Did you know that your digestive tract contains over 400 different types of bacteria? This complex ecosystem is called intestinal microflora. The concentration of bacteria in the gastrointestinal tract increases dramatically moving from the stomach towards the colon. In humans, the intestinal microflora is vital in many important functions including digestion of nutrients and prevention of infection. Disruption of the “normal flora” can lead to many problems including diarrhea, bloating, abdominal pain and poor absorption of nutrients.
What is a probiotic?
Probiotics are “friendly bacteria” or “good bacteria” similar to those that occur naturally in the digestive tract. A few years ago, the Food and Agriculture Organization defined “probiotics” as “live microorganisms which, when administered in adequate amounts, confer a health benefit on the host.”
You might have noticed that current marketing strategies focus on routine use of probiotics to “promote intestinal health.” Unfortunately there is no evidence to support the routine use of probiotics in healthy people. However, the medical literature is full of clinical trials examining the role of probiotic use in situations when normal intestinal health has been compromised. The most common reason for a change in the type of bacteria that inhabit a child’s gut are due to infectious diarrhea or the use of antibiotics. As most parents can confirm, frequent exposures in daycare or school increase the likelihood that most children will require antibiotic use or contract a gastrointestinal infection at some point. It is important to consider the fact that not only do antibiotics kill “bad bacteria,” but they can also kill “good bacteria.”
Many clinical trials have analyzed the benefits of providing probiotics to alleviate symptoms of infectious diarrhea and antibiotic-associated diarrhea. Undoubtedly, the largest of such studies is the Cochrane Database 2010, which included analysis of 63 studies, 56 of which focused on young children and infants as the target population. The good news is that probiotics were shown to be effective in reducing the duration of acute infectious diarrhea in children. Also reassuring is that no adverse effects were reported. Other studies, including Cochrane Database 2013, have also concluded that probiotics are also effective in the prevention of antibiotic associated diarrhea in children and adults. The strains of bacteria proven to be most effective are Lactobacillus Rhamnosus GG and Saccaromyces Boulardii. Check the ingredient labels of your probiotics and look for these specific types.
Are probiotics helpful for other conditions?
There are some studies that report that probiotics are beneficial in treating symptoms of irritable bowel syndrome including abdominal pain, bloating and gas. Other trials have been conducted to assess the value of probiotics in treatment of other conditions such as upper respiratory infections, ulcerative colitis, necrotizing enterocolitis, recurrent urinary tract infections, and eczema from cow’s milk allergy. Some of the results are promising, but no definite conclusions can be drawn.
Should I be giving them to my child?
Routine use of probiotics in healthy children is not recommended. However, the use of probiotics during an episode of infectious diarrhea is often helpful in reducing the duration of the illness. Probiotics can also be used to prevent or treat antibiotic-associated diarrhea. If your child has a viral illness with diarrhea or is being treated with antibiotics, check with your child’s doctor to see if probiotics may be beneficial.
Clinical evidence is weak in supporting the routine use of probiotics for the other health conditions listed above.
Remember that when clinical trials show that a treatment is effective, this is based on statistical significance. This means that while the vast majority may see positive benefits, others might not. It is also important to consider that although small trials might show positive or negative results, the strongest evidence comes from large population based trials. Always check with your child’s doctor first before starting probiotics.
Nora Erhart is a pediatric gastroenterologist, Arnold Palmer Hospital for Children, Orlando, FL who blogs at Illuminate.
