Should I Supplement My Child with Probiotics?

Written by Jeff Blattner and Collin Blattner, DO
Edited by Paul M. Graham, DO

Parents constantly inquire about what they can do to protect their child from the development of skin diseases. Well, if the parents have a skin condition called atopic dermatitis, probiotics may help. Probiotics are natural organisms that have a symbiotic (working together) relationship with our own normal gut bacteria. They have been used to treat a wide variety of ailments, but until recently, the literature on their use for preventing atopic dermatitis was scarce.

The classic clinical triad of atopy (tendency to develop allergic diseases), asthma, and allergic rhinitis has been well documented in its association with atopic dermatitis. It has now been found in recent Cochrane literature reviews that supplementing mothers starting at 35 weeks of gestation (development) and 6 months following delivery may decrease the chance of high-risk infants developing atopic dermatitis by 33%. Mothers should be informed that they are not the only ones that needs to supplement with probiotics; babies should also be supplemented. I personally recommend to patients to break up the probiotic capsule and dilute the contents in water before feeding it to their infant in a bottle. They should continue to do this for the first 6 months of life along with breastfeeding to get maximal benefits.

Specific strains of probiotics have been found to be most beneficial in the prevention of atopic dermatitis. I recommend that new mothers look for Lactobacillus rhamnosus GG on the back of the package since this strain has the best evidence in the prevention of atopic dermatitis. I also recommend looking for Bifidobacterium longum, although this strain does not have significant evidence behind it. Finally, parents may wonder if there are any contraindications to probiotic use. The one thing I always warn parents about is if their child has short gut syndrome or omphalocele (abdominal wall defect) since these are absolute contraindications to probiotic use. Although these diseases are rare, informing them of this is important. The FDA does not regulate probiotics at this time. In general, probiotics are considered to be very safe. If parents are still concerned, physicians may consider prescribing VSL#3 DS, which is a probiotic medical food that is regulated by the FDA. Finally, parents may wonder how long the benefits of probiotics last. To date, studies have shown that the benefits of probiotics may persist for at least nine years; although this is currently being debated.

In summary, probiotics are a reasonable choice to recommend to parents who are at high risk for having a baby with atopic dermatitis. Probiotics do not provide any additional benefit if the baby is not at high risk for developing atopic dermatitis (ex. the infant does not have a first-degree relative with atopy). Probiotics are relatively safe, cost effective, and should be considered for any parent who wants to decrease the risk of their child developing atopic dermatitis.

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References:

1. Eichenfield LF, Hanifin JM, Beck LA, Lemanske RF Jr, Sampson HA, Weiss ST, et al. Atopic dermatitis and asthma: parallels in the evolution of treatment. Pediatrics 2003;111:608-16.

2. Chen MH, Su TP, Chen YS, Hsu JW, Huang KL, Chang WH, Chen TJ, Pan TL, Bai YM. Is atopy in early childhood a risk factor for ADHD and ASD? a longitudinal study. J Psychosom Res. 2014 Oct;77(4):316-21.

3. Kramer MS, Kakuma R. Maternal dietary antigen avoidance during pregnancy or lactation, or both, for preventing or treating atopic disease in the child. Evid Based Child Health. 2014 Jun;9(2):447-83.

4. Falth-Magnusson K, Kjellman NIM. Development of atopic disease in babies whose mothers were receiving exclusion diet during pregnancy randomized study. J Allergy Clin Immunol 1987;80:868-75.

5. Lovegrove JA, Hampton SM, Morgan JB. The immunological and long-term atopic outcome of infants born to women following a milk-free diet during late pregnancy and lactation: a pilot study. British Journal of Nutrition 1994;71:223–38.

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