Probiotics for Kids

This article forms part 3 in our educational resource, ‘Early life microbiome series’, and is aimed for children between 2-12 years old. The other articles in this series are:

1. The Microbiome- all you need to know
2. A Child's Microbiome - this explores the factors affecting the microbiome in childhood
3. Probiotics for Kids
4. Probiotics for Pregnancy  
5. Baby Probiotics
6. Probiotics for Teenagers

Are probiotics good for kids?

If your children are generally fit and healthy, you might wonder if kids need probiotics. Having read Part 2, ‘A child’s microbiome’, you can see that the balance of the gut microbiome is very important, and that the levels of friendly bacteria can be easily disrupted. In fact, the childhood years can be very challenging time for the microbiome. Factors such as school, stress, high-sugar low fibre diet, medications/antibiotics, and busy lifestyles can impact your child’s microbiome composition and reduce levels of friendly bacteria.

Kids can benefit from probiotics to provide that extra support they may need in the hustle and bustle of daily life.

Benefits of probiotics for kids

There are many potential benefits of using probiotics for children. The functions of the microbiome are covered in more detail in The Microbiome- all you need to know. Let’s take a brief look at some key microbial functions in relation to children: 

• Digestion and energy: your child is growing fast! As such it’s vital they are digesting their food and absorbing the nutrients well. Our microbiome provides digestive enzymes to help kids to break down their food¹. Plus, they support a healthy gut environment ensuring good nutrient absorption. Many microbes in our gut can also produce essential vitamins!²
   
• Supporting immunity: Schools are notorious hangouts for harmful bugs; they seem to be all over the classroom and play areas! A government report studying the 2018/2019 academic year found on average children missed 5% (approx. 8 days) of the academic year³. This may not sound high, but consider if those days fell over exam periods, day trips or important days for you at work. With 70% of our immune system being located in the gut, you can support your child’s immunity with probiotics. Our microbes essentially act as teachers, they help ensure the immune system is responding to threats appropriately. Probiotics can even become part of our friendly bacteria barrier which protects our gut cells and immune system. For more information see Probiotics for winter immunity. 

Health care professionals can find out more about the complex relationship between probiotics and the immune system in this article on the Professionals site: Probiotics for immunity.

• Mood and wellbeing: Approx. 1 in 9 children between age 5-15 suffer with a mental health disorder in the UK⁴. Probiotics may be able to modulate our mood via the gut-brain axis. It’s estimated 90% of serotonin, otherwise known as our ‘happy hormone’, is produced in the gut. The neurotransmitter GABA is important for helping us to ‘switch off’ and sleep. GABA can be produced by friendly bacteria in the gut such as Bifidobacteria and Lactobacilli⁵. You can read more on the Gut-brain axis and probiotics. 
   
• Skin health: Children often suffer with skin problems, from eczema to pre-teen acne. Approx. 1 in 5 children in the UK suffer with eczema⁶. The gut-skin axis is starting to be explored and we can see that conditions such as acne, eczema and psoriasis are linked to gut health. Probiotics may be able to improve skin health by supporting a healthy gut lining, increasing the levels of good bacteria in the gut and calming down inflammation⁷. For more information, read Probiotics for acne and skin health

Healthcare professionals can find out more about eczema and the latest probiotic research in the article Do probiotics help with eczema?  

The best probiotics for kids

It’s best to find children’s probiotics containing probiotic strains that have been specifically researched in infants, babies, and children. Although it’s typically reported that the microbiome settles at around three years of age, some research disputes this. One study showed that a child’s (aged 7-12) microbiome was still different to an adult’s⁸. In this study, the composition and the functional qualities of the microbiome differed. These differences could be due to the extra energy and growth required for the childhood years.

Let’s look at some prebiotics and probiotics which have been researched in babies and children:  

Probiotics for kids with constipation

The science: There are many reasons why a child may suffer with regularity issues, e.g. low fibre and/or high sugar diet, dehydration, medications, and stress/anxiety. The NHS states 3 or less bowel movements a week may mean your child has constipation⁹. Laxatives are usually the go-to option but can cause dependency if used long term. A probiotic may be able to encourage regular bowel movements in numerous ways, including the production of SCFA’s which stimulate peristalsis, without risk of dependency.  If after a few days your child has still not had a bowel movement, or often suffers with regularity issues, then always consult with your child’s doctor.

