I’m becoming more of a believer in giving children probiotics. Not for everything and not for everyone; I really don’t think we should put them in the water. Probiotics, essentially live “good” bacteria we use to supplement our diet (usually Lactobacillus Acidophilus in the US), are becoming more and more available and recommended by more and more physicians. The role microbes play in our health is a hot topic. Probiotics are thought to improve intestinal health by restoring/elevating levels of helpful bacteria while concurrently diminishing the population of harmful ones. Bacteria in the intestine are a normal part of our digestive health, but population counts of bacteria living in our gut may be altered by illness, antibiotic use, ingested/modified foods, or life circumstance. What we eat and where we travel to drink water, change what lives in our gut. Research also finds that which bacteria cohabitate on our bodies may impact other illnesses outside the gut like eczema, allergies, and/or asthma.
In children, probiotic supplements may promote recovery from acute diarrhea by decreasing the number of episodes of diarrhea & the number of days. They also may help prevent the development diarrhea when children are taking antibiotics. The reality is many decisions we make affect our populations of bacteria. This starts on the day of birth. We know for example that babies born by C-section have different populations of bacteria in their poop when compared with those babies born vaginally, within a week after birth. So from the very beginning, the choices we make (or our parents make) may change the environment in our bodies. This ultimately may change our wellness. A set of doctors studied the effect of probiotics on colicky babies…
Probiotics are often found naturally in food (yogurt with active cultures) while some yogurt and commercially available foods (and infant formula) are fortified with additional cultures. You can also buy Lactobacillus capsules (or other probiotics) at drug and health food stores. How active, and how plentiful these probiotics remain in these products is up for debate. Probiotic supplements (and culture-fortified foods) are not regulated by the FDA. How much is in a capsule or packet is unknown and likely inconsistent from brand to brand or day to day. And if the probiotic cultures are dead, they may do very little to promote change in your body. As a consumer, knowing that a supplement is alive is impossible.
That being said, although the choices of probiotics are limited in the US, the literature and research surrounding altering a child’s bacteria to preserve their health and wellness is both fascinating and promising. Outside of Lactobacillus, relatively few studies have been done with US children and probiotics. But, we’re learning a lot from our European colleagues. The risks of giving a probiotic supplement continue to prove to be very low in children with a healthy immune system. But like anything in pediatrics, there is always theoretic risk when you intervene.
An Italian study in last month’s Pediatrics evaluated the benefit of probiotics for fussy or colicky babies. Researchers found positive results in breastfed infants receiving daily Lactobacillus reuteri. In Europe, probiotics are more carefully regulated than they are here in the US. So, it’s possible this data/study really isn’t applicable to our babies as we don’t have access to the same supplements. But read what they found.
In the study:
- Colic was defined using the rule of 3’s. A colicky baby is defined as one under 3 months of age who cries more than 3 hrs a day, more than 3 days a week for at least 3 weeks.
- About 50 exclusively breastfed, colicky babies were randomized into 2 groups. One group of babies was fed a placebo/inert supplement with no probiotics, while the other group got Lactobacillus daily. Parents and researchers didn’t know which babies got the bacteria (double-blind study).
- Among colicky infants who received the probiotic, there was a significant reduction in daily crying time at the end of the study (day 21) compared with placebo group.
- Crying improved by the end of the study in both groups, as is expected with colic.
- Researchers also analyzed the poop from both sets of babies and found different bacterial populations between the groups of babies. Those given the probiotic had far more Lactobacillus in their stool.
- Researchers theorize that changes in intestinal environment (bacteria, ammonia) may have changed sensory experience for babies and thus their crying behaviors.
It’s hard to prove that the bacteria fed to these babies is directly responsible for crying improvement but significant differences in the two groups were noted. And although it may seem counter-intuitive to families to feed their child bacteria, after we discuss benefits, many parents opt to supplement their children with Lactobacillus due to low cost and ease of administration (can sprinkle in anything). If your baby is a crier and you think and worry about colic, you may want to talk with your pediatrician about starting a Lactobacillus supplement. With the low risk, an improvement in crying would be good for everyone. The bottom line is I don’t think probiotics will cause a fussy baby any harm, and this is new research that indicates it may really help.
A spoonful of bacteria for baby, then.
My (then) 19 month-old daughter had a double ear infection and was prescribed antibiotics and recommended to take probiotics by the ARNP at our pediatrician’s office. She recommended the probiotics based on her experience/training in the SCH ED.
It was an additional $25 for the probiotics and I had to shop around at a couple of pharmacies before I found the correct brand – Culturelle I believe. However it was worth it!
My daughter had a couple of doses of antibiotics before the probiotics and experienced horrible diarrhea. By the end of the first day with probiotics the diarrhea had stopped. I missed a dose of the probitoics and the diarrhea started again. Then I became religious about the probiotics until her course of antibotics was complete.
