Can You Give Probiotics to Infants and Children?

As the data on the potential benefits of probiotics grows, they fill the dietary supplement shelves at our local stores. Although, for some time, probiotics were only recommended while using antibiotics, there is growing interest in their effects on human digestion, the immune system, and the prevention of colic or even allergies in babies. However, when using probiotics for infants, we need to be aware not only of their potential benefits but also of their disadvantages.

Different types of probiotics

There are different types of probiotics available for infants. Some are added to milk formulas, others are offered in drops as food supplements.

While not all milk formulas contain additional cultures of probiotics, some of them have various species like Streptococcus thermophilus, Lactobacillus reuteri, Bifidobacterium breve, Bifidobacterium lactis, Lactobacillus fermentum, Lactobacillus rhamnosus, and prebiotics like fructooligosaccharides (FOS), galactooligosaccharides (GOS), and human milk oligosaccharides (HMO). Probiotics and other gut microbiome-affecting substances (such as prebiotics and synbiotics) are added to formula milk to make it as similar as possible to mother breast milk.

Probiotic drops are also widely available and are claimed to improve the baby's digestion.

It is important to note that several different substances can affect the human microbiota:

• Probiotics are live microorganisms that provide health benefits when consumed in the right amounts.
• Prebiotics are special ingredients that the gut bacteria ferment and they changing the gut's bacteria composition as well as activity.
• Synbiotics are probiotics and prebiotics included together in one product.

Here’s a list of probiotics most commonly used in infant formula and dietary supplements:

• Lactobacillus species. These are rod-shaped bacteria that use carbohydrates to produce lactic acid. They are present in dairy foods and human intestines and play many roles, one of which is to protect us from infection by pathogenic bacteria. Lactobacillus rhamnosus probiotic strains are the ones studied most extensively. However, Lactobacillus acidophilus is the most commonly used species of this type in commercial probiotic products. Nevertheless, the effects on colic and regurgitation in infants have primarily been studied specifically with Lactobacillus reuteri.
• Bifidobacterium species. They are considered one of the first microbes to colonize the human gastrointestinal tract and are thought to have a positive effect on overall health. Bifidobacteria are the most abundant microorganisms in the gut flora of breastfed babies.
• Streptococcus species. These types of bacteria are more often found in food supplements in combination with other probiotics. Studies have investigated these probiotic species as potentially useful against necrotizing enterocolitis and antibiotic-induced diarrhea.
• Saccharomyces boulardii. This probiotic yeast strain does not permanently colonize the gut but may cause positive changes. It is unique to other probiotics since it is resistant to antibiotics. S. boulardii probiotics are commonly prescribed by the medical community to treat diarrhea in children. However, no reliable data is available for its use specifically for newborn babies.

Potential benefits of probiotics for infants

Colic relief

Infant colic, or the experience of excessive crying, impacts approximately 10–30% of healthy babies. By altering gut microbiota composition and gut function, probiotics may lead to less gas and hydrogen production and subsequent distention of the colon, which is suggested to play a role in pain and crying often observed in infant colic. One prospective, double-blind study found that infants who consumed formula milk with the probiotics Bifidobacterium lactis and Streptococcus thermophilus were less likely to experience colic or irritability compared with infants who consumed formula milk without probiotics.

The researchers also found that the probiotics L. reuteri reduced fussy infant crying time by an average of 45 minutes compared to those babies who took a placebo. This effect was observed in breastfed babies. No differences in colic reduction were observed in those who were formula-fed. Yet, the evidence is limited, and this remains only a hypothesis currently. Thus, more research is needed.

Diarrhea

There are several small-sample studies indicating that probiotics can shorten the duration of diarrhea in infants. While older research studies suggested that certain probiotic strains may reduce the duration of acute gastroenteritis, recent scientific reviews declare a lack of supporting evidence for any benefits to treat this condition. However, we have some evidence that probiotics (L. rhamnosus and S. boulardii) can shorten antibiotic-induced diarrhea in children by up to one day. It is important to note that the study was on all children under 18 and not specifically on infants.

Regurgitation

Reflux is highly prevalent among infants, and the approaches seeming to reduce the severity and frequency of it are very limited. These include thickened formula and maintaining an upright position after feeding. However, several studies have shown that L. reuteri can significantly reduce regurgitation in breastfed babies.

