Probiotics for kids: are they necessary? I’m taking a look at the research this week to let you know the latest science and recommendations out there!
Bear with me as I go in depth with the research. It's a lot of information, but hopefully it helps you make informed decisions in the future!
Probiotics are live bacteria that are found in foods and supplements. They are considered good for your health. Probiotics are especially beneficial for your gastrointestinal tract, but the full extent of their benefits are still unknown.
Have you heard the term microbiome in the news recently? It is the latest frontier in nutrition science, and can really be quite fascinating. Your microbiome is essentially all the different microorganisms that are in your body. One study estimated that there are around 30 trillion human cells in a body, and 39 trillion bacterial cells!
Probiotics, to put it simply, can change the composition of your microbiome. They help to favor the good bacteria over the harmful bacteria. Unfortunately, strains of probiotics needed as well as doses are still being studied.
Researchers are in the process of studying every facet of the microbiome. There are so many different avenues to pursue, though, that I imagine it will be many years before we have a more complete understanding of what is truly happening within the microbiome. Probiotics and their effect on diseases and common childhood illnesses are a major part of the current research into the microbiome.
Preterm and very low birth weight infants: Certain strains of probiotics were found to reduce the occurrence of necrotizing enterocolitis, a common cause of complications and death in preterm infants. (1)
Eczema and Allergies: The results of this research are somewhat controversial and not at all conclusive. Some studies report probiotics can help prevent eczema (2) (3) and others report that infants who took probiotics showed no difference later in life between themselves and children who hadn't received probiotic supplements. (4)
Constipation in toddlers and older children: The majority of studies have shown that there is an improvement in constipation with probiotics (5), although the specific strain and amount tends to vary between studies.
Ulcers: Studies have also been done into the effectiveness of probiotics in treating the bacterium that causes ulcers, and the overall results appear promising(6).
Preventing Lengthy Illnesses: This one has mixed results currently. One review looked at the length of time children receiving probiotics were sick versus children who didn't receive the probiotics. The general outcome from all the studies reviewed showed fewer sick days for kids receiving the probiotics (7). There are still studies out there that show no difference with illness when on probiotics (8), and a general consensus has still not been reached.
Ok, so now you say "What does this actually mean?" Bottom line, research is still in it's infancy. There are several promising avenues of probiotics use that are still being explored further. Some of these include using probiotics to treat chronic constipation and lessening the time kids are sick with upper respiratory tract illnesses. In preterm infants there is concrete evidence showing probiotics can lessen the severity of some diseases.
The problem with all the studies is that they use different strains of probiotics, different amounts, and different brands. On top of that, most of the probiotics used in the studies are not available to you and me at our local stores. The good news is that we know probiotics are beneficial in general, and they haven't been shown to cause any negative outcomes. (10)
As a dietitian, my number one recommendation is always going to be to get your probiotics through your food. By ensuring good sources of probiotics are common in your family's diet, you will eliminate any of the concern of whether enough of the bacteria make it to your child's gut alive. You also won't have to worry about which strain to buy for which illness. Most fermented foods have several different strands of probiotics.
Probiotics are present in fermented foods. For all of these it is important that you read the label, and buy ones that say live cultures or something indicating that there are still bacteria present. The heat processing done on many commercial foods kills the good bacteria, too, so it is important to be aware of what to look for! Here are some great examples:
(Pickles, Cauliflower, etc found in the refrigerator section of your grocery store and made with traditional brining methods and not vinegar.)
Some of these foods might be a hard sell for older kids, that's for sure. Fermenting foods tends to make them sour. We know that frequently you need to expose kids to unfamiliar foods multiple times before they will accept them. Don't take an initial refusal as a definitive dislike, and keep trying.
The easiest sell for kids of all ages is going to be yogurt and kefir. Know that kefir is going to have more strains of good bacteria in it than yogurt, so it is a slightly better choice. As kefir is a drink, avoid giving it to your baby until they are one year old. You don't want the kefir to replace the amount of breastmilk or formula your baby drinks. If you go for the fermented vegetables, make sure you look for "contains live cultures" or "not pasteurized" labels.
Even writing out "not pasteurized" above was hard for me to do in relation to kids! Most people are aware that pasteurization is key to food safety. Never give your child unpasteurized milk, and avoid soft cheeses that are unpasteurized until they are one. Dairy is really the main concern when we're talking about pasteurization, however. Fermented vegetables are very safe, and fermented vegetables can be easier to digest than raw.
Just to be on the safe side, I decided to re-check the research on fermented vegetables and fermented foods. I wanted to ensure their safety for babies and kids before recommending them. According to several food safety and fermentation experts, fermented veggies, when fermented properly, can actually be even safer than raw veggies (9). You do want to keep your eye on the sodium content when feeding to babies under a year. A little bit of salt is ok, but it shouldn't be a staple in the diet.
As I said above, I will always recommend food first. But sometimes it can be hard to get in adequate amounts of probiotic containing foods. While the research doesn't show specific strands that will benefit everyone, it does show that there aren't any negative effects of taking probiotics. In my mind, that essentially says it can't hurt. There are multiple illnesses and diseases that they can potentially improve, so it is good to get them one way or another.
The down side to commercial probiotics is there are many on the market today that are not worth their cost, at all. While I won't be recommending a specific brand of probiotics here, I will say that you want to favor probiotics from the refrigerated section. Probiotics should be live organisms. You should also look for one with at least 3-4 strands of bacteria, and you want there to be at least 10 billion bacteria per dose. Those are tall orders! Especially considering one serving of yogurt or kefir will generally satisfy those requirements.
Even if you can't find a supplement that meets all of those requirements, it's good to aim for as high of bacteria number as you can. You also want to make sure you take into account how the bacteria will get to the gastrointestinal tract. Many powders do not protect the bacteria from stomach acid, so their usefulness decreases.
Probiotics are very beneficial for people of all ages. That means parents as well as kids! Food sources are your best bet for getting the strains and amounts you need. You can take supplements if you feel you can't get them from food, but pay close attention to how many bacteria are in the dose and how they will be transported in your body effectively.
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