Prebiotics and probiotics, when obtained through a balanced diet or supplements, can support gut health, potentially aiding digestion, immunity, and overall well-being. Here is the current evidence based use of these in children..
Prebiotics and Probiotics in Children: Evidence-Based Guide for Primary Practice
🔬 Definitions
- Probiotics: Live microorganisms (e.g., Lactobacillus, Bifidobacterium) that may confer health benefits.
- Prebiotics: Non-digestible fibers (e.g., oligosaccharides) that promote growth of beneficial gut bacteria.
Evidence is scattered and emerging. Currently there is good evidence for its use in specific conditions, as listed below:
📊 Evidence by Conditions
1. Acute Gastroenteritis (AGE)
✅ Probiotics (Moderate Evidence)
- Lactobacillus rhamnosus GG (LGG) and Saccharomyces boulardii reduce diarrhea duration by ~1 day (Szajewska et al., JPGN 2014).
- ESPGHAN 2023 Guidelines: Consider LGG (≥10^9 CFU/day) or S. boulardii for rotavirus diarrhea.
2. Antibiotic-Associated Diarrhea (AAD)
✅ Probiotics (Moderate Evidence)
- LGG and S. boulardii reduce AAD risk by ~50% (Goldenberg et al., Cochrane 2015).
- Dose: Start with antibiotics, continue for 1 week after.
3. Functional Constipation
⚠️ Mixed Evidence
- Some trials show LGG or Bifidobacterium lactis improve stool frequency (Wojtyniak et al., Nutrients 2017).
- Not superior to PEG (first-line osmotic laxative)
4. Infant Colic
✅ Limited Benefit
- L. reuteri DSM 17938 may reduce crying time in breastfed infants (Sung et al., JAMA Pediatr 2018).
- No clear benefit in formula-fed infants.
5. Necrotizing Enterocolitis (NEC) in Preterm Neonates
✅ Probiotics (Strong Evidence)
- Combination products (e.g., Bifidobacterium + Lactobacillus) reduce NEC risk by ~50% (Sharif et al., Lancet 2020).
- Routine use in NICUs (but strain-specific protocols needed).
6. Atopic Dermatitis & Allergy Prevention
⚠️ Controversial
- Maternal/infant probiotics (LGG, B. lactis) may reduce eczema risk in high-risk
families (Zuccotti et al., JAMA 2015). - No clear evidence for asthma/allergy prevention.
Prebiotics in Children – mainly used in infant formula.
- Infant Formula: Prebiotic oligosaccharides (e.g., GOS/FOS) mimic breast milk and may soften stools (Braegger et al., JPGN 2011).
- Functional Constipation: Limited evidence for standalone efficacy (Korterink et al., Aliment Pharmacol Ther 2015).
🚨 Key Pitfalls
- Strain-Specific Effects: Not all probiotics are equal (e.g., LGG works for AGE, but L. acidophilus may not).
- Dosing Matters: <10^9 CFU/day often ineffective.
- Safety: Generally safe in healthy kids, but avoid in immunocompromised or critically ill.
Practical Recommendations for GPs
| Condition | Recommended Strain | Dose |
|---|---|---|
|
Acute diarrhea |
LGG or S. boulardii |
≥10^9 CFU/day x 5–7d |
|
Antibiotic diarrhea |
LGG or S. boulardii |
Start with antibiotics |
|
Infant colic |
L. reuteri DSM 17938 |
10^8 CFU/day |
© Dr Amit Saha, 2025
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