Probiotics for Babies and Young Children

What you need to know

I’m often asked about probiotics for babies and young children, and whether we should be offering them. The topic of gut health and gut bacteria has become quite popular in recent years, as research in this topic grows. It’s led to a lot of interest in probiotics and what they can do for our kids’ health.

In this blog, I’ll cover the most common questions parents have when it comes to offering probiotics to babies and young children.

Thank you to Lucy Jackman, of The Happy Tummy Dietitian for her support with this blog. Lucy is a Paediatric Dietitian, specialising in gastroenterology and gut health. For plenty more on gut health for babies and children, check out Lucy’s Instagram.

Why is gut health important?

Gut health is a topic with increasing interest in recent years. Many different microbes (including bacteria, fungi and viruses) are present within our bodies, mostly found within the large intestine to make what is known as the “gut microbiome”. There are trillions of microbes that make up our gut microbiome and play an important role in our health.

The gut microbiome begins to be established from birth, and is continually changing throughout our lives. The bacteria in our gut have a role in many different parts of our physiology, including supporting our digestion, supporting our immune system and producing certain vitamins. Actually, around 70-80% of our immune cells are located in the gut!

Generally, the greater diversity in our gut microbiome, the better it is considered to be for our health. There are many different factors that can influence the diversity of our gut microbiome, including age, illness – such as gastroenteritis – or taking antibiotics.

What are probiotics?

First, we need to explain a little about bacteria. Bacteria are micro-organisms that live both outside the body and within the body. There are MANY different types of bacteria – some that are harmful, some that are beneficial and some that are harmless. Certain types of bacteria are necessary for our bodies to function normally – those that are found within our digestive system.

You may have heard about both probiotics and prebiotics and be wondering what the difference is.

Probiotics are a type of bacteria that are found in certain foods (or supplements) and live within the human gut. They are considered a “good” type of bacteria, that help to keep our intestines healthy and can actually prevent the growth of harmful bacteria.

Prebiotics are a form of carbohydrates (mostly fibre) that cannot be digested by the human gut, but that “feed” probiotics and promote the growth of beneficial bacteria within the gut.  This helps the bacteria within your gut to produce nutrients to support your health and digestive system. Some prebiotics include inulin, galactooligiosaccharides (GOS) and fructoolgioscaccarhides (FOS) and are found in foods such as banana, garlic, onion and artichokes.

You may have more recently also heard of Synbiotics. This is essentially a combination of probiotics and prebiotics. Breast milk is a great example of a naturally occurring synbiotics; over recent years these have also started to be added to certain infant formulas too.

Probiotics in baby’s first food

Breastmilk contains naturally occurring probiotics, such as lactobacilli and bifidobacteria, and prebiotics in the form of human milk olgiosaccharides (HMO’s) and lactose. These are passed on to your baby when baby feeds, and have been suggested help to establish their gut bacteria early on. 

Breastmilk naturally adapts its composition to the needs of the baby, and so the amounts and types of probiotics and prebiotics present in breastmilk vary from mother to mother in vast amounts. This is one of the reasons why breastfeeding can be particularly important in helping babies to fight illnesses. 

Some infant formula milks have begun to add probiotics, prebiotics or both (synbiotics) to their formulation. All infant formulas are legally required to follow a certain composition, and adding probiotics is not currently included within that composition. Some manufacturers have chosen to add probiotics or prebiotics as an extra to their infant milks.

Research into the efficacy and benefits of probiotics in infant formula has so far shown varying results. Clear and consistent clinical improvements haven’t yet been seen in a large number of studies or patient cohorts so further research is needed to convince scientists that probiotics should be added to all infant formula. 

One of the biggest problems with adding probiotics to formula milk is that there are huge variations in the types of probiotics available and there is unclear knowledge on how much should be added as well. This makes it very difficult to make a specific recommendation about the addition of probiotics to infant formula. For these, formula with added probiotics, the preparation advice differs from that of formula that does not contain probiotics.  This is because formula with added probiotics is made with water that has been boiled and then cooled to room temperature, this helps protect the probiotics as very high temperatures will reduce their function or kill them completely.

