Probiotics in Children- Cutting through the Hype

There has been an explosion in the interest in the microbiome- the set of bacteria that form our world- in the past several years.  The industry that sells us “good bacteria” or probiotics to help us reset our “good” microbiome has also exploded. It can be very difficult to cut through the hype around the benefits of probiotics.  This is particularly true when it comes to weighing the evidence in the use of probiotics for children. The Pediatric Gastroenterology and Hepatology Nutrition published an article in September 2017 reviewing existing studies of probiotics in children.  (https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5636929/)

The following are some conclusions that might help guide our use of probiotics in children.

1. The definition of a probiotic is a live organism that, when administered in adequate dosing, confers a benefit to the host.  The key components in this definition are that it must be live and in proper dosing.
2. For gastroenteritis in children, probiotics containing lactobacillus and a strain called S. Bouraladii may shorten the length of diarrhea but must be used in association with hydration.
3. The jury is still out as to whether probiotics should be used every time an antibiotic is prescribed.  Lactobacillus and S. Boulardii have been found to help with antibiotic associated diarrhea. However, the best way to avoid potent types of infections like C. Difficile, is to avoid antibiotics in the first place.
4. Probiotics have been suggested for the prevention of day care acquired infections such as respiratory illness and gastroenteritis.  Limited evidence indicates that probiotics are better for respiratory infections than for gastroenteritis.

In conclusion, there is some evidence to suggest using probiotics in gastroenteritis and can prevent antibiotic associated diarrhea.  Always, the best way to prevent antibiotic associated diarrhea is to not use antibiotics when not necessary. The use of probiotics daily with children in day care is currently not recommended.  However, once we have more information, these promising agents can again be assessed for their usefulness for our children.

Becky Biqi Chen was a resident in general pediatrics for three years at the Children’s Hospital at London Health Sciences Centre. She is currently specializing in pediatric gastroenterology during her fellowship at the British Columbia Children’s Hospital.