Tummy Times / The Web's Most Searched Questions (And Answers) About Children's Probiotics 2022.07.18

The Web's Most Searched Questions (And Answers) About Children's Probiotics

Dr. Amira Kassis, PhD Human Nutrition

The gastrointestinal tract starts developing in the womb and continues growing throughout childhood.

The gastrointestinal tract, also known as the gut, can affect the function of other organs. It is the largest immune organ in the body and produces cells, vitamins, and other compounds that help us fight pathogens and prevent unnecessary immune reactions to foreign substances (allergies). The gut produces hormones that help with digestion and food intake and can also affect mood and cognitive function. Much of the gut function and overall health is affected by its tiny residents, trillions of them called the microbiota.

The gastrointestinal tract starts developing in the womb and continues growing throughout childhood. The microbiota also evolves throughout life, with significant changes happening at birth and weaning. At birth, bacteria from the mother can enter and settle in the infant's system -this is called colonization. Then, depending on various external factors[AA1] [GGR2], such as mode of delivery and feeding, the microbiota composition evolves and can vary from one baby to another. So, babies can go through digestive "growing pains" depending on their gut maturity and microbiota composition. A healthy microbiota is rich in beneficial bacteria species such as Lactobacillus and Bifidobacterium. It is associated with a lower occurrence of common "tummy troubles," especially colics (1), diarrhea (2), and constipation (3).   

1. What are probiotics and how do they work?

 Probiotics are defined by the World Health Organization (WHO) as "live microorganisms which when administered in adequate amounts confer a health benefit on the host." They are gut-friendly microbes that can improve gut microbiota composition by favoring beneficial bacteria such as Lactobacilli and Bifidobacteria and fighting harmful bacteria. By doing so, probiotics increase the production of beneficial substances in the gut and preserve its protective barrier. Through probiotics, a baby's gut (their largest immune organ) can defend itself against harmful bacteria that cause inflammation, disturb digestion, and produce gas and discomfort.  


2. Are probiotics safe for infants?

The most common probiotics are from the Lactobacilli and Bifidobacteria families. Although they are obtained from the diet, they are not foreign to our gut bacteria. Bifidobacteria are among the first bacteria to colonize a newborn's gut and remain the most abundant until the introduction of solid foods. Similarly, many probiotic Lactobacilli species are native to the human gut.

Research shows that probiotics are generally safe for infants at the prescribed doses. Studies in colicky babies have demonstrated that a probiotic mix of Bifidobacterium longum and Pediococcus pentosaceus was safe and well tolerated at a daily dose of 109 cfu—10 billion viable bacteria—for 2 weeks (4)


However, not all probiotics are the same, and children can react differently from one another. It is always recommended to consult your child's healthcare professional with any questions before administering probiotic supplements. 


3. Do probiotics have side effects?

Probiotics are generally safe; however, they should not be given to a child with a weakened immune system, a critical illness, or after surgery. In these cases, probiotics can increase infection risk or cause antibiotic resistance. In healthy children, some probiotics may cause discomfort or gas, especially during the first days. Studies using probiotics in infants and children usually report whether there were any observed side effects. A study on more than 100 colicky infants demonstrated that the probiotic mix of B. longum and P. pentosaceus caused no adverse effects compared to placebo and were shown to fight off gas-producing harmful bacteria (4, 5).


4. Do probiotics help with poop overall? 

A healthy bowel movement for a child or "poop" is regular, painless, and soft. Conversely, constipation (irregular bowel movement and hard stool), diarrhea (frequent and runny stool), and painful gas are the main three ailments that constitute an unhealthy bowel. In infants and children, these are due to the immaturity of their gut, in addition to other factors such as family history, antibiotic use, and diet. Probiotics can help by rebalancing the gut microbiota and promoting a healthy environment that influences gut activity and transit times.  


5. Do probiotics help with constipation? 

You must be asking yourself why children get constipated. It is a tricky question because constipation in children is complex. Causes may be due to the immaturity of the gut," changes in microbiota composition, aka "dysbiosis," withholding stools because of experienced pain, or from dietary changes. One thing is for certain; constipated children tend to have a less favorable microbiota profile (3). Weaning can also induce changes in gut activity, causing constipation. For these reasons, parents should ensure their baby is well hydrated and eats enough fiber when ending breastfeeding and the introduction of solid foods. 

Probiotics can help maintain an optimal and healthy microbiota composition by increasing the abundance of beneficial bacteria and improving their function. Probiotics can assist in releasing compounds that make the gut environment slightly more acidic, which in turn stimulates activity in the colon, improving transit in a way that alleviates constipation (6). However, not all probiotics have demonstrated apparent efficacy. In clinical trials, only some probiotics have proven to be efficacious (6).

When looking at constipation, we also consider stool quantity and texture. And in one previous study, a mix of the two probiotic strains Bifidobacterium longum and Pediococcus pentosaceus, slightly improved stool texture in babies after three weeks of treatment compared to placebo (5). In a separate study, the same mix was efficacious in reducing constipation symptoms at 14 days of treatment compared to the start of the study (7).


