Should all babies & children be given probiotics?

Gut health is a topic of increasing interest in the UK. As a result, there are are a growing number of probiotic-containing products coming to the market, and those developed specifically for infants and children are no exception. Probiotics are often seen as an attractive option for improving health, but do we currently know enough to be recommending that babies and children are routinely given a probiotic supplement?

 

The gut microbiome

We know that the gut microbiome influences many important aspects of our physiology; immunity, mental health and digestion to name a few. Whilst there are several known factors that can positively influence gut health - including sleep, stress and physical activity - the most obvious one is nutrition. One aspect of nutrition that is gaining increasing interest with respect to gut health is that of prebiotics and probiotics. Prebiotics are non-digestible fibres providing nutrients to facilitate growth of beneficial gut bacteria. They occur in the likes of wholegrains, onions and bananas to name a few. Probiotics are microorganisms promoting gut microbiome diversity and beneficial bacteria composition. Probiotics occur in food often through lactic acid-producing bacteria in things like fermented foods, live yoghurt and kefir. Additionally, an increasing number of probiotic supplement products are emerging as single and multi-strain varieties, both live and heat-killed and in various doses and forms.

 

A growing interest in gut health

A growing interest in gut health has inspired much of the probiotic product innovation amongst food and supplement manufacturers in recent years. It is estimated that one in ten people in the UK take a probiotic supplement, and the UK probiotics market is forecast to grow by 5.6% in the next five years. This has been driven largely by increased research in the field of gut health and benefits of a healthy gut being a growing topic within the media. Additionally, an increasing number of health professionals, both public figures and also in clinical settings, are citing gut health as a key influencing factor on overall health status. This is also the case specifically when it comes to babies and children, with nutrition professionals often being asked by their clients/patients whether they should be giving their child a probiotic supplement and some professionals recommending so. It is considered by many to be an attractive alternative to medicine.  

 

Factors influencing the microbiome of infants

Several factors are known to influence and establish an infant’s gut microbiome. Firstly, the mother’s microbiome plays a role; infants born vaginally will acquire bacteria from their mother during birth, and maternal diet during pregnancy can play a role as well. Furthermore, infants who are breastfed receive probiotics and prebiotics from their mother’s milk which is believed to influence their microbiome. Microbiomes of formula-fed babies may also be influenced by their milk, since some formula milks are voluntarily supplemented with probiotics and/or prebiotics. Exposure to the outdoors and general biodiversity in the home have also been found to influence an infant’s microbiome, and the introduction of solid foods alters the infant’s gut microbiome once again by shifting the gut microbiome to a composition which is more ‘adult-like’ and complex.

 

Research into probiotic supplements for infants and children

When it comes to how probiotic supplements may influence the microbiome of infants and children, evidence for the benefits of giving probiotics to this population group is somewhat limited. Most of the research investigating the effect of probiotic supplementation on the gut microbiome involves adult participants, and suggested benefits refer to the likes of antibiotic-induced diarrhoea, IBS, weight management and more. Far fewer trials have been conducted in infants and children, and have focused largely on areas such as colic, atopic dermatitis, antibiotic-induced diarrhoea and infection and disease reduction in preterm infants. Let’s break each of these areas down:

 

Colic

Research in this area suggests that probiotic supplementation may be beneficial for relieving colic in infants. It is mainly the probiotic strain Lactobacillus reuteri that has shown some promise. However, more research is needed on this and research is mostly limited to breastfed babies at present.

 

Atopic Dermatitis

Some studies have examined whether the use of a probiotic supplement during pregnancy and early into a breastfed baby'’s life can reduce the incidence of atopic dermatitis in respective infants. Whilst some studies show promising outcomes, the definition of the condition being examined differs across studies. This area would benefit from further research and greater consistency in study designs.

 

Antibiotic-induced diarrhoea

When it comes to diarrhoea which can occur after a dose of antibiotics due to disturbance in the gut, there is evidence to suggest that specific strains and doses could provide protective benefits to infants and children. Specifically, strains Lactobacillus rhamnosus GG and Saccharomyces boulardii seem to be most promising when taken alongside antibiotics, according to some studies.

 

Infection and disease reduction in preterm babies

There is evidence to suggest that certain strains/combinations of probiotics may be beneficial to preterm babies. Research suggests that some probiotics may help in preventing severe necrotising enterocolitis, late onset sepsis and all-cause mortality in these infants when under hospital care.

 

Considerations for using probiotics

Whilst emerging research is promising in some areas, more randomised controlled trials are needed in order to gain a greater understanding and confidence in the use of probiotic supplements in babies and children. Aside from research findings, there are also other factors to consider when it comes to babies and children being given a probiotic. Firstly, probiotic supplements can be costly, therefore parents would need to consider whether such products are worth purchasing and trialling for their children. Additionally, with varying strains, dosages and dosage forms of probiotics on the market, it isn’t always easy for parents to decipher which product is the best fit for their child’s need. Additionally, it could be argued that the use of a probiotic may overlook other factors in an infant or child’s lifestyle that may support their gut health more effectively, such as sleep, stress and of course diet. It is also possible that an infant or child would not consistently take/be offered the probiotic every day due to competing day to day priorities of typically time-poor parents, which reduces their ability to take effect. It is also important to acknowledge that whilst probiotics are generally considered safe to use for the majority of babies and children, there is still a call for further research into probiotic safety. Additionally, those who are immunocompromised are advised not to take them. There is also a lack of strict regulations in probiotic manufacturing, which may deter parents from purchasing such products.

 

Conclusion

There is a growing interest in gut health and many new probiotic supplementation products are coming to the market. There is increasing discussion surrounding their use for babies and children. Although emerging research suggests potential benefits of administering some strains in particular circumstances, research is very limited at present and therefore further studies are essential to understanding more about the potential effects of these products on babies and children. Additionally, the probiotic supplement market would benefit from stricter manufacturing regulations, lower cost products and offerings which provide appropriate doses and strains for an babies or child’s specific needs which reflect evidence in this field.

 

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The importance of nutrition during the post-partum and breastfeeding period