- The Review Course in Family Medicine
When Should You Consider Probiotics in Your Paediatric Population?
Probiotics are live microorganisms that when consumed in sufficient quantities, can have beneficial health effects.
Here are 10 use cases for your practice:
Neonatal sepsis: While single-strain probiotics have no benefit, multi-strain probiotics can reduce mortality risk in pre-term and low birth weight infants with sepsis.
Necrotizing Enterocolitis (NEC): Probiotics can reduce NEC incidence in preterm neonates >1000g, but do not impact NEC mortality.
Neonatal feeding: Probiotics cannot improve weight gain but may reduce time to enteral feed and feeding patterns.
Infantile colic: Lactobacillus reuteri is effective in relieving Infantile colic symptoms.
Cow’s milk protein intolerance (CMPI): Some children develop tolerance faster with probiotic supplementation, but the evidence is insufficient.
Antibiotic-associated diarrhea (ADD): High dose probiotics (≥5 billion colony-forming unit/day) are effective at preventing AAD.
C. Diff associated diarrhea (CDAD): probiotics reduce incidence of CDAD in infants with >5% baseline risk, but do not have a role in treating established CDAD.
H. Pylori: Probiotics alongside triple therapy allows for better eradication and fewer adverse effects than triple therapy alone. However beware the pitfalls of testing for H. Pylori in pediatric patients.
Functional gastrointestinal disorders: Lactobacillus sp. can improve abdominal pain related to FGIDs, especially IBS.
Atopic disease: probiotics can prevent atopic dermatitis and eczema, but limited evidence for asthma and allergic rhinitis.
References: Rilla Schneider MD, Ana Sant’Anna MD; Canadian Paediatric Society, Nutrition and
Gastroenterology Committee. Paediatr Child Health 2022 27(8):482–491.