6. What about colics?

What are colics exactly? The Mayo Clinic defines colics as 'predictable periods of significant distress in an otherwise well-fed, healthy baby' (Mayo Clinic). The most common symptoms of colics are excessive crying in a well-fed baby, gassy tendencies, and abdominal distension or "tummy swelling." A common culprit is an imbalance in the gut microbiota composition. Our little gut residents help digest nutrients and maintain the balance between beneficial and harmful bacteria. A study on colicky infants observed increased colonization of the gut with gas-producing bacteria and lower colonization of anti-inflammatory bacteria such as Bifidobacteria and Lactobacilli (1). In this context, reducing inflammation and supporting healthy digestion of nutrients through probiotics may alleviate colic symptoms.

Similarly, a 2018 review of 7 previous colic-related studies on 471 exclusively breastfed babies found that Lactobacillus reuteri DSM 17938 reduced the daily crying time by more than 50% compared to placebo (8). Two more recent studies using a probiotic mix in colicky babies demonstrated that probiotics improved the number of beneficial gut bacteria (4, 5) and halved excessive crying time after one week, with more babies responding to the treatment after two and three weeks (5). The probiotic mix used in this study was composed of strains Bifidobacterium longum and Pediococcus pentosaceus, which are non-gas forming probiotics.


7. Do probiotics help with diarrhea? 

Probiotics can help reduce the frequency and duration of diarrhea by reinforcing the protective barrier of the gut to block harmful microbes from entering and attenuate inflammation that worsens diarrheal symptoms. Clinical trials have demonstrated the efficacy of probiotic mixes against conventional treatments for different types of diarrhea in infants and children by reducing the frequency and duration of episodes within three days of treatment (9).

8. How long do probiotics stay in your system?

There may be two questions to answer here. The first one is, do probiotics colonize the gut? The answer is no. Colonization refers to settling bacteria in the gut, which usually happens in the long term (months to years). Available research shows that probiotics stay in the gut for shorter durations (days). This brings us to the second question: does this mean that probiotics are not efficacious if they can't colonize the gut? The answer is no. Probiotics exert their beneficial effects on the resident microbiota without colonizing the gut and permanently settling. For these reasons, it is recommended that probiotics treatment are taken regularly to maximize the exposure of our gut microbiota to the probiotic and the resulting beneficial effect. 

9. How quickly do probiotics work? 

It depends on the particular probiotic and the condition to be treated. Probiotics can induce changes quite early after the start of treatment. Studies have shown that infants and young children with diarrhea treated with a mix of B. bifidum, B. infantis, and L. helveticus [AA3] can reduce symptoms within 72 hours of the start of treatment. For colics and constipation, positive changes with the probiotic mix of B. longum and P. pentosaceus were observed as early as seven days, with best results at two weeks (5).

10. What are the best probiotics?

Different probiotic types have demonstrated a variety of health benefits in adults and children. While Lactobacilli and Bifidobacteria genera are known to be beneficial for general human health, a few strains stand out when we talk about the digestive health of infants and children. For example, Bifidobacterium infantis is a gut-friendly bacteria native to our gastrointestinal tract. It even lives in the oral cavity. Researchers at the UC Davis children's hospital have shown that this strain of probiotics significantly reduced intestinal inflammation in infants (10). Bifidobacterium bifidum is another natural resident of the gut, having shown efficacy against diarrhea and other digestive disorders when given to infants (11). 

The Biostime probiotic supplements containing B. bifidum, B. infantis, and L. helveticus successfully decreased diarrhea episodes by 40% in a study on 122 infants ages six months to two years (12).

The Biostime supplement containing P. pentosaceus significantly improved colics and constipation symptoms in infants (5, 7).

11. What are traditional ways of alleviating colics and constipation symptoms for kids? 

 Tummy Massage: has a long history of use and usually brings comfort to a baby experiencing gas or colics. Today's Parents has a few great tips here on how to best massage your baby.

● Hydration: make sure infants and children are well hydrated to avoid hard stools and constipation.

 Fiber: Add fiber to your child's diet by adding fruits, vegetables, and whole grains. Fiber will stimulate bowel movements and help alleviate constipation.

● Prune juice: Prune juice may have a stool softening effect for children one year and older. Tip: Mix prune juice with apple juice for a sweeter taste.  

 Exercise: Regular physical activity can mechanically promote bowel movements reducing transit time in the intestine resulting in softer stools that are easier to pass. 


12. What should I look for in probiotics?

Here are a few essential tips to guide you in your choice: 

●    Go for a high bacterial count: Clinical studies demonstrated the efficacy of probiotics when doses were 1 billion (109) CFU or higher. 

●    Choose a supplement containing strains that have shown benefits for digestive health; these probiotics usually belong to the genera Lactobacillus and Bifidobacterium.[AA6] [GGR7] [GGR8] 

●    Make sure the supplement label mentions enteric coating. This refers to a hard coating that protects the probiotics from the harsh, acidic stomach environment and releases them into the intestine, where the conditions are optimal for survival.

Dr. Amira Kassis, PhD Human Nutrition
Dr. Amira Kassis, PhD Human Nutrition


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