What are the benefits of probiotics for babies and children?

Some of the suggested benefits of probiotics/prebiotics or synbiotics for babies and young children include:

• Fewer respiratory infections
• Fewer gastrointestinal infections
• Increased diversity of gut microbiota
• Overall reduction in infectious diseases
• Improvement in gastrointestinal symptoms (diarrhoea and constipation)
• Prevention of eczema
• Improvement in symptoms of colic

Currently, the evidence to support the above benefits is limited, and so it’s not clear whether, or how much of an impact probiotics, given as a supplement to babies and children, may have. I’ve covered specific cases below where there is more promising evidence for certain strains of probiotics.

There is good evidence for babies that are born prematurely to be supplemented with probiotics to prevent the development of a condition called necrotising enterocolitis (NEC). However, this is done under the supervision of hospital staff when babies are in the neonatal unit.

Are probiotics safe for children?

Probiotics are not thought to be harmful for babies or young children. It is a good idea to discuss with a healthcare professional before offering your child probiotics, to be able to help you choose the best option.

What foods contain probiotics?

Including a variety of probiotic-containing foods is an effective way for most children to get a good intake of beneficial bacteria. Some foods that contain probiotics are:

• Yoghurt with live or active cultures (check label)
• Kefir – this is a type of fermented drink, typically made by adding kefir grains to dairy milk
• Fermented foods (such as sourdough, sauerkraut, kimchi)
• Miso (remember that miso is very high in salt so may not be suitable to included regularly in your child’s diet, depending on their age – read about how much salt your baby or child can have.)
• Tempeh
• Wholegrains
• Some cheeses (e.g. cheddar, parmesan, gouda and mozzarella – check the labels as not all cheeses do contain probiotics and also some cheeses aren’t suitable for babies)

Additionally, many other foods contain beneficial prebiotics (see above for the difference). These include:

• Wholegrains – such as oats, brown rice and pasta
• Beans and pulses
• Peas
• Fruits and vegetables – including berries, bananas, garlic, onions and leeks

For most healthy children, a balanced and varied diet is the most important aspect of promoting diverse gut bacteria. Lots of plant-based diversity is key to support gut health and keeping gut bacteria happy. For example aiming to include plenty of fruits, vegetables, beans, pulses, nuts and seeds where possible can help with this.

Other factors that can influence the gut microbiome in children include:

• Maternal health and diet during pregnancy
• Use of antibiotics in pregnancy
• Type of birth (vaginal vs caesarean)
• Method of feeding (breastfed vs formula fed)
• Genetics
• Hygiene
• Time spent outside
• Exposure to furry friends / pets
• Health conditions
• Use of antibiotics in childhood (it is important to ensure that if your child is recommended by a medical professional to take antibiotics, as in many cases these types of medication can be life-saving)

Should I give my baby or child probiotics?

Currently, there’s not enough strong evidence to suggest that babies and young children should routinely be given probiotics. It is a totally personal choice if you would like to give them to your baby or child. 

There are certain conditions where there is more evidence that probiotics may be helpful, which I’ve covered in this blog. It’s really important to note, however, that not all probiotics are equal and the strain, as well as the dose, really matter when choosing which probiotic to offer your child.

Will probiotics help my baby with colic?

Probiotics are sometimes recommended for young babies that suffer with colic symptoms. Some research does suggest that there could be a benefit to symptoms of colic in breastfed infants, and some parents do report improvements with using them.

However, the evidence is currently quite limited, and a lot more research is needed to be able to recommend probiotics as a general rule for babies with colic.

The probiotic strain that has shown the most promise with relation to colic is Lactobacillus reuteri DSM17938. It’s important to note that the evidence for any effect to colic symptoms is currently only in breastfed babies.

Based on the research the recommended dose would be 10⁸ colony forming units (CFUs) for at least 21 days in a breast fed infant with suspected colic.  Improvements are usually seen between 2 – 4 weeks of taking the probiotic.  Unfortunately, there is no evidence to suggest that taking a probiotic will prevent colic.

