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In the supplement world, probiotics are a hot commodity. They’re used to replenish good bacteria in the body. They may help with conditions like irritable bowel syndrome, eczema, and the common cold.

Most adults use probiotics without negative side effects, but are they safe for children? Here’s what you need to know before giving them to your kids.

Bacteria get a bad rap, but they aren’t all bad. Your body needs certain bacteria to stay healthy. Bacteria help with digestion, absorbing nutrients, and battling other germs that make you sick.

Within your body, you have your own community of germs called a microbiome. It’s made of good and bad bacteria, viruses, and fungi. They live:

  • on your skin
  • in your gut
  • in your urogenital tract
  • in your saliva

When the balance of good to bad germs in your microbiome gets tipped, infection and illness may occur. For example, antibiotic use kills infection-causing bacteria. But it also obliterates some of the good bacteria that keep the bad bacteria in check. This leaves the door open for other bad organisms to multiply and take over, which may cause secondary infections. Common secondary infections include yeast infections, urinary tract infections, and intestinal infections.

Probiotics contain live, good bacteria naturally found in your body. They may have one type of bacteria, or a blend of several species.

Children develop their microbiome in the womb and through early childhood. It’s thought that an unhealthy microbiome is responsible for many diseases. Probiotics may play a role in keeping the microbiome healthy, but it’s unclear how.

Probiotics are a popular natural remedy for kids. According to the 2012 National Health Interview Survey, probiotics are the 3rd natural product most used by children.

More studies are needed to prove the benefits and risks of probiotic use in children. Some research is encouraging:

  • An American Family Physician review found that probiotics might help treat inflammatory bowel disease. They may also reduce the duration of diarrhea caused by gastroenteritis. When given to pregnant and breast-feeding mothers, probiotics may reduce the development of eczema and allergies in their infants.
  • A study published in JAMA Pediatrics found that giving infants probiotics in the first three months of life may help prevent colic, constipation, and acid reflux.
  • A 2015 research review concluded that probiotics were better than placebo in reducing the incidence and duration of upper respiratory tract infections in study participants. Antibiotic use and school absence due to colds were also reduced.

There’s a lot of anecdotal evidence supporting probiotic use in children. But the health benefits may be strain-specific. A strain that helps one condition may be useless against another. For that reason (and due to lack of research), there’s no clear answer as to whether you should give your child probiotics, especially for long periods of time.

Giving probiotics to kids isn’t without risk. Kids with compromised immune systems may experience infection. Others may have gas and bloating. Probiotics can cause serious side effects in very sick infants. Check with your pediatrician before giving probiotic supplements to your child.

Probiotics are added to some foods like yogurt and cultured cottage cheese. They are naturally occurring in fermented foods like buttermilk, kefir, and sauerkraut. Raw cheese made from unpasteurized milk is another source.

Some experts support the health benefits of raw milk and products made from raw milk, but it shouldn’t be given to children. Raw milk may contain dangerous bacteria. It can cause life-threatening illness.

If you’re wondering if probiotic supplements or foods are better, the answer isn’t clear-cut. Getting nutrients from whole foods is usually best. But in the case of probiotics, your child may not be able to get enough from food alone. Probiotics in foods may not survive the manufacturing and storage processes. Unless you have a lab in your kitchen, there’s no way of knowing exactly how much made it out alive.

The same could be said for probiotic supplements. In the supplement world, products are not created equal. Supplements are not well-regulated. When you buy probiotic supplements, you assume the product contains what it advertises. In reality, you may not always get what you think you’re buying.

Only buy supplements from reputable brands. Check the expiration date before using. Review storage requirements so you know if the product needs refrigeration.

If your doctor recommends giving your child probiotics, consider these options:

  • Culturelle: Culturelle’s Probiotics for Kids contain Lactobacillus GG in individual packets. They’re flavorless and may be added to your child’s favorite drink or food.
  • Nature’s Way: This brand offers a chewable, cherry-flavored probiotic containing Lactobacillus rhamnosus, Bifidobacterium longum, and Lactobacillus acidophilus.
  • Ultimate Flora: These chewable probiotics come in a kid-friendly, berrylicious flavor. They contain six strains of good bacteria.

Probiotics may help relieve acute constipation, colic, and acid reflux in healthy infants and children. They may also help prevent secondary infections and diarrhea in kids using antibiotics. Probiotics may even help prevent eczema and allergies in some children.

If you think probiotics may help your children, ask your doctor these questions:

  • What are the benefits of probiotics for your child?
  • How long should you give them to your child before seeing benefits?
  • If you don’t see obvious benefits within a certain period of time, should your child stop taking them?
  • What dose should your child use?
  • What brand do they recommend?
  • Are there any reasons my child should not take probiotics?

Since long-term probiotic effects on kids are unknown, children shouldn’t use probiotic supplements as a preventive remedy, unless recommended by a doctor.

Instead, add probiotic foods like yogurt to your child’s diet to help keep their microbiome healthy. Check the label to make sure the yogurt you choose has “live and active cultures.”

If your child isn’t a fan of yogurt on its own, try using it in place of mayo on their favorite sandwich, or to top a baked potato.

Most kids enjoy yogurt smoothies. To make, blend 1/2 cup plain or vanilla yogurt with 1 cup fresh or frozen fruit, until smooth. Add your favorite sweetener to taste.

Note: Don’t give honey to children under age 1 because of the risk of botulism.