Probiotic: One of the most researched strains for constipation is Bifidobacterium lactis BB-12^®. The strain has also been researched in children¹⁰. B. lactis BB-12^® was used in one of the largest clinical trials in ever conducted in probiotic research. In this gold standard trial, individuals who took B. lactis BB-12^® had significantly more bowel movements per week¹¹. It’s also been shown in other trials to harmonise bowel movements and not cause loose stools¹². The benefit of probiotic supplementation for constipation is that probiotics typically are not associated with dependency unlike many medications.  

Healthcare professionals can find more information by reading this article in the Professionals site best probiotics for constipation and by reading this strain’s entry in the Probiotics Database Bifidobacterium lactis BB-12^®

Probiotics for kids on antibiotics

The science: Antibiotics do not always recognise between good and bad bacteria, as such they can wipe out lots of friendly bacteria causing a microbial imbalance¹³. When this happens side effects like thrush, diarrhoea, constipation and low energy may occur. Taking a probiotic helps to support the microbiome during antibiotic treatment.  

Probiotics: If your child needs to take antibiotics and is already taking a daily probiotic, you may wish to continue with this, just leaving at least a two-hour gap between the antibiotic and probiotic. If children are not already taking a probiotic supplement, or if it’s more convenient, then alongside the medication you could give them a specific probiotic designed to be taken with antibiotics. There is a unique combination of extensively researched probiotic strains, Lactobacillus acidophilus Rosell 52 and Lactobacillus rhamnosus Rosell 11, which won’t be affected by the action of the medicine and therefore can be taken with breakfast daily, regardless of when the medicine is being taken, making them a very convenient option. Lactobacillus acidophilus Rosell 52 and Lactobacillus rhamnosus Rosell 11 have been shown to reduce antibiotic associated diarrhoea when taken alongside a broad spectrum antibiotic¹⁴.

For more information on this topic, you can read Probiotics with Antibiotics  

Probiotics for kids’ immunity

The science: As previously mentioned, the immune system and microbiome go hand in hand. They are in constant communication with one another, with our microbes modulating immune responses and encouraging speedy responses¹⁵. The immune system is heavily challenged in school environments so needs all the support it can get!

Probiotics: A combination of three probiotic strains has been shown to reduce the risk of childhood illnesses as well as reduce the time taken off school¹⁶. L. acidophilus Rosell 52, Bifidobacterium infantis Rosell 33 and Bifidobacterium bifidum Rosell 71 were the three strains used in this gold standard study of 135 children. These strains are good probiotics for children.

Health care professionals can find more information on the research of these three strains here, in the Professionals area: Research on three Rosell Probiotic strains

Probiotics for kids with asthma

The science: It’s estimated 1 in 11 children suffer with asthma¹⁷. Asthmatics often have imbalanced immune responses exhibiting a more inflammatory profile. There is some preliminary evidence showing differences in the airway microbiome between healthy children and asthmatics¹⁸. These differences may even be a reason why asthmatics are more vulnerable to viral infections¹⁸. Some probiotics have been researched in asthmatics and shown beneficial effects but the gut-lung axis is just starting to be explored!

Probiotics:  In addition to their benefits for immune health (see previous section), L. acidophilus Rosell 52, B. infantis Rosell 33 and B. bifidum Rosell 71 were shown in a clinical trial with 78 children to reduce wheezing like symptoms. Symptoms were reduced after three 3 months and disappeared after six months, this was maintained to nine months¹⁹. Lactobacillus reuteri Protectis^® has also been shown to significantly reduce bronchial airway inflammation in 43 asthmatic children²⁰. There is also some evidence for Bifidobacterium breve M-16V^® to reduce the frequency of wheezing and noisy breathing in infants²¹. You can find more information here: Probiotic potential for Asthma  

Healthcare professionals can find more information on Probiotics for asthma and Lactobacillus reuteri Protectis^® and Bifidobacterium breve M-16V^®

Probiotics for kids with allergies

The science Allergies are a common childhood complaint. Children with allergies often exhibit a more inflammatory profile, dysbiosis and leaky gut^22,23. Probiotics can help to support gut health and modulate immune function.

