Probiotics and their use with children
Probiotic – the word literally means "for life". Another meaning for "biotic" may be bacteria and when we speak of probiotics, we are referring to the "good" bacteria that live in our digestive systems.
In recent years our awareness of the importance of probiotics has increased. There has been the clever television advertising of a certain brand and with increasing research and promotion by manufacturers, most Doctors and Pharmacists now promote their use after a course of antibiotics. You see, unfortunately antibiotics will tend to wipe out ALL bacteria – both the pathogenic for which they are prescribed and the good!
But how many of you are aware of the many other uses of probiotics, in helping to manage other conditions and their role in the immune system? I would like to focus here on the importance and benefits of probiotics for children, in giving them their best start in life.
But firstly let’s cover a little background information on these good little bugs! Probiotics tend to fit into two main groups – Lactobacillus and Bifidobacteria – and there are many species in each group - see Table 1. Another strain sometimes seen is Streptococcus thermophilus. Something to note at this point is that many people just say "Oh you need some acidophilus" referring to all probiotics, but as you can see it is really only one species of many!
Different strains have different actions, so it can not be assumed that L. rhamnosus will necessarily do the same as L. acidophilus.
TABLE 1
Many people ask if they can just use yoghurt? Well, there is yoghurt and then there is yoghurt with probiotics, so you really need to go for the right stuff and make sure you read the label. A good yoghurt will usually be of the plain variety, with the probiotic strains listed on it and no added sugar. Have a look at Valia, Bornhoffen and Jalna as some good examples. Yoghurts tend to be better to use for general day-to-day health, but usually after antibiotics or in some conditions, the more therapeutic levels of a potentised supplement are required.
A good probiotic will have the following characteristics:
• Able to survive digestive secretions such as stomach acid and bile salts
• Ability to adhere to intestinal wall or lining and
• Ability to colonise the intestinal tract (ie: stay and multiply)
They should generally be stored in the fridge but most manufacturers will put in an "overage" so you are guaranteed to get at least what is labelled and most can be kept out of the fridge for a certain time if kept under 30C. Look for numbers in the billions as these are the amounts needed to generate the therapeutic effects.
Birth
The first time a child has exposure to probiotics is during the birth process. The child will pick up a healthy dose of Bifidobacteria from the mother on its passage through the birth canal. Bifidobaterium infantis is the major probiotic to inhabit the bowels of babies up until weaning at the approximate age of 6-12 months.
If the mother herself is deficient in probiotic bacteria or if the birth is caesarian, you can see how the child may not get that important first pickup. Breast-feeding passes on good bacteria to the child, bad bugs like E. coli are more prevalent in formula fed children. It is possible to get probiotic supplements for babies with just the Bifidobacterium infantis in them.
Adequate probiotics in the first few months of life are required to set up and maintain a good gastrointestinal barrier and we will see why this is so important.
Immunity, Candida & Leaky Gut Syndrome
Probiotics are very important for setting up a good gastrointestinal barrier. Did you know that a very large component of our immune system resides in our gut and this is one of our main barriers to pathogens and foreign particles from the outside environment?
The cells lining the digestive tract are tightly woven together keeping large molecules, bacteria and toxins out but allowing smaller food constituents through into our blood stream. Proteins and carbohydrates can’t fit through but the amino acids and the simple sugars like glucose, they break down to, can.
Certain things can damage this closely woven barrier and create larger spaces for larger food particles and pathogens to fit through – imagine the gut wall is like a mesh sieve but if it gets a hole in it, it can let anything through. X-rays and repeated antibiotics can do this by various mechanisms and one of the ways is by killing off the army of good guys and letting the bad guys such as Candida Albicans grow unchecked. Candida sets down its roots in the gastrointestinal wall and makes the holes bigger. This is called increased intestinal permeability or "leaky gut syndrome".
This can be one of the factors behind food allergy or sensitivity. Now things like whole proteins can get through and because the immune system that resides in the gut wall does not recognise them, it sets up an immune reaction. When the bad guys grow out of control and there are not enough good guys, this is called "dysbiosis".
While immunology and food intolerance/allergy is a very complex area and I am in no way saying that it is all to do with dysbiosis and leaky gut, this is a major area of consideration, especially in the age of easy prescribing of antibiotics to children, poor dietary practices and increasing food intolerances.
Leaky gut, dysbiosis & eczema
Many don’t realise it, but eczema is actually an allergic condition and really needs to be treated from within as well as with soothing creams and washes. Its proper name is atopic dermatitis and "atopic" means allergic. Eczema now affects 18% of children under two, up from only 2% 20 years ago. Childhood eczema is almost always a food allergy and many parents do not relate the horrible itchy rash covering their child to what he or she may be eating and complain that without suppressive cortisone creams, it does not resolve.
One of the main food groups to cause eczema and other food related allergic symptoms is dairy (milk, cheese, icecream, cream etc) but other common foods are wheat, eggs, soy, corn, chocolate, peanuts, shellfish, fish, citrus, sugar and yeast. Several studies have shown promising results using Lactobacillus Rhamnosus but another using L. fermentum provided inconsistent results. This shows that using the right strain for the job is important.
Did you know that Lactobacillus is able to produce its own lactase? Lactase is the enzyme required to digest lactose, the sugar in dairy foods; so probiotics can actually help one to digest lactose better. This is good to know because most of us really only produce sufficient quantities of lactase as babies and young children and make less and less of it as we age. Lactose intolerance is not a dairy allergy – dairy allergy is to the casein which is the protein component in milk products and is much less common.
Infectious Diarrhoa & Gastroenteritis
Probiotics can both prevent and help to treat infectious diarrhoea. A study used a combination probiotic along with Zinc in a group of 65 children under two. It resolved the vomiting and diarrhoea within 1.5 days with only one child having any watery stools at all by the third day, as compared to 10 in the control group who had no probiotics.
In an analysis of 20 studies involving 2,685 patients there were no reports of any major side effects from taking probiotics and it found that they were more effective in reducing diarrhoea in children who had been infected with rotavirus. Several studies showed benefits of probiotics against antibiotic induced and travellers diarrhoea.
Antibiotic Resistance & Otitis Media
There has been a shift in the patterns of childhood illnesses over the last 20 years, with past illnesses being replaced with chronic recurrent otitis media, asthma, eczema and food allergies. Otitis media (OM) is a middle ear infection and children with OM are often prescribed antibiotics, which are often ineffective. This can be a vicious cycle! OM often involves increased mucous production due to a food allergy. As the antibiotics further deplete the gastrointestinal flora, the propensity for allergies and intolerances is increased, therefore perpetuating the middle ear infections if they are due to a suspect food.
Summary
So as you can see, Probiotics are an essential part of life and there are many factors that can interfere with them. It is interesting to think about whether there would be so many food sensitivities, ear infections, skin problems and cases of diarrhoea if all children were given a healthy dose of probiotics at birth as par for the course?
In the meantime we need to educate ourselves and try to do our best! So mothers taking probiotics during their pregnancies, having natural births, breastfeeding for the first six to twelve months and not giving children cows milk until at least one year old is a good start and there is always supplementation readily available in your Pharmacies and Health Food Stores if need be.
Perhaps it is worth considering a supplement for your child if he or she has any of the mentioned health problems, but of course consult your Healthcare Professional as probiotics may not be the only answer and other medication may be required.
Sara Hopkins is a Naturopath who has worked in the Complementary Medicine industry for the past 8 years, including Pharmacy, Health Foods and Clinical Practice. She has a Bachelor of Health Science and currently works for one of Australias leading Complementary Medicine manufacturers in Customer Support, Technical Research and Writing.
References available on request.