From the Guidelines
Probiotics have a established role in pediatric care, particularly for the prevention of nosocomial diarrhoea, acute gastroenteritis, and antibiotic-associated diarrhea, with specific strains such as Lactobacillus rhamnosus GG (LGG) and Saccharomyces boulardii CNCM I-745 showing promise. The use of probiotics in pediatrics is supported by recent guidelines and position papers, including a 2021 overview of new guidelines and position papers in pediatric nutrition 1.
Key Indications for Probiotics in Pediatrics
- Prevention of nosocomial diarrhoea: LGG at more than 10^9 CFU/day is recommended 1
- Acute gastroenteritis: Saccharomyces boulardii CNCM I-745, LGG, and L. reuteri DSM 17938 can be recommended for adjunct treatment 1
- Antibiotic-associated diarrhea prevention: S. boulardii and LGG can be recommended 1
- Treatment of infantile colics: L. reuteri DSM 17938, especially in breastfed babies 1
Safety Considerations
- Overall, the use of probiotics is safe, but caution is recommended in premature neonates, immunocompromised patients, critically ill patients, those with a central venous catheter, cardiac valvular disease, and short-gut syndrome 1
- Specific probiotics with a history of safe use in preterm and term infants can be recommended for the prevention of necrotizing enterocolitis 1
Limitations and Future Directions
- The evidence for other probiotics is less supportive, and strain-specific effects are important 1
- Commercial products vary in quality and bacterial content, and parents should consult healthcare providers before starting probiotics 1
From the Research
Efficacy of Probiotics in Pediatrics
The use of probiotics in pediatrics has been studied extensively, with various studies demonstrating their potential benefits in preventing and treating certain conditions.
- Probiotics have been shown to be effective in treating acute viral gastroenteritis and preventing antibiotic-associated diarrhea in healthy children 2, 3, 4, 5.
- Specific probiotic strains have been found to be beneficial in preventing nosocomial diarrhea and treating infantile colic in breastfed infants 3.
- Probiotics may also be useful in preventing necrotizing enterocolitis in very low birth weight infants, although more studies are needed 5.
- However, the use of probiotics in immunocompromised, chronically debilitated, or seriously ill children requires caution due to the risk of complications, including sepsis 4, 5.
Conditions with Proven Benefits
Certain conditions have been found to benefit from the use of probiotics, including:
- Acute diarrhea 2, 3, 5, 6
- Antibiotic-associated diarrhea 2, 3, 4, 5, 6
- Nosocomial diarrhea 2, 3
- Infantile colic in breastfed infants 3
- Necrotizing enterocolitis in very low birth weight infants 5
- Prevention of cow milk-induced food allergy in infants and young children 6
- Prevention of traveler's diarrhea 6
- Prevention of relapsing Clostridium difficile-induced colitis 6
- Prevention of urinary tract infections 6
Safety and Limitations
While probiotics are generally well-tolerated, there are safety concerns associated with their use in certain populations, including:
- Immunocompromised children 4, 5
- Chronically debilitated children 4, 5
- Seriously ill children with indwelling medical devices 5
- Premature infants, although specific probiotic strains may be beneficial in preventing necrotizing enterocolitis 3, 5 The current available evidence limits the systematic administration of probiotics, and more well-designed, properly powered, strain-specific, and dedicated-dose response studies are needed to fully understand their benefits and risks 2.