Probiotics: Lactobacillus rhamnosus GG^® has been shown to increase IgA in saliva, thus potentially boosting immune responses in those with birch pollen allergy (hayfever)²⁴. A similar gold standard study was conducted over the birch pollen season using a combination of Lactobacillus acidophilus NCFM^® and Bifidobacterium lactis Bl-04. The strains were given to 47 children with hay fever. Generally, fewer children reported runny and stuff noses, plus white blood cells associated with allergy (eosinophils) were reduced in the probiotic group²⁵.

You can read more about this subject here: Could probiotics help with allergies?  

Healthcare professionals can find more information about related research on the Probiotics Database: Lactobacillus acidophilus NCFM^® and Bifidobacterium lactis Bl-04

You can find more information about probiotics for eczema in Part 5 - Baby probiotics . Other notable strains for eczema include Lactobacillus rhamnosus GG. Healthcare professionals can read more about the research into this strain on the Probiotics Database: Lactobacillus rhamnosus GG^®. 

Probiotics for kids with autism

The science: kids with autism have a different microbial composition to non-autistic kids, with higher levels of some harmful bacteria and reduced Bifidobacteria (Find out more about Bifidobacteria in our glossary)²⁶. They also have lower levels of short chain fatty acids (SCFA’s) which are produced when gut bacteria ferment fibres, especially prebiotics. SCFA’s are essential for gut and all-round health. Gut issues such as constipation, diarrhoea and abdominal pain are very common in autistic children and can cause additional distress.

Probiotic: research on specific probiotic strains is lacking for autism with inconsistent results. However, there is some promising research using prebiotics. One study using prebiotic galactooligosaccharides (GOS) found a significant improvement in anti-social behaviour²⁷. You could also consider a probiotic to support digestive symptoms. Saccharomyces boulardii is a well-known probiotic that has been extensively researched for loose stools in hundreds of children, making it a nice natural option to try. Persistent symptoms should always be discussed with your child’s doctor.

Healthcare professionals can read more on probiotics and autism in the Professionals area, and find more information about Saccharomyces boulardii on the Probiotics Database. 

How to give your kid probiotics

Now we’ve gone through the potential benefits and looked at some of the best probiotics for children, let’s look at some easy ways you could give prebiotics and probiotics to your kids.

We know this can be a challenge, especially for some fussier kids. But fear not, there’s lots of ways kids can take their probiotic supplement– read our inspirational article for more ideas: How to get kids to take probiotics! Just remember- if you’re adding a probiotic to any type of food or drink, make sure it’s not too hot or acidic or you’ll risk killing those friendly little microbes.

• Probiotic drops for kids - that’s right, you can give your kid an easy liquid probiotic!  Simply drop the recommended drops per day right into your child’s mouth or you could mix it with their food or drink if you prefer. This is a particularly useful format for very young children.
   
• Powder probiotics for kids – many probiotics come in a powder or sachet format. This can be particularly useful as children don’t like to swallow capsules. The powder can be easily hidden in their favourite foods or drinks e.g. in their breakfast cereal or yoghurt.
   
• Probiotic foods for kids – some fermented foods naturally contain good bacteria. This can be a good way to boost the diversity in your child’s microbiome. The only downside is many of these foods such as kefir, kimchee and sauerkraut have strong tastes and may not be child friendly! Take a look at some of our favourite fermented foods!
   
• Probiotic yogurt for kids- probiotic yoghurts from the supermarkets can be a popular choice. However, these yoghurt drinks can be very high in sugar, or contain artificial sweeteners which may have negative effects on the gut microbiome²⁸. Consider finding a well-researched probiotic supplement and adding it to yoghurt.

