Pros and Cons of Probiotics in Children
Safety and Effectiveness of Good Bacteria
Probiotics popularity has tripled from 1994 to 2003 alone, as research continues to show benefits of probiotics in adults. This so-called good bacteria has been touted as the natural supplement that can rebalance the immune system and protect against or improve symptoms of many diseases. With ever-increasing reports of childhood food allergies, atopic dermatitis, and antibiotic overuse effects, parents are looking for a natural and healthful solution for their children as well.
What are Probiotics?
Probiotics are bacteria that are normally found in the human digestive tract. These bacteria enhance the activity of immune system supporters like natural killer cells, IgA, and the process of phagocytosis (when the body's cells clean up unused materials). In addition, probiotics may balance the presence of foreign, or bad, bacteria introduced to the stomach during illness. Two common types of probiotic strains found in supplements are lactobacillus and bifidobacterium. However, there may be hundreds of bacterial strains and species present in the gut and available as prepared products. Because probiotics are regulated as food products and not drugs, there are limited specific data from studies in people.
Beneficial Claims and Studies in Kids
Probiotics have been touted as a treatment for numerous common childhood illnesses like colic, rotavirus, atopic eczema, food allergies, viral diarrhea and antibiotic-induced diarrhea. There also is a general claim of improved wellness, evidenced by fewer colds and faster recovery time from sickness. Because of these potential benefits, friendly bacteria are now included in some infant formulas as supplements and in kid-friendly yogurts as active cultures. Although theoretical and anecdotal evidence offer widespread support for these claims, the studies available in children are less definitive.
In a 2004 study of more than 300 Chinese children age 3 to 5 years old, the children who received lactobacillus and bifidobacterium, or even lactobacillus alone, twice daily during the winter and spring experienced fewer colds, antibiotics use and missed school days than children who received placebo (no treatment). However, studies in the United States between 2007 and 2009 have been less supportive. Research in thousands of children who received probiotics to prevent allergic disease, reduce severity of atopic eczema in newborns and reduce diarrhea from antibiotic use in children have shown inconclusive benefits. Although the trend in each study appears beneficial, the extent of improvement has not been great enough to support increased probiotic use or to identify an effective strain or dose.
Possible Side Effects or Concerns
Although probiotics seem safe overall, risks have been identified and include mild gas and bloating, possible bacterial infection and possible overstimulation of the immune system. In families with infants, the cost and taste may be prohibitive as well. More serious concerns are potential changes in growth parameters of infants (e.g., head circumference) with large amounts of probiotic supplementation, unhealthy changes in metabolism, or genetic changes within body cells because of the new balance of bacteria.
Challenges to Use
In addition to the concerns and uncertain benefits of probiotics, use is more complicated than just eating active cultures in dairy on occasion. Among the large number of bacterial strains, only a handful have been studied or regulated as food supplements. The only thing completely certain is that each strain provides its own particular health benefits, so different types of bacteria are likely needed to improve allergies and stomach symptoms, for example. The amount of probiotics needed to improve health for each condition are unknown as well. Although the claims are partially accurate in early studies, the strains and doses of probiotics used differ so much that true efficacy in children is still unknown.
References
Lomax and Calder: Probiotics, immune function, infection and inflammation: a review of the evidence from studies conducted in humans. Curr Pharm Des. 2009;15(13):1428-518
Reuters, July 27, 2009: Probiotics May Prevent Colds in Children
NCCAM: An Introduction to Probiotics
Medline Plus: Lactobacillus acidophilus
Yogurt can contain live probiotic cultures.
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