Probiotics for Babies: What Do We Know?

If you Google probiotics for babies you will get hits like “10 Best Probiotics for Your Baby!” The term Probiotics means for life, and most people assume probiotics must be good for everybody, including babies. The truth is that the scientific jury on probiotics is still out.

The theory behind probiotics is simple. We have lots of bacteria in our gut, called our microbiome. Some are healthy bacteria and some are not. Adding good probiotic bacteria, shifts the balance toward better health.

We know that the gut microbiome in infants plays a huge role in developing a healthy body defense system, the immune system. In developed countries, diseases of the immune system in children like allergies, inflammatory diseases, and immune system diseases are on the rise. Many researchers believe an unhealthy microbiome in infancy is the cause.

Probiotics for Premature Infants

Because premature infants do not have a developed microbiome, they are at risk for a life-threatening gut infection called necrotizing enterocolitis. Probiotics have been added to breast milk or formula to prevent this condition. Some neonatal intensive care units use probiotics in these infants, and some studies show that probiotics increase survival.

In 2020, a review of 56 studies on probiotics for pre-term infants found that there was little consistency on the dose or the type of probiotics used. This points out one of the major problems with studying or using probiotics. They are very complicated. Success depends on the type and the dose, and it may not be the same for every baby or every condition. The 2020 review found that evidence for benefits was low, and more trials were needed.

Probiotics for Infant Formula

Many infant formulas now include probiotics. The most common types of probiotics are Bifidobacterium and Lactobacillus. According to the American Academy of Pediatrics (AAP), some research has found that probiotics may reduce a baby’s risk for infectious diarrhea, atopic dermatitis, asthma, urinary tract infections, and colic. But AAP says the evidence for these benefits is limited and only lasts as long as the probiotics are given.

For example, take infantile colic. It is a condition that can bring parents to tears. Gas, belly pain, and distention can cause inconsolable crying that starts after 2 weeks and may continue for 3 months. It can happen in both breast and bottle-fed babies. Lots of studies have been done to see if probiotics help, but no consistent results have been found. A review of studies found probiotics was no better than a placebo.

Probiotics Added to Breastfeeding

Breastfeeding is generally considered better for gut health than formula, but researchers from University of California have discovered that babies fed exclusively with breast milk may develop an unhealthy microbiome.

The reason is a gradual decline in gut bacteria called B. infantis, a subspecies of Bifidobacterium. B. infantis have been decreasing due to antibiotic use, C-sections, and formula feeding. B. infantis is the only bacteria that can break down a sugar in breast milk called human milk oligosaccharides (HMOs). If HMOs are not broken down, they are eaten up by unfriendly bacteria, which produce toxic molecules that may be damaging to the immune system.

The good news is that once the researchers learned the right probiotic to use, adding it to breast milk feedings established healthy numbers of B. infantis. Unlike other probiotics that die off as soon as they are stopped, B. infantis survives. These encouraging findings are published in the journal Pediatric Research. Infants were given B. infantis along with breast milk for 28 days after birth and followed for up to 12 months. At 12 months, the babies still had B. infantis as part of their microbiome. This study shows that when you use the right probiotic for the right reason, the benefits might be there.

Bottom Line on Probiotics for Infants and Babies

Americans will spend over 6 billion dollars on probiotics this year. Probiotics are now the third most common supplement used by Americans after vitamins and minerals. However, the benefits of probiotics for babies are similar to benefits of probiotics for the rest of us, unproven.

According to the National Institutes of Health and AAP, we still don’t know which probiotics are helpful and which are not, how much we should take, or who can benefit. Researchers are actively trying to find the answers. Probiotics may still live up their name and be good for life. For now, if you are thinking about a probiotic for your infant or baby, talk to your pediatrician first, says AAP.

Christopher Iliades
Dr. Chris Iliades is a medical doctor with 20 years of experience in clinical medicine and clinical research. Chris has been a full time medical writer and journalist since 2004. His byline appears in over 1,000 articles online including EverydayHealth, The Clinical Advisor, and Healthgrades. He has also written for print media including Cruising World Magazine, MD News, and The Johns Hopkins Children's Center Magazine. Chris lives with his wife and close to his three children and four grandchildren in the Boston area.

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