Can Baby Probiotics Boost Your Child's Health?
June 18, 2020
Walk into a drug or grocery store and you’ll spot any number of products touting probiotics (a good kind of bacteria) as an added health benefit—even in the baby aisle. What started with yogurt has now spread to an almost $2 billion-a-year industry in the US, complete with products enhanced with probiotics, including chocolate, gummies, infant drops and even some baby formulas.
It’s not surprising: Specific probiotics have shown some promise in clinical studies to aid digestive health in their attempt to balance the body’s gut microbiome, the living organisms that inhabit our digestive tract. But how much do we really know about probiotics for babies? Are they safe and effective? How can you identify which are the best baby probiotics out there? Here, we break down the basics.
Many of the good bacteria that baby probiotics contain are the same or similar to the microorganisms that live naturally in our bodies—namely in our digestive tracts, but also in places like our noses and a mother’s breast milk. Baby probiotics feature different bacteria species and strains depending on the condition they aim to treat: lactobacillus and bifidobacteria are two bacteria groups commonly found in probiotics for babies. They’re sold in formats that are easy to administer to infants: drops and powders that you can mix into milk; some come as added ingredients in baby formulas.
In situations where a baby’s gut microbiome may be disrupted—like when they’ve had a course of antibiotics, which kills off beneficial bacteria just as much as the pathogens they’re targeting—giving your little one a probiotic for babies could help restore the balance of good vs. bad strains. “If there is a belligerent ecosystem in your gut, the probiotic can bring peace,” says Alessio Fasano, MD, a pediatric gastroenterologist and the director of the Mucosal Immunology and Biology Research Center at Massachusetts General Hospital. “Their function is beneficial for us, but the confusion and mixed messages you get about the use of probiotics is based on the fact that we’ve started to widely use them before knowing exactly what they do and why they should be used.”
It’s hard to predict how effective baby probiotics are at enriching an infant’s microbiome, which in the first few years of life helps map the development of their immune response system. Research into probiotics for babies is still in its infancy, and much of it is a mixed bag. “The findings aren’t always consistent,” says Stephen Eppes, MD, director of pediatric infectious disease at ChristianaCare. “What are the species of microorganisms? What is the concentration you’re looking at? Do the probiotics survive going through the stomach and get to the intestines? A lot of these studies have not always addressed these major points.”
A gut that’s off-kilter could predispose a baby to various illnesses later in life, such as allergies, autoimmune diseases or diabetes. “There’s compelling evidence that a lot of the things that have helped us stay healthy—c-sections and antibiotics and good hygiene practices—are changing intestinal microbiota that have been with us for millions of years,” says Mark Underwood, MD, the chief of neonatology at UC Davis Children’s Hospital. “The compelling question for parents is, ‘is there something I can do to help my baby develop a healthy gut microbiota that will have a long-term impact?’ That’s the key question yet to be worked out.”
In terms of the efficacy of probiotics for babies, it’s helpful to think about babies in subgroups, Underwood says: those who are born prematurely, and those born full-term. There’s strong evidence showing that very preterm babies—those born at less than 32 weeks of gestation or with a birth weight of less than 3 pounds 5 ounces—who are treated with a probiotic are less susceptible to necrotizing enterocolitis, an inflammation of the intestines that can lead to severe infection. “Their risk goes down by half,” Underwood says. Still, giving preemie infants baby probiotics is not yet commonplace in the US, as some studies have shown marginal or no benefits at all, he adds.
A baby probiotic may be beneficial for healthy full-term babies if they have any of these risk factors, which are believed to have the potential to alter an infant’s gut microbiome, according to Underwood:
- birth by C-section
- being administered antibiotics shortly after birth
- a mother who took antibiotics during labor
- lack of breastfeeding
- a prolonged stay in the hospital after birth
When asking your child’s pediatrician about probiotics for babies, Underwood also says to consider your family’s history of certain diseases like allergies, diabetes and Crohn’s. Research has shown that babies who have more good bacteria in their poop could be less likely to contract some of these later on, he says.
Probiotics for babies don’t commonly pose safety concerns or cause side effects, but don’t buy them over the internet if you can’t verify exactly where they’re coming from, says Gail Cresci, PhD, an expert in pediatric gastroenterology at Cleveland Clinic Children’s. Because most baby probiotics are considered dietary supplements, they’re not required to be as rigorously formulated and tested as medicines are, although that may change, according to the US Food and Drug Administration. Looser restrictions mean a probiotic could very likely contain fewer microorganisms than its label promises; it might also contain more or different strains of bacteria than it claims to, says Underwood, who has overseen tests on probiotics his staff bought at drugstores.
