Probiotics In Children: The Scientific Evidence

Professor Simon ATEGBO

The beneficial role of probiotics has been suspected for centuries. In relation to children, this includes the studies by Tissier, a Parisian doctor who in 1900 drew attention to the possible relationship between the presence of bifidobacteria in the feces of a child and the first signs of severe diarrhea. A prospective comparison of children who are breastfed and those on infant formula during a rotavirus epidemic showed that the disease was less severe in the children who were breastfed [1].The breastmilk protected against diarrhea through a microbiota dominated by bifidobacteria, and the repression of other anaerobic bacteria [2].

Numerous research papers have shown the narrow interrelationship between the microbiota and the host. The microbiota exercise multiple functions such as metabolic activities (including fermentation); a barrier effect against pathogenic microorganisms; development and maturing of the immune system; effects on the movement and absorption of the colon; which all relate to physiological functioning. The microbiota is also protective during specific disease conditions and is therefore a major biotope indispensable in the maintenance of optimal digestive and immune functions. It therefore ought to be protected against any alteration of its equilibrium and can even be positively modulated to enhance protective effects [3].

The term “probiotics”, proposed by Fuller, defines nonpathogenic microorganisms, that once ingested in adequate quantities, remain alive during intestinal transit and settle in sufficiently to modify the intestinal flora and have a proven beneficial effect on the health of the host [4]. These are bacteria or yeasts characterized by the type (Lactobacillus, Bifidobacterium, Saccharomyces) and strain. The effects of probiotics have been proven in the treatment of severe diarrhea [5], the prevention of diarrhea associated with antibiotics [6], colitis, or inflammation of the colon by Clostridium difficile [7], food allergies, atopic or hypersensitivity dermatitis [8,9], the prevention of necrotizing ulcerous entero-colitis [10], infantile colic [11], inflammatory bowel disease, constipation, the treatment of Helicobacter pylori [12].

The effect of probiotics in these different disease conditions depends on the strain, the dose (108 or 109 cfu) and the mixing of several strains or types. The interpretation of the rather abundant research data on probiotics must take into account this notion while avoiding certain extrapolations. The results of meta-analyses are more significant. The effectiveness of probiotics, though sometimes quite modest, must not bar the question of their safety as medicine or food, including fermented mild products and enriched milk. The risk of bacterial translocation (sepsis, hepatic abscess) is rare but has been described with immuno-compromised patients. Globally, tolerance is quite satisfactory. Probiotics has also proven to be beneficial in preterm babies, particularly those at risk for anomalies of the intestinal flora and immune development. Proof is growing in favor of the safety of their use with preterm babies weighing more than 1000g [13, 14]. Lactobacillus reuteri improves gastric emptying, and increases food tolerance in preterm babies [15]. In this population it has been proven henceforth that the combining of several strains of probiotics in a preparation is more effective than the use of a single strain of probiotics [16]. In certain formulations, probiotics are positively associated with prebiotics ( FOS, GOS, Inulin) , the concept known as symbiotics.

References

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