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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