Probiotics and Prebiotics for Babies: Should You Give Them to Your Child?
If you've ever stood in the pharmacy aisle staring at a probiotic bottle wondering "does my baby actually need this?" — you're not alone. It's one of the questions we get asked most often, and the honest answer is: it depends.
As a child's gut microbiome develops in those early months and years, it's shaped by a whole mix of factors — how they were born, whether they're breastfed or formula-fed, any antibiotics they've had, and even their everyday environment. Because this microbiome plays such a big role in digestion, immunity, and overall health, it's no wonder probiotics have become such a hot topic for parents and clinicians alike.
So what does the actual evidence say? We've pulled together the latest guidance from the major paediatric societies — including the European Society for Paediatric Gastroenterology, Hepatology and Nutrition (ESPGHAN) and the American Academy of Pediatrics (AAP) — to help you make sense of it.
For the colicky baby: does it actually help?
If you're in the trenches of the witching hour with a screaming newborn, this is probably the bit you care about most.
"There is evidence supporting the use of probiotics, particularly Lactobacillus reuteri DSM 17938, in infants with colic, with the most consistent benefit observed in exclusively breastfed infants."
In practical terms, multiple systematic reviews and meta-analyses demonstrate a reduction in daily crying time, typically ranging from 25 to 65 minutes per day at 2–3 weeks of treatment, and an increased likelihood of achieving at least a 50% reduction in crying duration compared to placebo.[1-5] The number needed to treat for success at 21 days in breastfed infants is approximately 2.6.[5]
Translation: for breastfed babies with colic, this particular strain has genuine, well-documented backing.
What about tummy bugs?
When your little one comes down with acute gastroenteritis (the classic vomiting-and-diarrhoea combo), it's tempting to reach for anything that might help. Here, the evidence is a bit more cautious. ESPGHAN provides weak recommendations for the use of Saccharomyces boulardii and Lactobacillus rhamnosus GG, noting low to very low certainty of evidence. The American Gastroenterological Association (AGA) and ESPGHAN both highlight that evidence for efficacy is limited and strain-specific, and that routine use is not supported for all children.[6-8]
After a course of antibiotics
Antibiotics can wreak havoc on little tummies, and it's common for parents to ask about probiotics to prevent the dreaded antibiotic-associated diarrhoea. For prevention of antibiotic-associated diarrhoea, ESPGHAN supports the use of L. rhamnosus GG and S. boulardii in otherwise healthy children. The AGA and ESPGHAN caution that not all probiotic products are equivalent, and only those with documented efficacy should be considered.[6][8]
That last point matters — not every product on the shelf has been studied, so strain and dose really do matter here.
A note for parents of preterm babies
If your baby arrived early, this section is especially important. In preterm infants, the AAP, Canadian Pediatric Society, and ESPGHAN recommend caution. ESPGHAN conditionally recommends L. rhamnosus GG or a combination of B. infantis, B. lactis, and S. thermophilus for the reduction of necrotizing enterocolitis (NEC) in preterm infants >1 kg, but emphasizes low certainty of evidence, the need for pharmaceutical-grade products, and the importance of local laboratory capacity to detect probiotic bacteremia. Routine use in extremely low birth weight infants (<1000 g) is not recommended due to insufficient safety data.[9]
It's also worth knowing that safety considerations include the risk of probiotic-associated sepsis, especially in immunocompromised or critically ill children, and the lack of regulatory oversight for many commercial products. Both ESPGHAN and AAP stress that only products manufactured according to current good manufacturing practices should be used, and that parents should be informed of potential risks and benefits.[9]
What about everything else — constipation, allergies, tummy pain?
Here's where we'd urge a bit of caution before reaching for a bottle. Routine use of probiotics for other indications, such as constipation, functional abdominal pain, or allergy prevention, is not supported by current guidelines due to insufficient or inconsistent evidence.[6][10-12]
The bottom line: in summary, current guidelines from ESPGHAN and the American Academy of Pediatrics recommend probiotics for specific indications, with careful attention to strain, dose, and safety, and advise against routine use in healthy children or for unproven indications.[6-10]
What is the difference between probiotics and prebiotics?
These two get lumped together constantly, but they work in completely different ways.
