Probiotics in Pediatrics. A Review and Practical Guide

Overview

This review and practical guide, published in Nutrients in 2021, summarizes the evidence on probiotics for preventing and treating common pediatric conditions. Probiotics are live microorganisms that confer a health benefit when given in adequate amounts. Their effects depend on the specific strain, the condition, the dose and the product matrix, and most products are sold as food supplements with less strict quality control than medicines. They are generally safe, although rare serious infections have been reported in vulnerable patients. The authors reviewed randomized controlled trials, meta-analyses and guidelines published over the past two decades.

Gastrointestinal infections and diarrhea

Older meta-analyses and European guidance supported certain strains for shortening acute gastroenteritis, but the most recent high-quality reviews find little benefit in children in developed countries. Specific strains, notably Lactobacillus rhamnosus GG and Saccharomyces boulardii, can be considered to prevent antibiotic-associated diarrhea when risk factors are present, and S. boulardii is recommended across guidelines for preventing Clostridioides difficile-associated diarrhea. L. rhamnosus GG may reduce the risk of nosocomial diarrhea.

Functional and inflammatory disorders

Lactobacillus reuteri DSM 17938 reduces crying time in breastfed infants with colic, but this has not been shown in formula-fed infants. Evidence is insufficient to recommend probiotics for regurgitation, irritable bowel syndrome or functional constipation, although some strains show promise. In ulcerative colitis a few preparations may help as an adjunct to standard therapy, while no benefit has been shown in Crohn's disease. In Helicobacter pylori eradication, some probiotics may reduce side effects, but the evidence is weak.

Preterm infants and allergy

Several strains and combinations appear to reduce necrotizing enterocolitis in preterm infants, and European and American gastroenterology bodies give conditional support to certain options. The American Academy of Pediatrics, however, does not support routine use, especially in extremely low birth weight infants, because of safety and product quality concerns. For atopic dermatitis, asthma and allergic rhinitis, the evidence is insufficient to recommend probiotics for prevention or treatment.

Conclusion

Selected strains benefit selected conditions, but study heterogeneity and strain specificity limit routine use. Clinicians should choose a strain with evidence for the specific indication, and larger, strain-specific trials are needed.