarios and supported by very low quality evidence. (3)
Best Probiotics for Preventing Eczema in Kids
Check out Best Probiotics for Kids for recommendations on which probiotics to buy to prevent eczema in kids.
Common Cold and Ear Infections and Probiotics
Kids gets colds. A lot. When you are friends with a bunch of snotty nosed kids and are constantly putting your hands in your mouth, you have the recipe for non-stop coughs and runny noses.
We know washing hands can help prevent spreading germs.
However, probiotics may provide another way to prevent the never ending runny noses that kiddos seem to have.
And, get this. Probiotics may also help to shorten the common cold!
Check it out.
Background: Upper Respiratory Infections and Probiotics
In 2013, researchers reviewed the data from 4 randomized controlled trials (these are high quality scientific research studies). They found that, in children treated with probiotics containing lactobacillus rhamnousus:
the incidence of ear infections was reduced by 24%, and
the risk of upper respiratory tract infections (URIs) was reduced by 38%.
What does this mean? If 4 children take probiotics, 1 will be spared an actual upper respiratory tract infection. (7)
In 2016, a HUGE review of 23 randomized controlled trials involving 6269 children showed similar results. (1)
Want more great news?
In 2014, researchers reviewed the data on duration of illness (how long the cold lasts) from 20 randomized controlled trials, half of them focused just on children. They found that participants who took a probiotic were sick for about 18 hours less than those who did not take probiotics. (7)
Some not as great news?
Despite the encouraging results of studies like these, other studies have shown mixed results. Researchers have noted, however, that despite mixed results, at least one beneficial effect of probiotics on upper respiratory infections was observed in the majority of studies. (7)
The mechanisms by which probiotics may prevent or shorter the course of upper respiratory infections (URI) are not obvious. Current theories include boosting the immune function of the respiratory mucosa, acting as a competitive inhibitor for viruses, and secreting antiviral compounds. (7)
So where does this leave us?
Recommendations: Probiotics and Common Cold/Ear Infections
There may be benefit from using probiotics for the prevention of and shortening of the common cold and ear infections.
These recommendations are by very low quality evidence. (1, 7)
If you have a kiddo who gets frequent ear infections or colds, it may be worth it to add a probiotic to your daily routine.
However, the evidence is not strong enough for health care professionals to make a blanket recommendation that all parents spend their hard earned money on probiotics in order to prevent or shorten colds and ear infections.
Best Probiotics for Preventing Common Cold and Ear Infections in Kids
Check out Best Probiotics for Kids for recommendations on which probiotics to buy to prevent and treat the common cold and ear infections in kids.
Antibiotic-Associated Diarrhea and Probiotics
Antibiotics are helpful because they kill bad bacteria.
The down side, they can also kill good bacteria that they come across, specifically those in our stomach and intestines. It is thought that this disruption of bacteria in the gut can cause diarrhea.
About 1 in 4 children on antibiotics develop diarrhea. (1)
Probiotics to the rescue?
Check it out.
Background: Antibiotic-Associated Diarrhea and Probiotics
An expert panel convened by the European Paediatric Association reviewed 5 randomized controlled trials covering 445 children. These studies show that
probiotics (specifically Lactobacillus rhamnosus) reduced the risk of antibiotic-associated diarrhea from 23% to 9.6%
which means, if 8 children take probiotics with their antibiotics, 1 child will be spared of antibiotic-associated diarrhea.
The same expert panel reviewed 6 randomized controlled trials covering 1653 children. These studies showed that
probiotics (S. boulardii) reduced the risk of antibiotic-associated diarrhea from 20.9% to 8.8%
which means, if 9 children take probiotics with their antibiotics, 1 child will be spared antibiotic-associated diarrhea (1)
For every 7-8 children taking probiotics with their antibiotics, 1 will be spared antibiotic-associated diarrhea. (7)
Recommendations: Probiotics and Antibiotic-Associated Diarrhea
The ESPGHAN Working Group on Prebiotics and Probiotics, the expert group mentioned above, makes the following recommendations:
In order to prevent antibiotic-associated diarrhea, probiotics (Lactobacillus rhamnosus or S. boulardii) should be considered
Other strains of probiotics are not currently recommended (1)
Best Probiotics for Preventing Antibiotic-Associated Diarrhea in Kids
Check out Best Probiotics for Kids for recommendations on which probiotics to buy to prevent antibiotic-associated diarrhea in kids.