It’s worth nothing that there are dairy-free probiotics. If your kids have dairy allergies or if you want vegan products, have a look on the packaging or reach out to the brand to ask.

Are probiotics safe for kids?

If you’ve read this far, you’ll now be well-informed and hopefully convinced about the potential benefits of giving probiotic supplements to your children. But when it comes to your kids, of course you want to know that the supplements you’re giving them are safe. We’re always told that bacteria are bad and can cause infection, but it’s important to understand that not only are some bacteria ‘good’, our bodies couldn’t work optimally without them!

Probiotic bacteria have been extensively researched, especially those available in supplement form. It's best to use strains which have been extensively researched in children but in general, probiotics are very safe supplements and suitable for most people from infancy into old age.

The only time you'd need to exercise caution when giving your child probiotics, is if they have a serious illness and/or a compromised immune system. In this case, you should always speak to your child's doctor before giving any natural supplements. For more information read the following articles:

Are probiotics safe?

When should I NOT take probiotics?

I’m severely immunosuppressed: why can’t I take live cultures?

Conclusion

This article has hopefully given you lots of advice on choosing the best probiotic for your child. It can be a minefield but aim for a probiotic supplement that has been researched in kids and supports your child’s health complaint or circumstances.

Summary:

• A child’s microbiome is really important for their overall health and wellbeing!
• Friendly bacteria carry out essential roles for our kids e.g. digestion and immune support
• Adult probiotics may not always be suitable for children - find strains which have good research in kids
• Choose a strain that has been researched for your child’s health condition
• If your child is taking antibiotics, consider specific probiotic strains researched alongside antibiotics or give their usual supplement 2 hours away from the medication
• You have plenty of options – you can give your child their probiotics in drops/liquid, powder/sachet, or capsule, and can add to foods including yoghurt- so many options for any fussy mouths!
• Don’t forget diet – even if you’re giving them a probiotic supplement, it’s always good to keep sugar to a minimum, and include gut-supporting high fibre and fermented foods.

Wishing your children a healthy and happy future!

For other articles of interest:

How to get kids to take probiotics  

Boost your child's immune system

Are cleaning products impacting kids gut health? 