I do believe there is value, especially easing the digestive problems little ones can encounter and probitotics can be useful in the situations when antibiotics truly do need to be taken. Thanks for your great blog!!
Do you believe in supplementing healthy children with probiotics? The main reason I am asking is that my husband has a very poor digestive system, so I am being extra careful with my daughter’s. I was starting to think about whether I should give her probiotics routinely. I tend to believe that if someone eats a healthy diet, they don’t need supplements from a bottle, but with probiotics being fairly new, I haven’t quite decided what I think yet.
Wendy Sue Swanson, MD says
HereWeGoAJen (Can I call you Jen?),
I think you ask a fantastic question. The answer, I fear, is extremely complicated. But to dumb it down, I’d say, “no.”
My instinct, having read many studies and having had many discussions with specialists about probiotics in children is that normal healthy children don’t need them on a day to day basis. What children eat, what they drink, & where they go will provide them a great, normal set of bacteria.
I don’t think of probiotics like I think of Omega-3 vitamins or vitamin D.
Rather, I think we can use probiotics when we intervene (like prescribe antibiotics) or when illness ensues (stomach flu, IBD, possibly eczema or food allergies) to preserve the wellness a child has and maintain a healthy mix of bacteria in and on the body.
If your child is otherwise healthy, I just don’t know it’s worth the money to pay for a daily supplement that may not do much for ongoing health. Rather, I’d avoid anti-bacterial soaps around the house on a daily basis. That will likely do more good to preserve good, healthy bacteria in a healthy child. Purell and hand-sanitizer are okay because they kill bacteria, but not all the anti-bacterial soaps and products out there that may simple encourage bacteria to modify.
Thanks Dr. Swanson for relaying this interesting study. As a pediatrician interested in the relationship between the bacteria that colonize us and our health, I think we have lots yet to learn about the world of organisms within us. In the past, our only way of identifying these bacteria was through getting them to grow in culture, but more recently other techniques have been developed that allow us to examine the genes and proteins of these bacteria, even from those that do not readily grow in culture. So our understanding of how we relate to these bacteria is, like your patients, in its infancy. Is it possible that giving a baby Lactobacillus simply displaces some other “bad” or gas-forming bacterium? Sure. And in the future we may be able to understand these relationships and tailor specific therapies for our patients even more precisely.
For further reading about the Human Microbiome Project:
I have given my 19mo old son probiotics since he was a few months old. We get his from the pharmacy at Bastyr. I don’t see a downside to it at all. Great article – thanks!
When Will had a week long bout of diarrhea, we tried these and they worked great!
I was actually able to take the NDC number into my local pharmacy and they ordered them for me. Obviously, it wouldn’t work for babies, but it was ideal for a toddler. They have a number of products on their website and more information about probiotic use and infants. Obviously, they are selling the products, so the information should be taken with a grain of salt, but I believe it’s the same study you have quoted here.
Will defiitely had something. . . whether it was colic, who knows? But I would have been willing to try ANYTHING to get him to feel better in those early weeks.
Lots to say. Babes go from zero bugs in their gut at birth to trillions in a matter of months its inconceivable that that transition couldn’t somehow go off the rails. I see alot of miserable babies as you do and I have been able to ‘explain’ perhaps half of them – the other half remain a mystery of sorts and likely fall into temperament or possibly issues related to enteric flora. Compared to 1954 when “colic” was first reported, we know a little more about potential causes these days. What was once a description of behavior may be slowly becoming dated.
I have to disclose that I have served as a spokesperson for Biogaia (manufacturer of reuteri) in the past. I will add that I know Francesco. He’s very funny and very Italian although we didi get into a bit of a kerfuffle over the definition of colic over dinner at the AAP last year. Things got prickly with the language barrier but we ultimately ended it with a big, sincere, hug. Any way, I regularly try reuteri in those babies who fit into the category of the unexplained. I also use it when babies present with severe, excessive, foul smelling gas when I’ve excluded chaotic/disorganized feeding with aerophagia. I’ve had some terrific response but your mileage may vary.
It isn’t clear from this current study but I don’t think the moms were blinded and I wish that allergic enteropathy had been eliminated as a possibility in some of these babies. I think that the effect in inflammatory states may be greater. This has been seen with LGG in allergic babes as well. Marc Rhoads at UT in Houston pub’d in JPeds in December some interesting data showing high levels of calprotectin in ‘colic’ babies.
The problem is that the current literature of this type creates more questions than answers. I do feel, however, that the enteric flora will evolve to play a much larger role in understanding childhood disease in the years ahead.
Wendy Sue Swanson, MD says
Thanks, DrV. Kerfuffle is one of my favorite words. Particularly when followed by a good hug.
