Should I give my baby probiotics?

We all know how important it have a healthy gut biome for our health, and this can all start in infancy. Promoting a healthy gut in babies has been usually all about probiotics but if it were only as easy as giving a probiotic to fix a gut that is imbalanced (gut dysbiosis) then i would not be writing this blog now. A healthy gut in a breast fed baby rests heavily on a attracting bifidobacteria to inhabit the gut. This is done by the Human Milk Oligosaccharide (HMO) naturally present in breast milk.

HMOs rank as the third most prevalent solid substance in human milk, trailing only lactose and fat.

Human milk contains much more oligosaccharides than the milk of any animal.

The highest concentration of HMOs is found in colostrum, the breast fluid that is secreted before and a few days after giving birth. Although breast milk has a lower concentration of HMOs, breast milk is still very HMO rich, by design. About 10 grams of HMOs are consumed daily by a term infant ingesting 800 mL of human milk.

HMOs Promote Bifidobacteria in a Baby's Gut

Bifidobacteria are among the first colonizers of the infant gut and sustaining this abundance of Bifidobacteria is crucial to preserving the gut microbiota composition.

HMOs in breast milk are not digested in the small intestine, with the majority reaching the large intestine where they do all their good stuff!

Eaching the large intestine intact, HMOs are fermented by bacteria. Not all bacteria will ferment HMO, but Bifidobacteria in general are particularly good at this.

Not all HMOs cause the same changes in the composition and/or activity of the gut microbiota and have the same effects on host well-being and health. B. longum subsp. Infantis is the most effective consumer of HMOs, and B. bifidum and B. breve can also partially consume HMOs.

The Impact of Bacteria fermenting HMOs on Infant Gut Health

When HMOs are fermented in the infant's gut, short chain fatty acids are produced which cause the pH of the gut environment to be lowered. This encourages the growth of beneficial bacteria and strongly discourage harmful bacteria, preventing them from adhering to the gut lining. Short chain fatty acids also have well established anti-inflammatory properties.

Dominance of healthy bacteria further promote other desirable gut bacteria to promote a whole healthy biome.HMOs strengthen the gut barrier so reducing leaky gut and assists gut cells to mature and become more robust. HMOs have been proven to directly modulate goblet cells, causing them to produce more mucus, another important component of the intestinal barrier system.Furthermore, immunity is boosted by HMOs which have been found to prevent infections and supporting immunity via impacting cytokines and cytokine networks.Other roles in modulating immune cells, pathogen recognition receptors and signalling pathways relating to maturation of lymphoid tissue a a further testamount to the immune boosting capacity of HMOs in the infant's gut.

Other positive impacts include potential support to the brain and cognitive development.

20% of breast feeding Mothers maybe low Secretors of HMO

As high as 20% of breast feeding mothers may produce lower amounts of HMO which may result in depleted levels of bifidobacteria in the baby's gut.

This may result in a diminished level of biological defense against infections and more harmful bacteria species such as Clostridium and Enterobacteriaceae may be able to adhere to the gut wall lining. It is possible that mother's with allergies may produce less HMO.

HMO levels in milk can be tested, but unfortunately not in Australia. Fortunately there are HMO designed for babies that can be given directly, for example in a bottle of expressed milk to boost HMO levels in the baby's gut.

HMO supplementation was safe and well tolerated across all age groups and health states, and regardless of the HMO structures and doses applied.

PROBIOTICS

If your baby is having gut issues or reacting to some allergens in breast milk, or is bottle fed, It may be useful to look at probiotics once a HMO supplement has been trialled.

A probiotic for gut issues without a HMO supplement is a bit like havving a pet and not giving the food to sustain the pet- in this case the friendly gut bacteria, especially bifidobacterium.

Current Evidence for Giving Babies Probiotics

Studies looking at probiotics given to babies in the first year tend to be varied in their results so reliable conclusions are difficult to draw, however there are some probiotics that have been linked with particular issues, which you can read below.

ALLERGY PREVENTION & Probiotics in Babies

Early introduction to potential allergen foods for normal infants or probiotics for infants at high risk of allergies may protect against development of allergic disease later in life (2). 

No individual probiotic strains recommended with regards to reducing allergy risk.

More studies are needed to explore the relationship between LGG and milk protein allergy (5).

