When babies are born, they have a sterile digestive system. During birth, then from breastmilk or formula and later on from food, probiotic bacteria are introduced. These bacteria make up an important part of your littles ones health and different experiences and exposures throughout her childhood will affect how their digestive system is colonised.
A guest post by Gabriella Goodchild www.healthfuldietitian.co.uk
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What are probiotics?
Probiotics are live cultures or ‘friendly bacteria’, naturally found in many foods or available as a supplement.
They may have health benefits for children, helping to maintain a healthy digestive system and the right balance of bacteria.
Most of the research has been carried out in adults, and shows that probiotics can help with IBS symptoms, constipation, diarrhoea and even reductions of tonsillitis, laryngitis, and dental caries. Certain probiotic strains may also help with migraines, mood, mastitis, seasonal allergies, liver health and weight management .
In children, the research shows that probiotics are effective in helping improve constipation, diarrhoea, relux, colic and irritable bowel syndrome.
Why do we need them?
Daily probiotic intake has shown to be beneficial for digestive health, by helping to restore the right balance between good and bad bacteria.
The friendly bacteria from probiotics, compete with bad bacteria in the gut and help remove it, resulting in a healthier digestive system.
Which foods have probiotics in?
Foods containing probiotics include yoghurt with ‘live’ or ‘active’ cultures. You will see this labelled on certain yoghurts and yoghurt drinks.
Some fermented foods such as kefir (a fermented milk drink), kombucha (a fermented tea drink) and sauerkraut (fermented cabbage) also contain beneficial bacteria.
Should children be eating more of these foods?
If possible, yes, but getting children to eat more high probiotic foods could be challenging, as fermented drinks and cabbage may not typically be children’s favourite foods!
Some fermented drinks or yoghurts may be high in sugar and some fermented foods may be high in salt and therefore unsuitable for children.
Supplements or food, which is better?
Both have a place in keeping tummy’s happier and healthier. Where possible, it’s always good to get what we need from food but when this isn’t always practical, a probiotic supplement is another way to get the beneficial live cultures.
Are all probiotics the same?
No. There are different strains of probiotics and each may have a different effect on the body. One of the most common strains are the Lactobacillus species. Some probiotic supplements contain one main strain and others contain a number of different strains.
Do probiotic supplements really contain billions of probiotics?
Probiotics are counted by the number of colonies of live cultures. These are known as Colony Forming Units or (CFU’s). Probiotics normally contain at least one billion CFU’s.
Many kids probiotics contain 3 – 6 billion CFU’s.
What are prebiotics?
Probiotics and prebiotics are different. Prebiotics are parts of foods that are difficult to digest and are found in foods such as garlic, onions, leeks, asparagus and bananas. Prebiotics assist the friendly bacteria by acting as food for the friendly bacteria to thrive.
Are probiotics safe for children?
From all the research into probiotics for children, no serious side effects have been found from taking a daily probiotic supplement . However, probiotics are not suitable for all children, especially those with medical conditions which may cause weakened immune systems.
Probiotics can cause side effects, including nausea, rashes, constipation or bloating. These are usually mild and temporary but will vary for each child.
Always take advice from your child’s GP or Registered Dietitian prior to starting a new supplement or if you are concerned about any side effects.
Which probiotics are best for constipation?
Constipation can be very distressing for both parent and child. Research into probiotics and constipation has been quite inconsistent, some declaring that there is not enough evidence  and others have found that probiotics could help constipation in some children, particularly by helping them go to the toilet more often .
However, if you did want to trial probiotics for your little one, there are two probiotics which may help with constipation . These are; Lactobacilli and Bifidobacteria. One or both strains are found in:
Ultimate Flora Kids (age 2 plus)
Optibac Probiotics for babies and children (suitable from birth)
Up 4 Probiotics Kids Cubes (age 3 plus)
Alflorex Chewable tablets (aged 3 plus)
Symprove (suitable for children but no minimum age given)
Biocult Infantis (suitable from birth)
In addition, research published in 2020 found that the strain Bacillus Coagulans may help constipation and the associated symptoms for some children.
This is found in the probiotic gummy;
Bioglan Smart Kids Vitagummies (age 4 plus).
Probiotics may also help with tummy aches and improving the consistency of stools.
They have been found to be particularly useful alongside other treatment options such as the stool softener Lactulose .
Are there probiotics for diarrhoea?
Research has looked at how probiotics could help diarrhoea, caused by tummy bugs such as Gastroenteritis.
Some of the best evidence we have available for probiotics is their role in helping to treat infectious Gastroenteritis .
Two strains may help reduce the duration of diarrhoea ; Lactobacillus Rhamnosus, found in:
Culturelle Kids (suitable from age 1) and
Optibac Probiotics for Babies and Children (suitable from birth).
Also, the friendly bacteria called Saccharomyces Boullardii may be helpful. It is found in:
Although this is in capsule form, the manufacturers state that the capsule can be opened and the contents can be mixed with cold food or drink.
Unfortunately, there’s not enough evidence that probiotics can prevent tummy bugs before they happen .
Of course, the usual advice to treat diarrhoea must still be followed. This includes plenty of fluid to prevent dehydration.
Signs of dehydration include:
less urine than usual (such as dry nappies)
darker colour urine
less responsive behaviour and alertness or a sunken fontanelle (soft spot on your babies head).
Rehydration drinks such as Dioralyte may be suitable for some children, especially those over 5 years.
Breastfed babies should continue to be fed and may need extra feeds.
Bottle-fed babies should be offered sips of cooled boiled water in between their feeds.
Seek medical advice for;
all babies under 12 months or children under 5 years with any signs of dehydration
children over 5 years with ongoing signs of dehydration
children or babies with bloody diarrhoea, or if diarrhoea continues for more than 7 days.
