Luke Voytas is a pediatrician and author in Portland, Oregon. His posts combine research and common sense to help parents be calm and confident in raising their kids.

The Promise of Probiotics

The Promise of Probiotics

Probiotics have been around since people started letting foods get funky thousands of years ago, and they've been one of the great hopes of medicine for the past decade.  There’s been a realization that the “good” bacteria in our guts play a huge role not only in our digestive health, but also our overall immune system. But where exactly are we at with probiotics? There have been a flurry of fingers-crossed studies hoping to show improvements in everyone from premature babies to children with allergies to adults with IBS. I mentioned in an earlier post how they have been shown to help colicky babies (and their desperate parents). There are two other scenarios where probiotics have been shown to be helpful for your kids.

1. Your child has infectious diarrhea, or a stomach bug - a huge 2004 review of multiple studies found that probiotics help the symptoms resolve about 30 hours earlier. (1) (Other studies have shown that each hour spent dealing with your kid's explosive diarrhea is like 4 non-diarrhea hours. . .) That’s huge for keeping your kid hydrated and preserving your sanity.

2. Your child is starting antibiotics - diarrhea, sometimes pretty terrible, is one of the biggest side effects of antibiotics. A 2006 study pooled together a bunch of smaller studies to find that people who take probiotics along with their antibiotics are less than half as likely to develop diarrhea. (2) 

If probiotics are so awesome and have no side effects, will giving them everyday make your kid healthier overall? An excellent 2017 study tried to answer that question by assigning 290 healthy kids between eight and fourteen months to receive either daily probiotics or a placebo for six months. (3) The outcome was whether or not the kids on probiotics had fewer absences from daycare due to upper respiratory or gastrointestinal illnesses. Sadly, there was no significant benefit. The average number of missed days over the six months was eleven days in both groups– which means eleven days of missed work for a parent. So it’s hard to recommend probiotics as a daily supplement.

Probiotics are a complex business.  It is possible that they can provide some of the loftier benefits that we're hoping for.  But what is the right combination of good bacteria? And in what amounts? What’s the best way to give them? Do those factors depend on age? Do they depend on our diet, since that gives the good bacteria the food they need to thrive? Scientific progress is slow, and good research like this provides a foundation to build on.

 A quick word on which probiotic to give: most of the studies looking at probiotics in kids have used strains present in two brands, Culturelle for Kids and Align Jr. These come in kid-friendly forms and are available everywhere. Yogurt has probiotics too, but not in sufficient concentrations to show the same benefits mentioned above.

1. Probiotics for treating infectious diarrhea. Allen SJ et al. Cochrane Database Syst Rev. 2004; (2):CD003048.

2. Meta-analysis of probiotics for the prevention of antibiotic associated diarrhea and the treatment of Clostridium difficile disease. McFarland, LV. American Journal of Gastroenterology. 2006 Apr; 101(4):812-22.

3. Probiotics and child care absence due to infections: a randomized controlled trial. Laursen RP, Larnkjaer A et al. Pediatrics. 2017;140(2):e20170735. doi:10.1542/peds.2017-0735.

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