COLIC RELIEF & Probiotics in Babies

The aetiology of infantile colic is not well understood; however, studies have suggested that changes in the intestinal microbiota can lead to symptoms of infantile colic.

For this reason, different strains of probiotics have been studied to help understand their effectiveness in the treatment of infantile colic.

According to a systemic review and analysis, All probiotic strains studied (15 in all) seem to have some positive effect in treating infantile colic.

Exclusively breastfed infants have demonstrated more significant reduction in crying time. However, the available evidence on the effectiveness of probiotics in formula-fed and caesarean-born infants is limited (3).

This is a meta-analysis so a review overall, and so while it would seem there is not one probiotic that can be recommended over another until there is more research done, you will find some probiotics such as Lactobaccillus. reuteri  and Lactobaccillus rhamnosus: GG (LGG) have been studied MORE so there is more evidence linking these probiotics to improving colic in babies.

Lactobaccillus reuteri and colic relief:

Lactobaccillus reuteri DSM 17938 is the most studied probiotic for infantile colic and is supported by the strongest evidence in the treatment of infantile colic and reduction of its symptoms (decrease in crying time and fussing) in predominantly breast fed babies (4).

• Note: Insufficient evidence for formulae fed babies.

• Study levels: 1 × 108 colony-forming units (CFU)/day

Lactobaccillus rhamnosus: GG (LGG)

A study and first meta-analysis concluded that LGG is effective in treating infantile colic, with their particular study showing that excessive crying was reduced on average by 32 minutes per day. Other studies included in the meta-analysis showed a variation in results.

The study concluded while LGG seemed to help with colic in babies, more studies are needed to explore the effects of LGG with different doses, administration time, and duration on infants with different feeding moods (5).

Bifidobacterium breve

Less studies done on Bifidobacterium breve with colic, but some show positive results for breast fed and formulae fed infants.

A study of infants bottle fed showed an improvement in colic in babies (4).

• Treatment: 108 CFU/dau, for 21-28 days

REFLUX & Probiotics in Babies

There is insufficient evidence to recommend a specific strain in the management of regurgitation, although there are some promising data for Lactobaccillus reuteri  DSM 17938.

• Treatment: 108 CFU/dau, for 21-28 days

ECZEMA & Probiotics in Babies

Several studies have been conducted for Atopic Dermatitis prevention in children with probiotics, administering them both to their mother in pregnancy and to the child in the first months of life. In protecting eczema, the most efficacious strains of probiotics were Bifidobacterium, but strains of Lactobacillus also showed a protective effect. Potentially having a mixture of these probiotics rather than alone may have a better protective effect (6).

MASTITIS & Probiotics in Breast Feeding Mothers

Lactobaccillus fermentum CECT5716 during the breastfeeding period in a couple of studies was found to reduce the incidence rate of mastitis (7, 8).

Safety of Probiotics in Babies

It has been established that probiotics are safe and well tolerated in normal healthy infants and children.

Probiotics and Histamines or Amines

Probiotics contain amines as a result of the fermentation process so not recommended if your baby seems to be sensitive to amines or histamines through your breast milk, unless has already demonstrated to be useful, then may consider continuing.

See my blog on amine or histamine sensitivity and babies if you think your baby is histamine/amine sensitive.

Tips Starting Probiotics in Babies

The accepted wisdom if giving probiotics to infants is to start with very, very small amounts of the probiotic if been given directly, for example 1/8 of the suggested dose and very, very slowly build up to the recommended baby dose. While there may be an evident improvement in colic or bowel motions, there also maybe no noticable difference.

After trialing a probiotic for a month and seeing no improvement, a different one could be trialled.

Overall, there is patchy scientific evidence to guide choce of probiotics for babies, so individual trialling is best, using the issue as a guide as to which probiotic to choose.

We are only at the beginning of the gut microbiome journey- one can only guess what will be uncovered in the next 5 years! REFERENCES

INFANTS and HMO

Okburan G, Kızıler S. Human milk oligosaccharides as prebiotics. Pediatr Neonatol. 2023 May;64(3):231-238. doi: 10.1016/j.pedneo.2022.09.017. Epub 2023 Jan 2. PMID: 36642576.

