Writing in Pediatrics, Dan Thomas, MD, and Frank Greer, MD and the AAP’s Committee on Nutrition; Section on Gastroenterology, Hepatology, and Nutrition report that clinical trials have provided ‘encouraging’ but ‘preliminary’ evidence for a range of benefits, including treatment of childhood Helicobacter pylori gastritis, IBS, and infantile colic.
There was also evidence potentially preventing childhood atopy, wrote the pediatricians, but “require further confirmation”.
“Important questions remain in establishing the clinical applications for probiotics, including the optimal duration of probiotic administration as well as preferred microbial dose and species,” wrote the committee.
“The long-term impact on the gut microflora in children is unknown. It also remains to be established whether there is significant biological benefit in the administration of probiotics during pregnancy and lactation, with direct comparison to potential biological benefit derived from probiotic-containing infant formulas.
“Similar questions exist for the use of prebiotics,” they added.
According the FAO/WHO, probiotics are defined as "live microorganisms which when administered in adequate amounts confer a health benefit on the host".
Prebiotics are "nondigestible substances that provide a beneficial physiological effect on the host by selectively stimulating the favourable growth or activity of a limited number of indigenous bacteria".
The new review, available here, also notes that there is “some evidence that probiotics prevent necrotizing enterocolitis in very low birth weight infants”, but again more research was called for to further substantiate the potential benefits.
The reviewers also raised concerns regarding probiotics for infants and children with weaked immune systems, or for those who are seriously ill.
Regarding prebiotics, the reviewers note that human breast milk contains substantial quantities of the fibers, and while there may some “long-term benefit of prebiotics for the prevention of atopic eczema and common infections in healthy infants” there currently exists a “paucity of RCTs examining prebiotics in children”.
“Addition of oligosaccharides as prebiotics to infant formula is not unreasonable but lacks evidence demonstrating clinical efficacy at this time. Cost/benefit studies are also necessary to support their addition to infant formulas,” they added.
Published online ahead of print, doi: 10.1542/peds.2010-2548
“Clinical Report—Probiotics and Prebiotics in Pediatrics”
Authors: D.W. Thomas, F.R. Greer
The full article can be accessed here.