Gastoentertitis (GI Virus) and Probiotics
The GI bug is the worst! For parents and kiddos alike.
The American Academy of Pediatrics and the European Paediatric Association both recommend treating gastroenteritis with oral rehydration solutions. Things like Pedialyte.
However, could adding probiotics to the mix help?
Check it out.
Background: Gastroenteritis and Probiotics
An expert panel from the European Paediatric Association reviewed 11 randomized controlled trials on 2444 children, and 11 other studies covering 306 subjections, all studying the use of probiotics in the treatment of gastroenteritis.
These studies showed that
probiotics (Lactobacillus rhamnosus) reduced the duration of diarrhea associated with gastroenteritis by at least 1 day
probiotics (S. boulardii) reduced the duration of diarrhea by 1 day (1)
An additional review of 5 randomized controlled trials in 2013 showed that
probiotics may help reduce stool frequency by 13% on day 2 of diarrhea (7)
Recommendations: Probiotics and Gastroenteritis
The ESPGHAN Working Group on Prebiotics and Probiotics, the expert group mentioned above, makes the following recommendations:
When treating gastroentertiis in children, probiotics (Lactobacillus rhamnosus or S. boulardii) may be considered as an adjunct to oral rehydration therapy
Probiotics should ideally be initiated early in the course of diarrhea
Other strains of probiotics are not currently recommended (1)
Best Probiotics for Treating Gastroenteritis in Kids
Check out Best Probiotics for Kids for recommendations on which probiotics to buy to help treat gastroenteritis in kids.
Colic and Probiotics
There are few things sadder (or more exhausting or frustrating) than a colicky baby.
What is colic?
well fed and healthy infant
infant less than 5 months, although generally resolves by 3 months
recurrent and prolonged periods of crying - irritability, fussiness, or crying for at least one week in an infant who has no failure to thrive
cries without an obvious cause, cannot be prevented or resolved
symptoms include flushing of the face, lots of gas in the belly (belly is distended because of gas), flatulence, drawing up legs, inconsolable crying
occurs in both breastfed and formula fed babies
affects 10-30% of healthy, thriving babies (8)
The cause of colic is unknown. Some theories:
an imbalance of intestinal bacteria may play a role
babies with colic have different intestinal bacteria than those without colic
human breast milk naturally contains prebiotics which could selectively enhance the proliferation of certain probiotic bacteria in the colon, and may be effective treatments for allergy and food intolerance and for crying in formula fed infants with colic
dietary protein hypersensitivity
25% of infants have cows milk protein dependent colic which improves after hypoallergenic diet
lactose intolerance
lactose is sugar, type of carbohydrate, and carbohydrate malabsorption leads to fermentation of sugars in the GI tract, causing gas and water which can distend the bowels and cause pain
nicotine intolerance
colic is 25% more prevalent in babies of cigarette smokers and mothers who have used nicotine replacement during pregnancy/breastfeeding, suggesting intolerance of nicotine itself(8)
Findings are mixed as to whether probiotics are helpful in babies with colic, however, some evidence shows that probiotics reduce the amount of crying in breastfed babies.
Check it out.
Background: Colic and Probiotics
In 2018, a group of researchers with the intent to study if probiotics can help prevent colic, reviewed 6 randomized controlled trials which included 1886 babies. The infants in the probiotics groups were given different types of probiotics, and in different doses. Two of the studies began probiotics during pregnancy and continued giving them to the baby after birth.