Dinleyici, M., Barbieur, J., Dinleyici, E. C., & Vandenplas, Y. (2023). Functional effects of human milk oligosaccharides (HMOs). Gut Microbes, 15(1). https://doi.org/10.1080/19490976.2023.2186115

PROBIOTICS

(1) Marißen J, Haiß A, Meyer C, Van Rossum T, Bünte LM, Frommhold D, Gille C, Goedicke-Fritz S, Göpel W, Hudalla H, Pagel J, Pirr S, Siller B, Viemann D, Vens M, König I, Herting E, Zemlin M, Gehring S, Bork P, Henneke P, Härtel C; PRIMAL consortium. Efficacy of Bifidobacterium longum, B. infantis and Lactobacillus acidophilus probiotics to prevent gut dysbiosis in preterm infants of 28+0-32+6 weeks of gestation: a randomised, placebo-controlled, double-blind, multicentre trial: the PRIMAL Clinical Study protocol. BMJ Open. 2019 Nov 21;9(11):e032617. doi: 10.1136/bmjopen-2019-032617. Erratum in: BMJ Open. 2020 Sep 18;10(9):e032617corr1. doi: 10.1136/bmjopen-2019-032617corr1. PMID: 31753895; PMCID: PMC6886923.

(2) Wang S, Yin P, Yu L, Tian F, Chen W, Zhai Q. Effects of Early Diet on the Prevalence of Allergic Disease in Children: A Systematic Review and Meta-Analysis. Adv Nutr. 2024 Jan;15(1):100128. doi: 10.1016/j.advnut.2023.10.001. Epub 2023 Oct 10. PMID: 37827490; PMCID: PMC10831899.

(3) Vaz SR, Tofoli MH, Avelino MAG, da Costa PSS. Probiotics for infantile colic: Is there evidence beyond doubt? A meta-analysis and systematic review. Acta Paediatr. 2024 Feb;113(2):170-182. doi: 10.1111/apa.17036. Epub 2023 Nov 14. PMID: 37962097

(4) Pereira AR, Rodrigues J, Albergaria M. Effectiveness of probiotics for the treatment of infantile colic. Aust J Gen Pract. 2022 Aug;51(8):573-576. doi: 10.31128/AJGP-07-21-6062. PMID: 35908751.

(5) Huazi Liu, Qiang Fei, Tianming Yua (2024), The effectiveness of Lactobacillus rhamnosus GG in the treatment of infantile colic: a systematic review and meta-analysis.

(6) Anania, C.; Brindisi, G.; Martinelli, I.; Bonucci, E.; D’Orsi, M.; Ialongo, S.; Nyffenegger, A.; Raso, T.; Spatuzzo, M.; De Castro, G.; et al. Probiotics Function in Preventing Atopic Dermatitis in Children. Int. J. Mol. Sci. 2022, 23, 5409. https://doi.org/10.3390/ijms23105409

(7) Hurtado JA, Maldonado-Lobón JA, Díaz-Ropero MP, Flores-Rojas K, Uberos J, Leante JL, Affumicato L, Couce ML, Garrido JM, Olivares M, Fonollá J. Oral Administration to Nursing Women of Lactobacillus fermentum CECT5716 Prevents Lactational Mastitis Development: A Randomized Controlled Trial. Breastfeed Med. 2017 May 1;12(4):202–9. doi: 10.1089/bfm.2016.0173. Epub 2017 May 1. PMCID: PMC5444431.

(8) Zhang Y, Gao Y, He X, Ding S, Gao H. Oral Lactobacillus fermentum CECT5716 in the patients with lactational abscess treated by needle aspiration: The late follow-up of a randomized controlled trial. Medicine (Baltimore). 2022 Jul 1;101(26):e29761. doi: 10.1097/MD.0000000000029761. PMID: 35777008; PMCID: PMC9239655

GENERAL

Pia S. Pannaraj, Fan Li, Chiara Cerini, Jeffrey M. Bender, Shangxin Yang, Adrienne Rollie, Helty Adisetiyo, Sara Zabih, Pamela J. Lincez, Kyle Bittinger, Aubrey Bailey, Frederic D. Bushman, John W. Sleasman, Grace M. Aldrovandi. Association Between Breast Milk Bacterial Communities and Establishment and Development of the Infant Gut Microbiome. JAMA Pediatrics, 2017; DOI: 10.1001/jamapediatrics.2017.0378