References

1. Pollet R et al., "An Atlas of β-Glucuronidases in the Human Intestinal Microbiome," Structure, vol. 25, no. 7, pp. 967-977, 2017.
2. LeBlanc J et al., "Bacteria as vitamin suppliers to their host: a gut microbiota perspective," Current Opinion in Biotechnology, vol. 24, no. 2, pp. 160-168, 2013.
3. D. o. Education, "Pupil absence in schools in England: 2018-2019," Gov. UK, 2020.
4. M. H. Foundation, "Mental Health Foundation," 23 November 2018. [Online]. Available: https://www.mentalhealth.org.uk/blog/what-new-statistics-show-about-childrens-mental-health. [Accessed 7 September 2020].
5. Foster J et al., "Gut–brain axis: how the microbiome influences anxiety and depression," Trends in Neuroscience , vol. 36, no. 5, pp. 305-312, 2013.
6. "British Skin Foundation," [Online]. Available: https://knowyourskin.britishskinfoundation.org.uk/condition/eczema/#:~:text=1%20in%20every%205%20children,have%20AE%20as%20a%20child.. [Accessed 7 September 2020].
7. Salem I et al., "The Gut Microbiome as a Major Regulator of the Gut-Skin Axis," Front Microl, p. 9: 1459, 2018.
8. Hollister E et al., "Structure and function of the healthy pre-adolescent pediatric gut microbiome," Microbiome, vol. 3, no. 36, pp. https://doi.org/10.1186/s40168-015-0101-x, 2015.
9. "Constipation in children," NHS, 14 February 2020. [Online]. Available: https://www.nhs.uk/conditions/pregnancy-and-baby/constipation-and-soiling/. [Accessed 7 September 2020].
10. Tan T et al., "Safety of Bifidobacterium animalis subsp. lactis (B. lactis) strain BB-12®-supplemented yogurt in healthy children," J Pediatr Gastroenterol Nutr., vol. 64, no. 2, pp. 302-309, 2018.
11. Eskesen D et al., "Effect of the probiotic strain Bifidobacterium animalis subsp. lactis, BB-12®, on defecation frequency in healthy subjects with low defecation frequency and abdominal discomfort: a randomised, double-blind, placebo-controlled, parallel-group trial," British Journal of Nutrition , p. doi:10.1017/S0007114515003347, 2015 .
12. Nishida S et al., "Effect of Yoghurt Containing Bifidobacterium lactis BB-12® on Improvement of Defecation and Fecal Microflora of Healthy Female Adults," Milk Science , vol. 53, no. 2, pp. 71-80, 2004.
13. Zhang S et al., "Facing a new challenge: the adverse effects of antibiotics on gut microbiota and host immunity," Chin Med J (Engl)., vol. 132, no. 10, pp. 1135-1138, 2019.
14. Evans M et al., "Effectiveness of Lactobacillus helveticus and Lactobacillus rhamnosus for the management of antibiotic-associated diarrhoea in healthy adults: a randomised, double-blind, placebo-controlled trial," British Journal of Nutrition, vol. 16, no. 1, pp. 94-103, 2016 .
15. Thaiss C et al., "The microbiome and innate immunity," Nature, vol. 535, pp. 65-74, 2016.
16. Cazzola, "Efficacy of a synbiotic supplementation in the prevention of common winter diseases in children: a randomised, double blind, placebo-controlled pilot study," Therapeutic advances in respiratory disease, vol. 4, no. (5), pp. 271-8, 2010.
17. "Asthma UK," [Online]. Available: https://www.asthma.org.uk/about/media/facts-and-statistics/. [Accessed 7 September 2020].
18. Fujimura K et al., "Microbiota in Allergy and Asthma and the Emerging Relationship with the Gut Microbiome," Cell Host and Microbe , vol. 17, no. 5, pp. 592-502, 2015.
19. Stojkovic A et al., "CLinical trial (consort compliant): Optimal time period to achieve the effects on synbiotic- controlled wheezing and respiratory infections in young children," Serbian journal of management , vol. 144, no. (1-2), pp. 38-45, 2016.
20. Miraglia del Giudice M et al., "Airways allergic inflammation and L. reuterii treatments in asthmatic children," J. Biol Regul. Homeost Agents, vol. 26, pp. 35-40, 2012.
21. Van der Aa et al., "Synbiotics prevent asthma-like symptoms in infants with atopic dermatitis," Allergy , pp. 170-177, 2011.
22. Pascal M et al., "Microbiome and Allergic Diseases," Front Immunol, vol. 8, p. doi: 10.3389/fimmu.2018.01584, 2018.
23. Salameh M et al., "The role of gut microbiota in atopic asthma and allergy, implications in the understanding of disease pathogenesis," Scandinavian Journal of Immunology , vol. 91, no. 3, p. https://doi.org/10.1111/sji.12855, 2019.
24. Piirainen L et al., "Effect of Lactobacillus rhamnosus GG on rBet v1 and rMal d1 specific IgA in the saliva of patients with birch pollen allergy," Annals of Allergy Asthma Immunology, vol. 100, no. 4, p. 338, 2008.
25. Ouewehand A et al., "Specific probiotics alleviate allergic rhinitis during the birch pollen season," World J Gastroenterol., vol. 15, no. 26, p. 3261–3268., 2009.
26. Vuong H et al., "Emerging Roles for the Gut Microbiome in Autism Spectrum DisorderThe microbiome in ASD," Biological Psychiatry, vol. 81, no. 5, pp. 411-423, 2017 .
27. Grimaldi R et al., "A prebiotic intervention study in children with autism spectrum disorders (ASDs)," Microbiome, vol. 6, p. 133, 2018 .
28. J. K. T. Z. D. e. a. Suez, " Artificial sweeteners induce glucose intolerance by altering the gut microbiota.," Nature, vol. 514, pp. 181-186, 2014.