The review found that,
probiotics are not effective in helping to prevent colic
probiotics decreased crying time by 32-44 minutes per day, depending on the study
it is safe to give probiotics to infants (8)
Another review of studies conducted in 2015, focused on a specific probiotic (Lactobacillus reuteri) as treatment of colic for breastfed. This review found,
probiotics may be an effective treatment of colic for breastfed babies
probiotics decreased crying time by 55.8 minutes per day
preparations containing fennel may also reduce crying by 72 minutes per day, although this evidence is weaker
same results were not shown in babies who were not exclusively breast fed (9)
Other studies show similar results. (1)
Recommendations: Probiotics and Colic
Probiotics are not effective for preventing colic in babies.
There is increasing evidence that probiotics may help reduce the amount of crying in babies with colic by 32-56 minutes per day. (8, 9)
The American Academy of Pediatrics acknowledges that probiotics may help reduce the amount of crying in babies with colic. (10)
The Latin-American Guidelines published in 2015 and Asia-Pacific region, both support use of probiotics for the prevention and treatment of infantile colic. (1)
Best Probiotics for Treating Colic in Babies
Check out Best Probiotics for Kids for recommendations on which probiotics to buy to treat colic in babies.
Irritable Bowel Syndrome (IBS) and Probiotics
Irritable Bowel Syndrome, or IBS, is a disorder of the GI tract that can affect up to 30% of children and teenagers.
It can cause a variety of symptoms including
abdominal pain,
diarrhea,
constipation,
gas
abdominal pain occurs during at least 4 days per month and is associated with a change in frequency of bowel movements and/or a change in the appearance of stools (1)
Some studies have shown that probiotics may contribute to a decrease in abdominal pain associated with IBS and improve quality of life.
Check it out.
Background: Irritable Bowel Syndrome (IBS) and Probiotics
In 2015, researchers reviewed non-pharmacological treatments for functional pain disorders including 3 randomized controlled trials that focused on IBS in children. These studies found that
probiotics (specifically Lactobacillus rhamnosus) given to children ages 5-17 with IBS showed improved abdominal pain
probiotics did not decrease frequency or severity of diarrhea or constipation
the frequency of improvements in pain are such that 4 people must receive the probiotics for 1 person to receive benefit (7)
More recent randomized controlled trials studying a different probiotic (lactobacillus reuteri) found even more pronounced pain reductions in children with IBS. (1)
Finally, a smaller study with a combination of probiotics (VSL#3) given for 6 weeks to children ages 4-18 years, showed a decrease in the frequency and intensity of abdominal pain and reported an improved quality of life. (7)
Recommendations: Probiotics and Irritable Bowel Syndrome (IBS)
Probiotics (specifically Lactobacillus rhamnosus, lacotobacillus reuteri, and a combination of different strains titled VSL#3) given to children with Irritable Bowel Syndrome (IBS) may improve abdominal pain and quality of life. (1, 7)
The American Academy of Pediatrics acknowledges that studies have shown a decrease in pain associated with probiotics. (11)
However, due to limitations of available evidence, the American Academy of Pediatrics and the relevant European Societies do not currently provide a recommendation for use of probiotics for treating IBS.
Best Probiotics for Treating Irritable Bowel Syndrome (IBS) in Kids
Check out Best Probiotics for Kids for recommendations on which probiotics to buy to treat IBS in kids.
Best Probiotics For Kids
Phew! That was a lot of information, right?
There are a ton of important take-aways from all of that. My favorite is #3 (below).
studies showing health benefits of probiotics have not been reproduced successfully using rigorous clinical trials
increasing evidence is, however, showing that probiotics may provide health benefits to children in certain situations
which probiotic you use depends on what you are preventing or treating
Understanding that specific probiotics help prevent or treat specific conditions was a huge surprise to me. When I didn't know anything about probiotics, I didn't know this. Duh.
The good news is, now that you know this, it will help you choose the best probiotic for your child.
What to look for in probiotics for kids
When deciding on a probiotic for your child, consider the following:
What are you treating or preventing?
What strain of probiotic do you need to help achieve your goals?
What dose is necessary to achieve a health benefit?
Will your child actually take the probiotic?
This is important, ya'll! If you find a "perfect" probiotic but it tastes yucky or has a funny texture, your child isn't going to take it. And it won't be effective.