Children may also experience persistent diarrhoea for other reasons. You should always seek advice from your GP for persistent diarrhoea in children. There is little evidence that probiotics may be able to help with diarrhoea not caused by a tummy bug .
Should my child take probiotics after antibiotics?
For some children, antibiotics can change the balance of bacteria in their gut, which can cause diarrhoea. There is some evidence that the same probiotic strains; Lactobacillus Rhamnosus and Saccharomyces Boulardii, thought to help diarrhoea after tummy bugs, may also help prevent diarrhoea caused by antibiotics in some children .
However, this does not seem to help all children and researchers are unsure why this is the case. As probiotics aren’t harmful, you could consider trying them to see if they help your little one.
There is stronger evidence to show probiotic supplements may shorten the length of time diarrhoea continues for after a course of antibiotics .
Are there probiotics for colic?
There is just one recommended probiotic strain called Lactobacillus Reuteri, which has evidence in relation to helping babies and young children suffering from colic  . This probiotic is found in the supplement:
BioGaia (suitable from birth)
Research has shown that this probiotic may increase the effectiveness of colic treatments, decrease colic symptoms, reduce daily crying and unsettled times . The evidence is strongest for breastfed babies and there needs to be more research for formula-fed babies.
There is not strong enough evidence that probiotics can prevent colic before it starts.
Do probiotics help reflux?
Researchers have also looked at the probiotic strain Lactobacillus Reuteri and how this could help with reflux and reduce symptoms such as regurgitation .
Some studies have shown that babies taking a probiotic with this strain, may have fewer episodes of reflux and regurgitation . The supplement containing this strain is:
BioGaia (suitable from birth).
Which probiotics are best for IBS symptoms?
For children with Irritable Bowel Syndrome (IBS), there is some evidence that probiotics could help with general IBS symptoms such as stomach pain.
Research has been carried out into Lactobacillus Reuteri and Lactobacillus Rhamnosus for IBS symptoms.
So far, probiotics containing Lactobacillius Rhamnosus may be more effective for symptoms such as stomach pain .
This is found in;
Which probiotics are best for wind and bloating?
Probiotics may not be helpful for wind and bloating, as this can be a side effect of taking probiotics for some children.
However, for children with Irritable Bowel Syndrome (IBS), there is some evidence that probiotics could help with general IBS symptoms such as stomach pain but more research needs to be done.
Is there a way to test whether my child needs probiotics?
There is no test but probiotics should be tried for around 4 weeks to see if they have helped. If they are not improving your child’s symptoms by 4-5 weeks, the probiotics could be stopped.
What probiotics can’t help with?
It has been suggested that probiotics could help respiratory tract infections or the immune system, but there is very little evidence to support this .
In fact, they are not recommended for children with a weakened immune system.
Research has been carried out to see whether probiotics could help children with eczema , as some children with eczema have changes in their gut bacteria. However, unfortunately, there is little evidence that probiotics can help the skin condition.
There has been some recent research into mothers taking probiotics during pregnancy and lactation and how this may help reduce incidences of eczema in their children , however much more research is needed to recommend probiotics for reducing eczema.
Probiotics and food allergies have also been studied. There is some evidence that probiotics could help children with symptoms of cow’s milk allergies but unfortunately not enough to recommend them . There needs to be more research into other food allergies.
What form do probiotics come in?
Probiotic supplements come in different forms. These include liquid drops, powders for mixing into food or drinks, chewable gummies or soft chews. They can be flavoured or flavourless. Different probiotics come in different forms.
How does my child take probiotics?
Gummies or chews are usually taken once or twice daily. Powdered probiotics are normally taken as 1-2 sachets daily, mixed into cool food or drinks. Liquid drops are usually taken on a teaspoon or mixed into cool food or drinks, once daily. Heating probiotics by adding them to warm foods or drinks may reduce how effective they are. Always follow the directions given.
Can my child take probiotics if they have special dietary requirements?
Some probiotics are suitable for vegetarians, gluten or lactose-free diets. Others are sugar or soy-free or kosher certified. You will need to check for allergens and ingredient lists.
Which are best for baby?
The best baby probiotic supplements for babies are liquid drops or powdered sachets.
Optibac Probiotic for Babies and Children is a powdered probiotic
BioGaia is liquid drops
Bio-Kult Infantis is a powder that can be placed on the nipple before breastfeeding
All are suitable from birth onwards.
BioGaia and Bio-Kult Infantis can be mixed with formula or breast milk. Optibac can be mixed with food or drinks, including formula. All three contain Lactobacillus strains which may be helpful for colic or constipation.
Which are best for toddlers?
All are suitable but if you have a fussy eater the best option may be the gummies or chewable types.
Alflorex is a chalky chewable tablet suitable from age 3
Up4 Probiotics Kids Cubes are gummies suitable for aged 3 plus
Ultimate Flora Kids are chewable and are suitable for aged 2 plus.
All three of these probiotics may help with constipation.
Which are best for older children?
Many children’s probiotics are suitable for up to 12 years.
Digestive Advantage is a probiotic for children aged 3-12 years containing a bacteria called BC30. There isn’t a great deal of published research to support its use and so it can’t be recommended.
Optibac Probiotics for Babies and Children may aid constipation in children up to 12 years.
Culturelle Kids daily chewable tablets are suitable for 3-12 years and may help both constipation and diarrhoea.
Alflorex chewable tablets are suitable for children over 3 years and also could help aid constipation.
Symprove is primarily aimed at adults but their website states it can be used with children at the discretion of the parent. It’s friendly bacteria are associated with improving diarrhoea, constipation and colic.
There are many other brands available and parents should decide which is best for their child. Seek the help of a Registered Dietitian if you are unsure.
Have you tried probiotics with your children and have they helped?