Childrens’ Probiotics: To Immunity and Beyond

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It’s no secret that Americans are in tune with the benefits of probiotics. According to the Council for Responsible Nutrition’s 2016 Annual Survey on Dietary Supplements, probiotics are among the most popular of supplements, with 13% of supplement consumers choosing them. And while about 71% of American adults overall take some kind of dietary supplement, an even higher percentage of adults shop the supplement aisle if they have kids at home. So, what happens when you pair probiotics’ popularity with parents’ increased interest in supplements? A booming market for children’s probiotics. 

According to John Deaton, PhD, vice president of science and technology at Deerland Enzymes & Probiotics (Kennesaw, GA), the rise in popularity of probiotics for children stems partially from parents’ interest and partially because more and more pediatricians are recommending probiotics for kids. As a result, the market is responding with a range of supplements. 

“Probiotics for infants and children come in all kinds of forms-flavoring, serving size, and mode of delivery are important considerations,” Deaton says. “For infants, there are infant formulas that already contain probiotics, powdered probiotics that can be added to milk or formula, and drops. Toddlers and older children have even more options for getting their probiotics. Chewable tablets, yogurt, drinks, gummies, and even special straws that are coated with probiotics are popular delivery systems for kids.”

While it’s true that a great deal of innovation in children’s probiotics lies in the creative deliveries hitting shelves, this is merely a symptom of the fact that the market for these types of supplements is growing by the day. And it’s all thanks to new research that supports probiotics’ efficacy for a number of health issues impacting children.

Immunity and Gut Health 

“One of the main driving factors in probiotic-fortified children’s products is immune health,” says Michael Bush, president and CEO of Ganeden Inc. (Mayfield Heights, OH), which markets its Ganeden BC30 Bacillus coagulans probiotic strain. 

“Seventy percent of the immune system is located in the digestive tract, and immune health in children can be compromised by factors such as antibiotics,” Bush says. “Taking a daily probiotic helps support children’s immune systems and is becoming more popular as a preventative measure.”

One recent study from Probi (Lund, Sweden) investigated the effects of probiotic supplementation in children prescribed antibiotics and found that those who previously encountered antibiotic-associated gastrointestinal symptoms like loose and watery stools benefited from taking a probiotic as compared to the placebo group.

“Antibiotic use is considered among the most severe causes of disturbance to children’s developing intestinal microbiota and frequently causes adverse gastrointestinal effects ranging from mild and transient diarrhea to life-threatening infections,” explains Ralf Jager, PhD, scientific advisor at Pharmachem Laboratories (Kearny, NJ). As a result, this specific immune application for probiotics has been a growing area of research.

Just recently, a study¹ investigated the influence of long-term Lactobacillus rhamnosus GG intake on preschool children as well as on 231 children aged 2-7 with antibiotic-associated gastrointestinal complaints. “The results show that long-term L. rhamnosus GG supplementation has an influence on the composition of the intestinal microbiota in children, causing an increase in the abundance of Prevotella, Lactococcus, and Ruminococcus [bacteria], and a decrease in Escherichia [bacteria],” Jager says. The treatment appeared to prevent some of the changes in the microbiota associated with penicillin use, he adds, and reduce the frequency of gastrointestinal complaints. “Finally,” he says, “the treatment appeared to prevent certain bacterial infections for up to three years after the trial, as indicated by reduced antibiotic use.”

Probiotics’ impact on children’s gastrointestinal health is also supported by another recent study, which examined the effects of probiotics on the symptoms of children with irritable bowel syndrome (IBS)². Researchers randomized 71 children between the ages of four and 16 years who were diagnosed with IBS to receive either probiotics (Bifidobacterium lactis B94), a prebiotic (900 mg inulin), or a synbiotic treatment of the probiotic and inulin. The probiotic and synbiotic treatments were found to improve a variety of symptoms (belching and abdominal fullness, bloating after meals, mucus in the feces, and constipation). The synbiotic treatment specifically caused a significantly higher percentage of patients to achieve full recovery than the prebiotic treatment group. Ultimately, the researchers recommend twice daily administration to treat children with IBS.

Beyond the Gut

While immunity and gut health still represent the most common areas for which probiotics are used in children, they aren’t the only ones. Emerging research supports probiotics for a range of associated conditions, from allergies to oral health.

BLIS K12, an ingredient from Stratum Nutrition (Carthage, MO), was recently the subject of a study³ surrounding incidence of group A beta-hemolytic streptococci (GABHS) infections, which can cause recurrent pharyngo-tonsillar infections, in children. “The results of this study demonstrated that, when compared to untreated children, those taking BLIS K12 had significantly fewer GABHS infections both during the 90-day period of prophylaxis and during the following nine months,” says Stratum Nutrition’s technical services manager, Nena Dockery.

Another recent study⁴ provided additional substantiation of BLIS K12’s benefits in reducing the occurrence of streptococcal pharyngo-tonsillitis (PT) and acute otitis media (AOM). “This study was somewhat different from other similar clinical trials in that the children were not susceptible to upper respiratory infections,” says Dockery. “However, they were children attending the first year of kindergarten, providing an environment of increased exposure to these common childhood infections.” 

