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Probiotics for Children
Some probiotics appear to be safe and
appropriate for children, if adequate caution is
used in administration. The introduction of
genetic changes to various probiotic species has
caused difficulty in keeping the safer strains
separated from lesser-known strains, at least in
terms of a public image. Although particular
laboratories may work hard to promote their own
synthetic probiotic strains, or "symbiotics," it
is unknown how humans will react to some of the
less familiar probiotic and prebiotic products.
However, with regard to children's health, there
are some major success stories concerning
specific probiotic strains that have met the
standard of repeated scientific studies on
animals and humans. Lactobacillus Reuteri, or "L
Reuteri," and Bifidobacteria Lactis (B Lactis)
are two such rising stars, both of which are now
recommended to children by pediatricians on a
regular basis for the relief of gastroenteritis.
Other claims regarding the immune benefits of
probiotics, such as the reduction of respiratory
infections in children, have received mixed
reviews in the academic and scientific
literature.
A 2002 university study of infant rhesus monkeys
produced very positive results for L Reuteri as
an effective additive to infant formula. This
study sought to find out whether the
introduction of L Reuteri would have beneficial
effects on infant health, assist with microflora
colonization in the gut, and help with resisting
infectious disease. Infant monkeys were fed
control infant formula, control formula with L.
Reuteri or control formula
with L Reuteri and supplemental zinc from birth
to four months. Many indicators of health were
monitored, including the monkeys' growth,
nutritional status, mineral absorption,
intestinal colonization of helpful bacteria, and
frequency and severity of enteropathogenic
gastroenteritis. Gastroenteritus was
deliberately induced in some of the subjects by
the introduction of E coli cultures, in order to
study the recovery ability that might be
increased or decreased with a probiotic
supplement.
The result of this rhesus monkey study was that
gastrointestinal L Reuteri colonization was
achieved with no adverse effects on growth or
nutrition. Infant monkeys fed with the L
Reuteri-supplemented formula exhibited reduced
diarrhea severity throughout the study period
and recovered more rapidly from acute diarrhea
than the other groups. The study concluded that
L Reuteri supplementation of infant formula is
safe and beneficial to infant rhesus monkeys,
which have many genetic similarities to human
infants. The probiotic-supplemented formula was
found to benefit recovery from gastroenteritis,
improve iron levels, and decrease the severity
of diarrhea. The study concluded that human
infants might receive similar benefits from L
Reuteri, given the positive results with rhesus
monkeys.
In 2005, researchers from Ben-Gurion University
in Beer-Sheva, Israel, examined whether a
formula supplemented with a particular probiotic
strain could help reduce respiratory and
gastrointestinal infections in infants attending
child care. This study was notable for its large
number of participants and a long period of
observation: 21 months. Over 200 healthy infants
and toddlers between the ages of four months and
ten months participated in this study. All of
them had been weaned from breast milk to formula
and all of them attended child-care centers in
Israel. Each infant was randomly assigned to
receive one of three infant formulas. The three
control groups consisted of a standard cow's
milk infant formula, the same formula
supplemented with the probiotic Bifidobacterium
lactis (B Lactis), and the same formula
supplemented with the probiotic L Reuteri.
At several points in the Israeli daycare study,
the infants' heights, weights, and head
circumferences were measured. Researchers
measured stool samples to check for the presence
of harmful bacteria, such as the species that
tend to cause diarrhea. Parents completed daily
questionnaires about their children's health and
habits during the study period of almost two
years. The parental questionnaire information
asked about indicators of respiratory and
gastrointestinal health, such as runny nose,
cough, shortness of breath and gastrointestinal
symptoms. Parents were also asked about general
behaviors in their children, such as eating
patterns and stool habits.
The conclusions of the Israeli study found that
infants who were fed the unsupplemented formula
had more frequent high fevers, compared to the
infants fed formula with either L Reuteri or B
Lactis. The children receiving the
unsupplemented formula experienced diarrhea more
often and for longer periods, compared to those
receiving the probiotic-supplemented formula.
The L Reuteri group showed better results than
both other control groups with regard to a
reduced number of days of sustained high fever,
lower number of clinic and doctor visits, and
fewer absences from child care.