Must taste good
Must be in a form that your child will take - liquid vs chewable vs swallow-able
Must survive passage of GI tract (and all the acidity of the stomach)
Must be live cultures
Avoid a probiotic that contains artificial coloring and sweeteners, and added sugars, because, duh
Check to see if the probiotic contains gluten or dairy derivatives if your child has a sensitivity to either
Best Probiotic to Prevent Eczema?
Probiotics may help prevent eczema in children at risk for allergic conditions (eczema, asthma, seasonal allergies), including possible long term prevention.
When shopping for probiotics to help prevent eczema in children, look for probiotics with the following strains: (7)
Lactobacillus rhamnosus
Lactobacillus paracasei
Bifidobacterium lactis
3-6 Billion CFU/day
Recommended probiotics to prevent eczema:
For Baby
Metagenics: MetaKids UltraFlora Baby Probiotic
6 drops = 1 billion CFUs
Will need to offer this 3x/day or at a higher dose
For Pregnant/Lactating Mama
Best Probiotic to Prevent the Common Cold?
Probiotics may prevent the common cold and ear infections.
When shopping for probiotics to help prevent upper respiratory tract infections and ear infections in children, look for probiotics with the following strains:
Lactobacillus rhamnosus (1, 7)
2-10 billion CFU/day
Recommended probiotics to prevent upper respiratory/ear infections:
Culturelle Kids: Multivitamin + Probiotic
Multivit + probiotic, huge win!
Perfect for a daily dose, which is needed to prevent colds and ear infections
Kids chewable tablets, fruit flavor
Culturelle Kids: Purely Probiotic, Packets
If your child doesn't prefer a chewable tablet, this is a good option
Unflavored, mix with milk, yogurt, applesauce, cold/easy to mix foods/drinks
Metagenics: MetaKids UltraFlora Baby Probiotic
6 drops = 1 billion CFUs
Will need to offer this 2-3x/day
Best Probiotic to Treat the Common Cold?
Probiotics may shorten length of the common cold and ear infections.
When shopping for probiotics to help treat upper respiratory tract infections and ear infections in children, look for probiotics with the following strains: (7)
Lactobacillus genera
Bifidobacterium genera
2-10 billion CFU/day
Recommended probiotics to treat upper respiratory/ear infections:
Culturelle Kids: Multivitamin + Probiotic
Multivit + probiotic, huge win!
Perfect since the daily prevention dose, is the same as the treatment dose
Kids chewable tablets, fruit flavor
Culturelle Kids: Purely Probiotic, Packets
If your child doesn't prefer a chewable tablet, this is a good option
Probiotic packet
Unflavored, mix with milk, yogurt, applesauce, cold/easy to mix foods/drinks
ReNew Life Organic Kids: Daily Complete
Meets the mark for treating upper respiratory infections
Unfortunately not as versatile as Culturelle Kids for preventing colds
Probiotic packet, unflavored
Metagenics: MetaKids UltraFlora Baby Probiotic
6 drops = 1 billion CFUs
Will need to offer this 2-3x/day
Best Probiotic to Prevent Antibiotic Associated Diarrhea?
Probiotics may help prevent antibiotic-associated diarrhea in children when taken with antibiotics.
When shopping for probiotics to help prevent antibiotic-associated diarrhea in children, look for probiotics with the following strains: (1, 7)
Lactobacillus rhamnosus
20 billion CFU/day
NOTE: This is a big dose, so you will likely need to buy specific probiotics that have high doses of probiotics (compared to doses used to prevent colds etc)
S. boulardii
500 mg/day
Recommended probiotics to prevent antibiotic associated diarrhea:
Culturelle Kids: Ultimate Balance for Antibiotics
10 billion CFU/tab, take 2x/day
Orange flavored kids chewable tablet
Culturelle: Digestive Daily Probiotic
10 billion CFU/capsule, take 2x/day
Cut open capsule and mix with applesauce, yogurt, ice cream, anything cold/easy to mix that your sick kiddo will tolerate
Florastor Kids: Daily Probiotic Supplement
250 mg/packet, take 2x/day
Probiotic packet
Best Probiotic to Treat Gastroenteritis (GI Bug)?