Allergies

Allergic diseases in children are on the rise. The most common types of allergic diseases in infancy are atopic dermatitis, eczema, asthma, and allergic rhinitis, but sometimes allergies are also associated with gastrointestinal disorders.

In 2015, the World Allergy Organization published guidelines on preventing allergies, suggesting a potential benefit from probiotic use. They suggest using probiotics in pregnancy and breastfeeding when there is a risk of having an allergic child and also using probiotics in infants at high risk of developing allergies. L. rhamnosus is the most researched probiotic for allergy prevention, but there is not enough data to recommend it to everyone.

Infectious diseases

Our immunity is thought to be closely linked to our microbiota, so it is not surprising that probiotics are considered a potential approach to managing infectious diseases. Although several studies demonstrate the beneficial effects of probiotics in children with upper respiratory tract infections, it is not clear exactly which bacterial strains should be used, in what quantities, or for how long. Data on gastrointestinal infections are even less valid. There remains inadequate research elucidating the potential benefits of probiotics in the prevention of infant infections.

Should you give probiotics to your infant?

The data on the use of probiotics in infants is not yet conclusive, and researchers are likely to conduct more studies in the future. It is important to note that probiotics can have potential benefits and side effects, especially for infants. If you think about giving probiotics to your baby, talk to your doctor and choose the best supplement for your situation together.

Signs that your baby may need probiotics

If your baby has frequent bowel movements, colic, diarrhea, or troublesome regurgitation, discuss the possibility of probiotic use with your doctor. The use of probiotics may also be considered if the baby or the breastfeeding mother is taking antibiotics. Different sources recommend various bacterial strains, so each case is unique — consult a pediatrician before introducing any new supplements to infants.

Additionally, consult your healthcare provider regarding the potential use of probiotics for yourself during pregnancy or breastfeeding if your baby is at a heightened risk of allergies. Lastly, ask the pediatrician about the option of probiotic supplementation specifically for your infant if there is a high risk of developing allergies.

Side effects of probiotics for infants

Limited studies suggest that probiotics will not lead to adverse effects in infants. For example, in a study conducted with infants younger than four months of age who have consumed baby milk formula containing B. lactis and L. reuteri, no adverse effects such as growth restriction, changes in bowel movements, or changes in infant behavior have been observed.

A similar study with older children, aged between three months and two years, also showed that the use of probiotics such as B. lactis and S. thermophilus in formula milk did not have a negative impact on the health of the infants, and there were no signs of intolerance.

However, large-scope studies and robust evidence on general recommendations for probiotics in infants are still lacking. Currently, it is not recommended for children who are immunocompromised or have long-term catheters. Probiotics are also not recommended for children with heart valve disease and short bowel syndrome. Another sensitive group is preterm newborns. The FDA suggests avoiding both bacteria and yeasts in products given to preterm newborns, as their weak immune systems put them at risk of sepsis. It's worth noting that the FDA has not sanctioned any probiotic product for use as a drug or biological product in infants, regardless of age.

Alternatives to probiotics

Keep in mind that your baby's diet can also be good for gut and whole-body health, so here are some alternatives to probiotics:

• Breastfeeding. Breast milk is a unique food containing biologically active substances and is rich in Lactobacillus bacteria. The composition of breast milk varies depending on many factors, such as the mode of delivery and the age of the child, and is different for each woman.
• Baby formulas. Milk formulas enriched with probiotics have been developed and shown to be well tolerated. However, before choosing such formula milk, check with the pediatrician whether probiotics are contraindicated.
• Food. Natural yogurt or kefir are suitable products from the start of weaning, but only if the baby is not allergic to milk. Choose yogurt that contains active bacterial cultures. At a later age, the child can be introduced to other probiotic-rich food sources, such as fermented cheeses (starting with a small amount), sauerkraut, or other fermented vegetables.

There are some hypotheses that probiotics may be useful in relieving colic, diarrhea, and regurgitation in infants and preventing allergic and infectious diseases in childhood. However, the evidence is not conclusive. While some products on the market offer probiotics as food supplements for babies or are added to infant formula, it is recommended to consult your child's doctor about the use of probiotics in any form.