Note that probiotics only work whilst they are being taken, they will not populate the gut bacteria in the long term. Some examples of probiotics that may be appropriate for use with colic include BioGaia and SMA Xpert ProCal.

At present in the UK the use of probiotics for management of colic is not recommended in clinical guidelines, however in other parts of the world this is routine practice and included in guidelines.

Should I give my toddler probiotics for constipation or diarrhoea?

Generally, for toddler diarrhoea and constipation, there isn’t enough research to suggest that taking a probiotic will be beneficial. There is some evidence for antibiotic associated diarrhoea, which I’ve covered in more detail below.

In cases of acute diarrhoea such as gastroenteritis, L.rhamnosus GG has been shown to reduce the duration of diarrhoea, stool output and length of hospitalisation.  The recommended dose is 10¹⁰ CFU daily for 5 – 7 days. Products that may be appropriate to offer to your child include Culturelle® Kids Daily Supplement Packets or Optibac Probiotics for Babies & Children. Speak to a healthcare professional for advice on the appropriate dose to give.

For more on gastroenteritis in babies and children under 5 years or constipation in children, check out my blogs.

Should I give my child probiotics if they’ve been prescribed antibiotics?

Antibiotics are known to cause some disruption to our gut bacteria, both in children and adults. There has recently been increasing research into the use of probiotics alongside antibiotics to off-set some of the negative impact of taking antibiotics.

There is some promising research that suggests that the probiotic strain Saccharomyces Boulardii or Lactobacillus Rhamnosus GG may significantly reduce antibiotic-associated diarrhoea in children. The dose is important, and should be at least 5 billion CFU (colony forming units) per day. The timing is also important; the probiotic should be started simultaneously with antibiotic treatment.

Culturelle® Kids Daily Supplement Packets contain Lactobacillus Rhamnosus GG. Optibac also offer a probiotic containing the correct dose of S Boulardii, although it is not a product designed for children. It may be appropriate for older children, but do check with a healthcare professional before offering to your child.

If I take probiotics in pregnancy, can I stop my baby getting eczema?

Another question many parents have, is whether taking probiotics in pregnancy can prevent children from developing eczema.

There is some evidence that taking a probiotic containing the strain Lactobacillus Rhamnosus HN001 from 25 weeks of pregnancy until 6 months post-partum (if breastfeeding) and if baby then continues to takes a probiotic from birth until age 2, the risk of developing eczema might be reduced. The dose used in the research was 6 × 10⁹ CFU (colony forming units) per day.

If offering a probiotic to your little one, do check the label for the dose and strain of probiotic included. Optibac “For Women” probiotic contains this strain of probiotic, in slightly smaller amounts than that used in the research. A healthcare professional could advise on adapting the dose appropriately.

It’s important to note that this is not conclusive evidence, and the evidence is still limited, so it’s not a guarantee that taking a probiotic will prevent your child from developing eczema.

Which probiotics should I give my baby or toddler?

Probiotics that are sold in the UK are considered a food supplement, and they are therefore not regulated in the same way that medicines are. This can result in misleading labels. For example:

• The probiotic may not contain the bacteria that’s stated on the label
• The actual bacteria content may not be sufficient to have any effect – we have huge amounts of bacteria in our gut and so the amount needed for an effect is quite significant
• The type of bacteria included in the product may not actually be able to survive long enough to reach the gut

There are so many different strains of probiotics and not all will have the same, or any, effect on certain conditions. Some people may also see benefits from a certain strain for one symptom, but none for another.

If you’re looking for a probiotic for a specific purpose, it may be helpful to speak to a relevant health professional, if you can, to determine the right strain and dose for your child.

Probiotics can be quite expensive, and if you’re finding that they’re making little difference to your little one’s symptoms, it’s absolutely not necessary to continue offering them.

Ultimately, there are so many factors that influence a child’s health, and particularly their gut health. There is still so much research to be done on gut health and the role of probiotics.

Current research suggests that, whilst offering probiotics to babies and children is unlikely to be harmful, the benefits are unclear for general health, and it’s therefore not necessary for most healthy children to take them.