This trial examined 222 otherwise healthy male and female children around three years of age. One group was given probiotic treatment; the other served as the untreated control. At the end of the six-month intervention period, diagnoses of streptococcal PT and AOM in the control group reached 54 children (49%) and 89 children (80%), respectively; in the probiotic group, just 18 children (16%) were diagnosed with streptococcal PT, and 49 children (44%) were diagnosed with AOM.

Since BLIS K12 is a bacterial species commonly found in the oral cavity of healthy individuals, it’s clear that supporting a healthy biome in the oral cavity can have implications for not only oral health but upper respiratory health.

Tangential to immune and gut health is allergy management. And some research shows that probiotics may have a role to play when it comes to kids’ allergies.

“Cow’s milk protein intolerance or allergy is among the earliest and most common food allergic disease of infancy,” says Jager. “Yet, its pathophysiology is not well understood.” According to one recent study⁵, the symptoms of four clinically diagnosed cases quickly and completely resolved with probiotic Lactobacillus rhamnosus GG administration. All four infants avoided any dietary restrictions, and the range of time from probiotic initiation to symptom resolution was seven to 28 days.

Similarly, another study⁶ showed that probiotics co-ingested with hydrolyzed protein may increase tolerance to food allergens. Infants aged one to 12 months with cow’s milk allergies received extensively hydrolyzed casein with or without Lactobacillus rhamnosus GG for six months. Oral food challenge 12 months after treatment showed that 42% in the L. rhamnosus GG group developed tolerance to cow’s milk, in comparison to none of the children in the casein-only group.

Going forward, the future looks bright for probiotics and their implications for children’s health. “We know from research that parents don’t like to give their children medicine, and we’ve also seen that parents are willing to give their children natural supplements that support health in the hopes their children will need less medicine,” says Megan DeStefano, global probiotics marketing leader for DuPont Nutrition & Health (Madison, WI). “I think these desires linked with probiotics trends definitely open the door for new product innovation.”

And if you ask Gun-Britt Fransson, vice president of research and development at Probi, the explosion of research in this area will only continue to boost the market: “With documented health benefits, it becomes possible to specifically target individual health indications, as well as target special groups of consumers. We believe the market for probiotics targeting children will grow significantly as research activities within this age group are drastically increasing.”  

Sidebar: Can Prebiotics Address Childhood Obesity?

According to the World Obesity Federation, 200 million school-aged children are overweight. This number is estimated to jump to 268 million by 2025; of these children, a whopping 91 million will be obese.

But new research shows that prebiotics may have a role to play in the childhood obesity epidemic. One recent study showed that oligofructose-enriched inulin may improve appetite regulation and decrease food intake in overweight and obese children.⁷

The 16-week study included 42 overweight and obese children between the ages of 7 and 12 and was conducted using Beneo’s (Morris Plains, NJ) Orafti Synergy1 prebiotic inulin. “Results illustrated that children given 8 g daily of Orafti Synergy1 supplementation had significantly higher ratings in their feeling of fullness and satisfaction, and a lower prospective food consumption,” says Anke Sentko, president of regulatory affairs and nutrition communication at Beneo. Further, fasting levels of ghrelin (the satiety hormone) increased at 16 weeks with prebiotics, as compared to placebo.

These findings show that supplementing with prebiotics could indeed play a role when it comes to fighting the obesity epidemic in children, says Sentko: “Considering that major lifestyle changes to treat overweight and obesity in children are most of the time unsuccessful, these studies confirm that prebiotic chicory root fibers become part of the solution in the battle against overweight and obesity.”

Also read:

Children’s Dietary Supplements

Trends in Healthy Kids Products

High-Priority Nutrients for Kids

References:

1. Korpela K et al., “Lactobacillus rhamnosus GG intake modifies preschool children’s intestinal microbiota, alleviates penicillin-associated changes, and reduces antibiotic use,” PLoS One. Published online April 25, 2016.
2. Basturk A et al., “Efficacy of synbiotic, probiotic, and prebiotic treatments for irritable bowel syndrome in children: A randomized controlled trial,” The Turkish Journal of Gastroenterology, vol. 27, no. 5 (September 2016): 439-443
3. Gregori G et al., “Reduction of group A beta-hemolytic streptococcus pharyngotonsillar infections associated with use of the oral probiotic Streptococcus salivarius K12: a retrospective observational study,” Therapeutics and Clinical Risk Management, vol. 12 (January 2016): 87–92
4. Di Pierro F et al., “Effect of administration of Streptococcus salivarius K12 on the occurrence of streptococcal pharyngo-tonsillitis, scarlet fever and acute otitis media in 3 years old children,” European Review for Medical and Pharmacological Sciences, vol. 20, no. 21 (November 2016): 4601-4606
5. Martin VJ et al. “Presumed allergic proctocolitis resolves with probiotic monotherapy: a report of 4 cases,” The American Journal of Case Reports, vol. 17 (August 29, 2016): 621-624
6. Berni Canani R et al., “Lactobacillus rhamnosus GG-supplemented formula expands butyrate-producing bacterial strains in food allergic infants,” The International Society for Microbial Ecology Journal, vol. 10, no. 3 (March 2016): 742–750
7. Hume MP et al., “Prebiotic supplementation improves appetite control in children with overweight and obesity: a randomized controlled trial,” The American Journal of Clinical Nutrition, vol. 105, no. 4 (April 2017): 709-799