I believe parents were blinded in the study. Correct me if I have interpreted the methods incorrectly. Direct from the methods section:
“The bottles (of probiotics) were coded and blinded by
the study statistician for both the participants
and for the physicians, and
the code was revealed to the investigators
once recruitment, data collection,
and all laboratory and statistical
analyses were complete.”
Thanks for your insight and experience. I haven’t used probiotics (L reuturi) ever in infants for fussiness (or what some call colic) but I may try because of this study. I liked your point about going from a sterile gut to one with trillions of bacteria…that something could possibly go askew…it’s one great argument for trying with probiotics, although we’re theorizing here. I think the only population that may be at risk from the intervention are those babies who could later develop primary immunodeficiency. And those are extraordinarily rare.
Thanks! And yes, absolutely call me Jen. I just use my blog name when I comment so that people can recognize me from all the other Jens without actually having to click to visit my blog each time.
We already use regular soap, both for handwashing and for cleaning. And my Elizabeth is most definitely a normal, healthy child- she’s actually never been sick and she’s twenty-one months old. Part of that is because for a long time we were hermits that never left the house, but I also attribute part of it to the fact that she has a good immune system because I let her eat dirt.
Hello, I guess I’m a rep for the “allergic enteropathy” babies so I was scratching my head and wondering if the moms of these babies did the basic eliminations first.
I have used probiotics a bit, like when my kids accidentally ate something and were recovering from colitis. When one of my babies got a whole spate of yeast rashes, I found that cutting out added sugar and processed grains worked better long term.
Wendy Sue Swanson, MD says
The babies were all exclusively breastfed (a requirement to be included in the study). At the beginning of the study they asked all mothers to restrict dairy in their diet. So these babies had elimination diets (if mothers were compliant) to cow’s milk protein. But not to soy, nuts, or other potential allergens.
Kathy Early says
Very interesting indeed! I wonder if they tracked what the moms consumed (I don’t have free full-text access to the newest articles in Pediatrics). I have always been interested in the effects of maternal diet on breast milk composition. Sounds like moms were asked to restrict dairy, but I wonder if they tracked the amount of fruits, vegetables, fiber, omega 3’s and short-chain fatty acids, and other healthy-gut-bacteria-supporting foods consumed by moms.
Wendy Sue Swanson, MD says
From what I can find in the methods section, they didn’t track diet, but just had moms restrict cow’s milk proteins. You make a good point as did Dr V and Viki–that maternal diet and the consequences of allergic enteropathy may play a role in fussiness or “colic.” It could have been a very heterogeneous group from a maternal intake stand-point!
I find this all so interesting. I got a degree in microbiology ten years ago, and this topic never even came up!
Kathy, you bring up an interest point. My daughter was plagued with yeast diaper rashes and oral thrush. I didn’t realize how much sugar I was consuming. We did an experiment where we replaced the refined grains with whole ones, and cut out all “added” sugar. It really helped keep the yeast away after treatment. I’ve never researched whether candida infection is associated with colic. Presumably this would be something straightforward for the researchers to spot in their subjects.
Jennifer Schulz says
I am really fascinated by all this. We have a 5 month old boy plagued with eczema and diaper rash. He was placed in the NICU at birth for breathing problems and fed antibiotics intravenously for 3 days until strep was ruled out. I’ve also had two rounds of antibiotics over the past few months due to mastitis – along with yeast infections – the works. Though I’m not a doctor, I have this strong suspicion that all these skin problems could be due to an imbalance in his microbiome, but our pediatrician says he doesn’t think that this idea has any merit and has strictly told me he is against probiotics. What would you say in this case? Is there any reason NOT to try them? Have you found them to be unsafe at all for an infant this age?
Wendy Sue Swanson, MD, MBE says
New data and research on the human biome is really fascinating. The jury is still really out on a lot of the recommendations. Does your doctor explain why they are against probiotics?
As I understand it, there isn’t a lot of concern or worry for safety on using probiotics. Only true safety concern would be in the face of an immune problem. Big issue is lack of oversight/regulation (some probiotics may not do much and it’s hard to know which are truly active culture, etc).
Once you start your baby on solid foods, consider talking with the pediatrician again about how to add in active cultures safely?
Have you read at all about bleach baths and atopic dermatitis? May be worth chatting with your 5 month-old’s pediatrician about. Here’s some info from some research back in 2009:
I have a 7 week old with silent reflux and want to give her some l reteuri but am not able to find it for babies. If I take the adult reteuri pearls will they transfer into my breast milk?
Wendy Sue Swanson, MD, MBE says
Great question, Lindsay.
Talk with your peds about recommendations for your baby in regards to supplements.
It’s unlikely that live cultures can cross from your body into your milk to support symptoms of reflux for your baby.