Probiotics may help reduce diarrhea in children with gastroenteritis.
When shopping for probiotics to help prevent gastroenteritis in children, look for probiotics with the following strains: (1, 7)
Lactobacillus rhamnosus
10 billion CFU/day for 5-7 days
S. boulardii
250-750 mg/day for 5-7 days
Recommended probiotics to treat gastroenteritis:
Culturelle Kids: Ultimate Balance for Antibiotics
10 billion CFU/tab, take 1x/day
Orange flavored kids chewable tablet
Culturelle: Digestive Daily Probiotic
10 billion CFU/capsule, take 1x/day
Cut open capsule and mix with applesauce, yogurt, ice cream, anything cold/easy to mix that your sick kiddo will tolerate
Florastor Kids: Daily Probiotic Supplement
250 mg/packet, take 1-3x/day
Probiotic packet
Some other things you can do to help your kiddos get through this virus:
Oral rehydration solutions (like Pedialyte) - addition of sugar and electrolytes to water helps prevent trips to the ER
Oral rehydration solutions are the gold standard for prevention/treatment of dehydration in children with vomiting and diarrhea
Zinc supplements (20 mg/day for 10-14 days, or 10 mg for babies under 6 months)
Best Probiotic for Treatment of Colic in Breastfed Babies?
Probiotics may help reduce crying time in babies with colic.
When shopping for probiotics to help treat colic in babies, look for probiotics with the following strains: (1, 7)
Lactobacillus reuteri DSM 17938
100 million CFU/day for 21-30 days
Recommended probiotics for treatment of colic:
100 million CFU/5 drops 1x/day
Gerber Soothe Probiotic Colic Drops
100 million CFU/5 drops 1x/day
Best Probiotic to Treat Pain with Irritable Bowel Syndrome (IBS)?
Probiotics may help reduce pain in children with Irritable Bowel Syndrome (IBS).
Look for probiotics with the following strains: (7)
L rhamnosus
6 billion CFU/day
Multiple bifidobacterium, lactobacillus, and streptococcus species (VSL#3)
450-900 billion CFU/day
Recommended probiotics for treatment of pain with Irritable Bowel Syndrome (IBS):
Culturelle: Digestive Daily Probiotic
10 billion CFU/capsule, take 1x/day
Cut open capsule and mix with applesauce, yogurt, ice cream, anything cold/easy to mix for younger kids
How Much Probiotics Should Kids Take Each Day?
If you take nothing else away from this article, take this.
Increasing evidence suggests that there are likely health benefits of probiotics for children.
However, there are still factors that we do not understand.
What we have learned, however is that the type of probiotic strains your child takes, and how much of that probiotic your child takes, depends on the health benefit you are trying to achieve.
Check out the ideal doses of probiotics for children:
prevent eczema in children at risk for allergic conditions (eczema, asthma, seasonal allergies), including possible long term prevention
prevent and shorten length of common cold and ear infections
prevent antibiotic-associated diarrhea in children when taken with antibiotics
reduce diarrhea in children with gastroenteritis
reduce crying time in babies with colic
reduce pain in children with Irritable Bowel Syndrome (IBS)
Of course, it is always best to speak with your child's pediatrician when adding any supplements for kids including probiotic supplements.
Are Probiotics Safe For Kids?
Short answer, yes! Probiotics are safe for healthy kids.
In 2011, the US Agency for Healthcare Research and Quality published a report on the safety of probiotics, based on a review of 622 Randomize Control Trials.
Here is what it said: (1)
use of probiotics in children seems to be safe in general, even when provided in high doses
probiotics should be used with caution in special situations such as prematurity, immunocompromised patients, critically ill patients, those with central venous catheter, cardiac valvular disease, and short gut syndrome
some probiotic strains are not recommended for use in children such as enterococcus faecium SF68 due to the possible transfer of vancomycin-resistance genes
no evidence that using a mixture of different probiotic strains had more adverse events than using one probiotic strain
long term effects of probiotic strains are unknown
It is important to note that the US Agency for Healthcare Research and Quality, the Food and Agriculture Organization of the WHO, as well as a group of experts from the European Paediatric Association, all state that further research is needed to establish the safety and efficacy of probiotics and prebiotic products for children.
