Kids and Probiotics: What You Need to Know

'Healthy germs' are a red hot trend, but should you consider adding them to your kid's diet? Here's what you need to know about good bacteria in food and supplements.
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From powdered packets and fruit-flavored chews, probiotics for kids are cramming the shelves in the supplemental section of drugstores. This 'good bacteria'—as opposed to the pathogenic or disease-causing kind—can also be found at the supermarket in naturally fermented foods such as yogurt, kefir, tempeh, miso soup, sauerkraut, and kimchi. And if sour milk and funky pickles don't appeal to your tot, you can check out the hundreds of products newly formulated with probiotics, including breakfast cereal, snack bars, juice, and even infant formula.

Whichever source you choose, the presence of these microorganisms in the gastrointestinal tract can temporarily alter the microflora, offering potential health benefits. But while promises of improved digestion and a stronger immune system are certainly alluring, it's not clear whether probiotics are a magic bullet for health. "At this point, there isn't an official recommendation regarding probiotics for children," says Frank Greer, M.D., a pediatrician in Madison, Wisconsin and former member of the American Academy of Pediatrics' committee on nutrition. "But at the same time, there's no indication that giving them to healthy kids in the form of foods or supplements is harmful."

Probiotics are friendly organisms, mostly bacteria (though some are yeast), that help sustain a healthy GI tract. "Not only are we colonized by bacteria on the outside of our bodies, but they are also found in our airways and gut and play a vital role in the regulation of the immune response," says Vincent Pedre, M.D., an internist, clinical instructor in medicine at the Mount Sinai School of Medicine in New York City, and author of the book Happy Gut.

The two most well known strains of probiotics are Lactobacillus and Bifidobacterium—both are commonly added to food products and supplements (Lactobacillus acidophilus is the one usually found in yogurt).

As with any supplement or change in your child's diet that you may be considering, check with your pediatrician before you begin. "Probiotics may offer health benefits to most kids, but they aren't recommended for children who are chronically or seriously ill or those who have a compromised immune system," warns Alissa Rumsey, RD, MS, CSCS, a registered dietitian and spokesperson for the Academy of Nutrition and Dietetics.

Here's what you need to know if you're thinking about probiotics for your kids:

How they function

"While we are still elucidating exactly how probiotics work in our system, they are thought to prevail over the pathogenic microorganisms of the GI tract by generating metabolic products that positively influence the immune system," Dr. Greer says.

"Probiotics create 'colonization resistance,' also known as the 'barrier effect,' which means they outnumber and fight bad pathogens in the stomach by preventing them from attaching to the gut," Dr. Pedre says. "And probiotics can help reduce inflammation and control harmful bacteria, parasites, and yeast that tend to distract the immune system from protecting the body against viruses."

Who may benefit

"There is little evidence that supplemental probiotics can prevent disease, but they may be able to shorten the course of an illness such as acute diarrhea," Dr. Greer says. These substances may also help a case of antibiotic-associated diarrhea, Rumsey adds. But probiotics have not been shown (in randomized controlled trials) to have any impact on indigestion, constipation, or chronic diseases such as pediatric inflammatory bowel disease.

"Extensive use of antibiotics, particularly for childhood ear infections, has changed favorable gut flora to the more harmful variety in some kids, so those who have been exposed to multiple courses of these drugs may benefit from the good bacteria of probiotics," Dr. Pedre says. "Probiotic supplements may also decrease the frequency of sinus, ear, and upper respiratory infections in susceptible children." And, according to new research, probiotic supplements have been linked to a lower risk of allergic eczema.

When to start

Kids of all ages who are healthy may benefit from a diet that includes probiotics. Probiotic foods are fed to babies the world over, so ask your doctor about adding yogurt, miso, and any others you think your tot would enjoy.

If a supplement is necessary, your pediatrician can instruct you as to dosage and frequency. "Probiotics are actually given from birth and are even being supplemented in some NICUs," Rumsey says. Babies who are breastfed don't need probiotics, however, because these gut-friendly microbes predominate in human milk-fed infants, Dr. Greer adds. And while cow's milk isn't recommended for kids until they are 1, yogurt made from cow's milk can be given at a younger age, between 4 and 8 months. "Any yogurt consumption at this point usually isn't substantial enough for babies to ingest enough milk protein to do damage," Rumsey says.

Who shouldn't take them

As mentioned above, probiotics aren't for children who are seriously or chronically ill, or who have a disease that renders them immuno-compromised, including preterm infants, children who are undergoing chemotherapy, and kids on steroids, Dr. Greer says. "This stance stems from the fact that probiotics aren't well studied in these populations," Rumsey explains. Probiotics are either bacteria or yeast-based, so there's the potential risk of infection if the immune system isn't functioning well, she says. Parents should also bear in mind that probiotics aren't regulated, either as supplements or food additives, Dr. Greer says, and there's little information about the dose, which ones work best, and how often they should be taken.

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