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Probiotics

People are often asking about the uses of probiotics in children. There are many conditions for which probiotics are often used, but the scientific evidence supporting their use is incomplete. Below are several conditions for which there does seem to be a benefit; also, we list the probiotic species that have been studied and shown to be of most benefit. This is not a comprehensive list, but the conditions with the most research showing the greatest benefits are included here. Generally, a dose of 10-20 billion colony forming units per day is necessary to have an effect for an adult. A good rule of thumb for children’s dosing is to use one quarter the recommended adult dosage for children up to 6 years of age, half the adult dosage for children 6 to 12 years of age, and a full adult dosage for teens.

It is important to recognize that probiotics are not as tightly regulated as medications. There really is no way to assure the purity of any particular preparation or the accuracy of what’s on the label. Your safest bet is to go with a well-known brand, if possible. Also, probiotics are often sold as combinations of species. How these combinations will work is not necessarily clear, so you may want to look for those preparations that are only a single species if you can.

Probiotics are not necessarily safe for all people and in all situations. People with the following conditions should probably not use them: chronic diseases (such as congenital heart disease or kidney disease), immune deficiencies (either from an immune disease or from medications such as chemotherapy), and those with indwelling catheters. If you have questions about whether it would be safe to use probiotics with your child, please check with us first.

Antibiotic-associated Diarrhea
Many of our patients realize that antibiotics can cause diarrhea by killing off the body’s normal intestinal bacteria. The use of probiotics can help replace these “healthy” bacteria and make it less likely that a person taking antibiotics will develop the diarrhea. Three probiotics have been shown to be helpful: Lactobacillus rhamnosus GG, Streptococcus thermophilus, and Bifidobacterium lactis (which is available in some infant formulas).

Acute Infectious Diarrhea
Also known as the stomach flu, stomach viruses, and viral gastroenteritis, acute infectious diarrhea if extremely common. Probiotics are not a cure for this, but can sometimes shorten the course by up to 2 days. Strains that may be of benefit are Streptococcus boulardii, Lactobacillus rhamnosus GG, Lactobacillus acidophilus, and Lactobacillus bulgaricus.

Inflammatory Bowel Disease (Crohn’s Disease and Ulcerative Colitis)
There is little research done in children and teens with these conditions. In adults a stain of E. coli (strain Nissle 1917) has been shown to be of some benefit in lengthening the time between relapses. The usual dosage is 250mg three times a day for 4 weeks.

Irritable Bowel Syndrome
This condition is poorly defined and difficult to treat. There have not been any research trials that have shown a clear benefit, but Lactobacillus rhamnosus GG may have some benefits.

Allergic Diseases (Eczema, Allergic Rhinitis, and Asthma)
There have been a number of studies to look at whether probiotics can either prevent or treat any of these conditions. It does appear that probiotics can make it slightly less likely that these conditions will develop, but studies on whether probiotics can actually treat these conditions have had mixed results. Eczema is the condition on this list most likely to benefit from probiotics. Most studies have used Lactobacillus rhamnosus GG, though there is no consistent recommendation.