Products marketed as dietary supplements, like probiotics, do not require premarket review by the FDA.
Infant formulas with probiotics, however, are under regulation by the FDA. (1, 11)
Can You Give Kids To Much Probiotics?
As far as we know, probiotics are safe for healthy kids. Even in high doses.
Guess what else we know. That we don't yet know everything we need to know about probiotics. Research is ongoing.
The evidence showing health benefits of probiotics to children is not strong enough for health care professionals to make evidence based recommendations for probiotics in children. This includes doses.
Therefore, it is safest to offer doses of probiotics that have been studied. Like the ones mentioned in this blog post.
Probiotic Foods for Kids
Ok, this is a great topic. And one that doesn't have a ton of research to back it up.
Researchers generally use probiotic supplements (rather than foods) when completing scientific studies. Why? Live cultures can be measured with accuracy. And ingested equally amongst study participants.
That said, eating a diet high in prebiotics and probiotics is surely a good idea.
Foods High In Prebiotics
Prebiotics are basically probiotic food, and food for other healthy gut bacteria.
Great news! Fiber is a prebiotic. And guess what kids love that has fiber in it? Fruit!
Easy win.
Check out a few foods high in prebiotics:
Fruit
Veggies
Beans
Whole Grains
Leafy Greens
Seeds
Onions + Garlic
Foods High In Probiotics
Fermented foods are high in probiotics.
Yogurt is a (kid) fan favorite on the list of fermented foods. And something easy to regularly include in your child's diet. Yogurt, yogurt with fruit, yogurt with granola, yogurt used to make smoothies, yogurt used for cooking muffins, yogurt dips, the list goes on.
And if you can't get your kiddo to take a probiotic regularly, you can consider yogurts with added probiotics like Stonyfield Organic Probiotic Yogurt. Live active strains in Stonyfield's Probiotic Yogurt include Bifidobacterium BB-12, L. paracasei and L. rhamnosus. These are all strains that have been shown to be beneficial to children's health.
Check out a few foods high in probiotics:
yogurt
tempeh
miso
kombucha
kefir
sauerkraut
kiumchi
Check out Foods For A Healthy Gut Microbiome by Plant Based Juniors. They are my go to for all things pediatric nutrition!
Probiotics for Kids With Constipation
Constipation can ruin anyone's day (and night, wah!). But especially a kiddo and their parent's.
One to 30% of children in the US experience constipation.
Since probiotics change the environment of the gut, and changing the environment of the gut can affect how the gut works, it has been thought that probiotics may be beneficial for treating constipation.
Unfortunately, studies have not found this to be the case.
In 2015, researchers reviewed 5 randomized controlled trials studying probiotics and constipation. Findings include:
no difference between probiotics and placebo in resolving constipation
no difference between probiotics and placebo on how often the kiddo moves their bowels
Lactobacillus reuteri did increase the frequency of bowel movements of formula fed infants (ages 6-12 months old) with chronic constipation, but did not change frequency of inconsolable crying
compared to laxatives, lactobacillus casei rhamnosus did reduce abdominal pain (in children which constipation) compared to treatment with laxatives, but did not resolve the constipation
Currently, evidence is lacking to support use of any probiotic strain in the treatment of constipation in children. (12)
Best Probiotics For Kids With Diarrhea
Whether your child has the GI bug (gastroenteritis) or antibiotic associated diarrhea, probiotics may be able to help.
Probiotics have been found to:
prevent antibiotic-associated diarrhea in children when taken with antibiotics
reduce diarrhea in children with gastroenteritis
Best probiotics for treatment of diarrhea:
antibiotic-associated diarrhea (including my favorite brands!)
acute gastroenteritis (including my favorite brands!
At What Age Should I Give My Kids Probiotics?
That depends. On the health benefit you are trying to achieve.
