Can Probiotics Safely Treat and Prevent Diarrhea in Children?

There is some evidence that administering probiotics early in the course of diarrhea from acute viral gastroenteritis can reduce its duration by one day in otherwise healthy children and infants, according to findings from a report published in Pediatrics.

In the report, Dan W. Thomas, MD, and Frank R. Greer, MD, of the American Academy of Pediatrics Committee on Nutrition review the health benefits of probiotic and prebiotic products, including those added to commercially available infant formula and other food products for use in children.

Probiotics—which are supplements or foods that contain viable microorganisms that cause alterations of the microflora of the host—have been found to be modestly effective in preventing antibiotic-associated diarrhea in healthy children, though there is no evidence probiotics are effective at treating this type of diarrhea.

Key findings from the study are as follows:

1. Human milk, a natural prebiotic, is preferred for infants through six months of age.
2. There is some evidence in otherwise healthy infants and young children to support the use of probiotics early in the course of diarrhea from acute viral gastroenteritis and that use of probiotics reduces its duration by one day. However, the available evidence does not support the routine use of probiotics to prevent infectious diarrhea unless there are special circumstances.
3. Although the results of some studies support the prophylactic use of probiotics during pregnancy and lactation and during the first six months of life in infants who are at risk of atopic disorders, further confirmatory evidence is necessary before a recommendation for routine use can be made.
4. There is some evidence to support the use of probiotics to prevent necrotizing enterocolitis in preterm infants with a birth weight of 1000g or higher. However, the amount and specificity of which probiotic or mixture of probiotics to use is problematic. Furthermore, many of the probiotics used and cited in the literature for treatment in preterm infants are not readily available.
5. At the present time, the sustained or long-term benefit of using probiotics for treating disorders such as Crohn disease, irritable bowel syndrome, constipation, and extraintestinal infections requires further clinical trials and cannot be recommended in children.
6. Long-term health benefits of probiotics in the prevention of cancer, allergy, or other diseases or providing sustained beneficial results on the developing immune system beyond early infancy remain to be proven.
7. Addition of probiotics to powdered infant formulas has not been demonstrated to be harmful to healthy term infants. On the other hand, evidence of clinical efficacy for their addition is insufficient to recommend the routine use of these formulas. No trials have directly compared the health benefits of feeding human milk versus infant formula supplemented with probiotics.
8. Probiotics should not be given to children who are seriously or chronically ill until the safety of administration has been established.
9. Prebiotics may prove to be beneficial in reducing common infections and atopy in otherwise healthy children. However, confirmatory studies, especially in children fed formula that is not partially hydrolyzed, are needed before any recommendations can be made.
10. Addition of oligosaccharides as prebiotics to infant formula is not unreasonable but lacks evidence demonstrating clinical efficacy at this time. Cost/benefit studies are also necessary to support their addition to infant formulas.
11. Important questions remain in establishing the clinical applications for probiotics, including the optimal duration of administration as well as preferred microbial dose and species. The long-term impact on the gut microflora in children is unknown. It also remains to be established whether there is significant biological benefit in the administration of probiotics during pregnancy and lactation. Similar questions exist for the use of prebiotics.

To read the report—Probiotics and Prebiotics in Pediatrics—click here.