Babies who are immunosuppressed shouldn’t take probiotics, as their systems may “reject the probiotic and cause a problem,” Cresci says. If your child is set to receive a powder-based baby probiotic in a hospital setting and has an IV or other catheter, be sure that the supplement gets mixed in another room. “Those probiotics can become airborne and get inside an end dwelling catheter and become asystemic—it’s not normal to have bacteria in your bloodstream,” says Cresci.
Research shows that probiotics for babies can be used to ameliorate specific health conditions—sometimes. “Always check with your physician. Because probiotics are strain-specific, there isn’t one-size-fits-all,” said Cresci, noting that one species of bacteria can contain hundreds of strains; some strains work for some things, others don’t work at all.
Conditions where studies have shown baby probiotics to have varying degrees of benefits include:
• Probiotics for babies with diarrhea. The best baby probiotic use case so far relates to antibiotic-related diarrhea, Fasano says. A recent meta-analysis of 33 studies concluded that for every nine children treated with antibiotics, probiotics—especially L. rhamnosus or S. bouldardii—will prevent one case of diarrhea.
• Probiotics for babies with diarrhea from rotavirus. Studies have shown that certain baby probiotics—namely L. rhamnosus—could cut the time some babies suffer from diarrhea caused by rotavirus by up to 24 hours.
• Probiotics for babies with colic and gas. Though doctors don’t know much about what causes colic and the gas that’s likely associated with it, some think it stems from undeveloped digestive systems and/or gut imbalances. A 2014 clinical trial involving 468 healthy newborns showed that babies who received baby probiotic drops containing an L. reuteri strain cried for about half as long each day vs. those who didn’t; they also regurgitated fewer times than the babies who didn’t receive the supplement.
• Probiotics for babies with eczema. A 2015 review of a couple dozen studies offers somewhat weak data showing that probiotics taken by pregnant or breastfeeding mothers—or given to infants themselves—reduced the risk of eczema in babies.
Decided to give baby probiotics a try? The next step is figuring out how to choose the best baby probiotic for your little one. Start with what your child’s pediatrician says. Keep in mind, though, that “it’s not easy for a parent or doctor who is trying to keep up on all the literature to say one brand is better over another,” Underwood says.
It’s also hard to know if the bacteria strains present in a certain baby probiotic are the same ones tested in lab settings; many products don’t mention everything they contain. “One of the hardest things is translating what we see in research studies into general practice,” Cresci says. “You may get a strain that looks great, but to get that into a commercialized product is challenging—you have to make sure the bacteria are live and they’re going to grow and maintain their viability until someone is going to consume them.”
Your best bet is to look at some of the studies, note the bacteria used and compare that to the ingredients listed on the boxes of baby probiotics you see on store shelves. Well-known brands like Culturelle and Florastor offer powder packets to help combat diarrhea; BioGaia, Garden of Life and Gerber offer baby probiotic drops with bacteria species shown to possibly help with colic (as does infant formula from Gerber); and Enfamil offers a probiotic-enhanced formula that could help with diarrhea.
Many other baby probiotics contain bacteria that supposedly mimic the good microbes found in breast milk, but most experts don’t yet recommend giving healthy babies probiotics to improve overall health. “Using a probiotic to fix something without knowing what’s wrong is not logical,” Fasano says. “We still don’t have the key answer to the question, ‘what is a normal microbiome?’—it depends on who you are, and we’re still trying to figure that out.”
About the Experts:
Alessio Fasano, MD, is a pediatric gastroenterologist at Massachusetts General Hospital, where he serves as the division chief of pediatric gastroenterology and nutrition and the director of the Mucosal Immunology and Biology Research Center. He earned his medical degree from the University of Naples School of Medicine.
Stephen Eppes, MD, is the director of pediatric infectious disease at ChristianaCare and also serves on the emeritus staff at Alfred I. duPont Hospital for Children. He earned his medical degree from the University of South Florida in Tampa.
Mark Underwood, MD, is the chief of neonatology at UC Davis Children’s Hospital. His research is focused on the development of intestinal innate immunity and mechanisms of probiotics and prebiotics in preterm infants. He received his medical degree from the University of Texas, Southwestern Medical School in Dallas in 1987.
Gail Cresci, PhD, is an expert in pediatric gastroenterology at Cleveland Clinic Children’s, where she has worked since 2010. Her research centers around the gut microbiome, gut metabolome and digestive diseases.
Please note: The Bump and the materials and information it contains are not intended to, and do not constitute, medical or other health advice or diagnosis and should not be used as such. You should always consult with a qualified physician or health professional about your specific circumstances.
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