As we know, use of probiotics in children seems to be safe in general, even when provided in high doses.
But we should only give probiotics to children when we are looking for a specific health benefit.
Check it out.
Best Age To Give Probiotics To Your Child
Newborn (0-6 months): prevent eczema in children at risk for allergic conditions (eczema, asthma, seasonal allergies), including possible long term prevention
Infant (less than 5 months): reduce crying time in babies with colic
Any Age (Age 0+): prevent and shorten length of common cold and ear infections
Any Any (as needed, with antibiotic use, Age 0+): prevent antibiotic-associated diarrhea in children when taken with antibiotics
Any Any (as needed, with antibiotic use, Age 0+): reduce diarrhea in children with gastroenteritis
4+ year old (as needed with diagnosis of IBS): reduce pain in children with Irritable Bowel Syndrome (IBS)
References:
1 Hojsak, I. et al (2018). Guidance on the use of probiotics in clinical practice in children with selected conditions and in specific vulnerable groups. Acta Pædiatrica. 2018 107, pp.927–937.
2 Makrgeorgou A, et al. Probiotics for treating eczema. Cochrane Database Syst Rev. 2018 Nov 21;11(11):CD006135. doi: 10.1002/14651858.CD006135.pub3. PMID: 30480774; PMCID: PMC6517242.
3 Fiocchi A, et al. World Allergy Organization-McMaster University Guidelines for Allergic Disease Prevention (GLAD-P): Probiotics. World Allergy Organ J. 2015 Jan 27;8(1):4. doi: 10.1186/s40413-015-0055-2. PMID: 25628773; PMCID: PMC4307749.
4 Health and nutritional properties of probiotics in food including powder milk with live lactic acid bacteria. Report of a joint FAO/WHO expert consultation on evaluation of health and nutritional properties of probiotics in food, including powder milk with live lactic acid bacteria. 2001: Cordoba, Argentina.
5 Cao L, et al. Long-term effect of early-life supplementation with probiotics on preventing atopic dermatitis: A meta-analysis. J Dermatolog Treat. 2015;26(6):537-40. doi: 10.3109/09546634.2015.1027168. Epub 2015 May 5. PMID: 25942569.
6 Dan W. Thomas, Frank R. Greer and Committee on Nutrition; Section on Gastroenterology, Hepatology, and Nutrition. Pediatrics December 2010, 126 (6) 1217-1231; DOI: https://doi.org/10.1542/peds.2010-2548
7 Dassow P, Fox S. When can infants and children benefit from probiotics? J Fam Pract. 2016 Nov;65(11):789-794. PMID: 28087866.
8 Ong TG, et al. Probiotics to prevent infantile colic. Cochrane Database Syst Rev. 2019;3(3):CD012473. Published 2019 Mar 13. doi:10.1002/14651858.CD012473.pub2
9 Harb, Tracyet al. Infant Colic—What works, Journal of Pediatric Gastroenterology and Nutrition: May 2016 - Volume 62 - Issue 5 - p 668-686
doi: 10.1097/MPG.0000000000001075
10 Meissner, H. Cody. Are Probiotics Ready For Prime Time? APP News. 2020 Jan 3. www.aappublications.org/nws/2020/01/03/idsnapshot010320
11 Dan W. Thomas, Frank R. Greer and Committee on Nutrition; Section on Gastroenterology, Hepatology, and Nutrition. Probiotics and Prebiotics in Pediatrics. Pediatrics December 2010, 126 (6) 1217-1231; DOI: https://doi.org/10.1542/peds.2010-2548
12 Tabbers MM, Benninga MA. Constipation in children: fibre and probiotics. BMJ Clin Evid. 2015 Mar 10;2015:0303. PMID: 25758093; PMCID: PMC4356179.
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Katie Ramirez is a Registered Nurse, Certified Lactation Counselor, and Coach for parents of babies and toddlers. She has spent more than a decade serving patients at major university hospitals such as Vanderbilt University and Penn State University Medical Centers. Katie now spends her time supporting and empowering parents of babies and toddlers as owner and Coach for Born Happy.
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