In this daycare study, the group who consumed L
Reuteri in their formula also needed fewer
antibiotic prescriptions during the study
period. However, with regard to respiratory
infections, the three groups did not differ in
the frequency and severity of illness; the
infants taking the two probiotic supplements and
those taking the unsupplemented formula had the
same rate of respiratory infections. Although
many health indicators were improved with the
probiotic formula, the L Reuteri and B Lactis
supplements could not claim a significant
benefit in the area of respiratory infections
among the 200+ infants included in the study.
For the stage known as early infancy (from the
age of birth to four months old), another
Israeli study conducted by the same team
examined the effects of probiotic-supplemented
formula at this first stage of life. This was a
randomized, placebo-controlled trial conducted
within the clinics of the Soroka Medical Center
in Beer-Sheva Israel for a period of four weeks,
during 2006. Only full-term healthy infants were
included, so the results cannot be generalized
to preterm or premature babies. The study was a
comparison of the safety and tolerance of two
formulas supplemented with different probiotic
agents. Fifty-nine infants were randomly
assigned to one of three formulas, including a
control group with a standard milk base and no
probiotics added. The other two groups of
infants received formulas supplemented with
either Bifidobacterium Lactis (BB-12) or
Lactobacillus Reuteri (ATCC 55730).
The indicators of a healthy outcome which were
measured throughout the early infancy study
included rate of growth, daily characteristics
of feeding, stool habits, behavior, and side
effects. The patients in all three groups were
comparable at the start of the study with regard
to gestational age, birth weight, sex, growth
parameters, and their previous breast-feeding
rate before the study. The supplemented formulas
were well-accepted and did not reveal any
adverse effects. Upon comparison of growth
parameters, variables of feeding, stool habits,
crying, and irritability, the subjects revealed
no statistically significant differences between
the control group versus the groups receiving
probiotic fortification in their formulas. This
pilot study concluded that the use of L Reuteri
and B Lactis in infant formula, even for the
ages of four months and younger, was safe and
well-tolerated.
With the increased standardization of particular
bacterial strains over the past decade, the use
of probiotics for infants and children becomes
better understood. When a definite nomenclature
and international labelling standards are set
for particular sub-strains of bacteria, the
risks of exposure to an unknown or unsafe
product will be further reduced. Many scientific
studies support the use of specific probiotic
sub-strains for the early stages of life, where
those sub-strains are well-identified and where
patients are monitored closely for adverse
reactions. However, the manufacturers of
microflora supplements will need to uphold high
standards in order to bring the full theoretical
potential of probiotics into safe and
well-tolerated food and beverage products for
children. Especially in the area of reducing
gastroenteritis, L Reuteri and B Lactis have
demonstrated the potential for widespread
food-grade uses. If the most beneficial
sub-strains of these species are fully
catalogued, controlled, advertised, and labelled
with integrity, they may offer significant
health benefits to children and infants.
References:
-Shannon L. Kelleher, Ivan Casas, Noris Carbajal,
and Bo Lonnerdal. "Supplementation of Infant
Formula With the Probiotic Lactobacillus reuteri
and Zinc: Impact on Enteric Infection and
Nutrition in Infant Rhesus Monkeys."
Department of Nutrition, University of
California, Davis, California, and Biogaia
Biologics, Raleigh, North Carolina. Journal of
Pediatric Gastroenterology and Nutrition.
35:162–168, August 2002.
-"Probiotic Formula Reduces Diarrhea in Infants
Attending Child-Care Centers." Zvi Weizman, MD;
Ghaleb Asli, MD; Ahmed Alsheikh, MD; Pediatrics,
January 2005. Reviewed by: Steven Dowshen, MD
for the Nemours Foundation/Kids Health, February
2005.
- Zvi Weizman, MD, FACN and Ahmed Alsheikh, MD.
"Safety and Tolerance of a Probiotic Formula in
Early Infancy Comparing Two Probiotic Agents: A
Pilot Study." Pediatric Gastroenterology and
Nutrition Unit, Soroka Medical Center, Faculty
of Health Sciences, Ben-Gurion University, Beer-Sheva,
Israel. Journal of the American College of
Nutrition, Vol. 25, No. 5, 415-419 (2006).
Published by the American College of Nutrition.
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