Research & Education

Staying Up-to-Date on Probiotics for Pediatric Health

Just as various antibiotics have different uses, the potential benefits of probiotics vary with the specific strain. This can make it challenging to stay informed about the best probiotics for pediatric health concerns.

Fortunately, certain probiotics have consistently performed well in helping support children’s health. Two of the most studied probiotics are the Lactobacillus rhamnosus GG (LGG) bacteria strain and the Saccharomyces boulardii yeast.

LGG and S. boulardii have been extensively evaluated for helping alleviate acute gastroenteritis and antibiotic-associated diarrhea in children. These probiotics are also being studied for other potential benefits.

Probiotic Considerations in Acute Gastroenteritis

It is estimated that young children experience 0.5 to 2 episodes of acute gastroenteritis per year. This can lead to diarrhea and sometimes vomiting and fever.

The most common causes of acute gastroenteritis are the rotavirus and norovirus infections. Medical intervention typically focuses on replacing lost fluids.  Based on reviews of well-designed, randomized controlled trials, the European Society for Pediatric Gastroenterology, Hepatology, and Nutrition (ESPGHAN) recommends LGG and S. boulardii for acute gastroenteritis, along with rehydration therapy for previously healthy children. Studies suggest these probiotic strains may help reduce the duration of diarrhea by approximately one day.

Probiotic Considerations in Antibiotic-Associated Diarrhea

Another potential trigger of diarrhea in children is antibiotic use. Antibiotic-associated diarrhea may occur in 11% to 62% of children who take the medications.

Antibiotics can disturb the natural balance of the gut microbiota. This dysbiosis can enable undesirable microbes to multiply beyond their normal numbers and increase diarrheal risk. Microflora changes may also disrupt carbohydrate digestion and contribute to diarrhea.

The most recent Cochrane Collaboration systematic review on probiotics and pediatric antibiotic-associated diarrhea looked at 33 studies in children up to 17 years old. The review results indicated that 11% fewer children experienced diarrhea when probiotics were co-administered with antibiotics.

In addition, the Cochrane Collaboration concluded that LGG and S. boulardii appeared to be the most appropriate probiotics for helping to prevent antibiotic-associated diarrhea in children. For this pediatric health concern, the minimum effective probiotic dosage may be 5 billion CFUs per day.

Some human studies suggest that probiotics may be most effective for helping mitigate antibiotic-associated diarrhea when they are started close to the first antibiotic dose. To help minimize the risk of antibiotics killing supplemental probiotic bacteria, it is generally advised to space antibiotic and probiotic doses at least 2 hours apart.

Exploring Other Potential Probiotic Uses in Children

Acute ear infections and upper respiratory tract infections are also common childhood challenges. A few randomized controlled trials in children suggest that LGG may help reduce the incidence of these conditions.

Scientists are also investigating whether LGG may play a role in helping prevent food allergies and asthma. In addition, researchers are exploring the use of S. boulardii for helping to address gastrointestinal symptoms in children with parasitic protozoan infections. Preliminary human studies seem promising, but more research is needed in these areas.

By Marsha McCulloch, MS, RDN, LN