Probiotics are defined as live microorganisms that, when administered in adequate amounts, confer a health benefit on the host. Prebiotics are substrates (typically nondigestible carbohydrates) that are selectively utilized by host microorganisms, conferring a health benefit.[14-16]
Think of it this way: the key mechanistic difference is that probiotics directly introduce beneficial bacteria into the gut, while prebiotics serve as a nutrient source that promotes the growth and activity of existing beneficial microbes, particularly bifidobacteria and lactobacilli.[15-16] Both play roles in modulating the gut microbiome, supporting immune function, and influencing metabolic health, but they act via distinct pathways: probiotics alter the composition by adding live organisms, whereas prebiotics enhance the growth of endogenous beneficial bacteria.[10,12-14]
The takeaway
Safety data for both probiotics and prebiotics in pediatric populations are limited, especially regarding long-term outcomes and use in diverse populations. While both are generally well tolerated in healthy children, further well-designed randomized controlled trials are needed to clarify their efficacy, optimal dosing, and safety profiles.
As with anything in your baby's early months, the best next step is always a chat with your paediatrician or health visitor — they can help you weigh up whether probiotics make sense for your specific little one.
By Dr. Perkins
References
1.The Efficacy and Safety of the Probiotic Bacterium Lactobacillus Reuteri DSM 17938 for Infantile Colic: A Meta-Analysis of Randomized Controlled Trials. Xu M, Wang J, Wang N, et al. PloS One. 2015;10(10):e0141445. doi:10.1371/journal.pone.0141445.
2.Probiotics for Infantile Colic: Is There Evidence Beyond Doubt? A Meta-Analysis and Systematic Review. Vaz SR, Tofoli MH, Avelino MAG, da Costa PSS. Acta Paediatrica (Oslo, Norway : 1992). 2024;113(2):170-182. doi:10.1111/apa.17036.
3.The Effect of Probiotics on Symptoms, Gut Microbiota and Inflammatory Markers in Infantile Colic: A Systematic Review, Meta-Analysis and Meta-Regression of Randomized Controlled Trials. Skonieczna-Żydecka K, Janda K, Kaczmarczyk M, et al. Journal of Clinical Medicine. 2020;9(4):E999. doi:10.3390/jcm9040999.
4.A Systematic Review of Prevention and Treatment of Infantile Colic. Hjern A, Lindblom K, Reuter A, Silfverdal SA. Acta Paediatrica (Oslo, Norway : 1992). 2020;109(9):1733-1744. doi:10.1111/apa.15247.
5. To Treat Infant Colic: A Meta-Analysis. Sung V, D'Amico F, Cabana MD, et al. Pediatrics. 2018;141(1):e20171811. doi:10.1542/peds.2017-1811.
6.Probiotics for the Management of Pediatric Gastrointestinal Disorders: Position Paper of the ESPGHAN Special Interest Group on Gut Microbiota and Modifications. Szajewska H, Berni Canani R, Domellöf M, et al. Journal of Pediatric Gastroenterology and Nutrition. 2023;76(2):232-247. doi:10.1097/MPG.0000000000003633.
7. Use of Probiotics for the Management of Acute Gastroenteritis in Children: An Update. Szajewska H, Guarino A, Hojsak I, et al. Journal of Pediatric Gastroenterology and Nutrition. 2020;71(2):261-269. doi:10.1097/MPG.0000000000002751.
8. AGA Clinical Practice Guidelines on the Role of Probiotics in the Management of Gastrointestinal Disorders. Su GL, Ko CW, Bercik P, et al. Gastroenterology. 2020;159(2):697-705. doi:10.1053/j.gastro.2020.05.059.
9. Use of Probiotics in Preterm Infants. Poindexter B. Pediatrics. 2021;147(6):e2021051485. doi:10.1542/peds.2021-051485.
10. Probiotics for Treatment of Chronic Constipation in Children. Wallace C, Sinopoulou V, Gordon M, et al. The Cochrane Database of Systematic Reviews. 2022;3:CD014257. doi:10.1002/14651858.CD014257.pub2.
11. Probiotics for Management of Functional Abdominal Pain Disorders in Children. Wallace C, Gordon M, Sinopoulou V, Akobeng AK. The Cochrane Database of Systematic Reviews. 2023;2:CD012849. doi:10.1002/14651858.CD012849.pub2.
12 Technical Review by the ESPGHAN Special Interest Group on Gut Microbiota and Modifications on the Health Outcomes of Infant Formula Supplemented With Probiotics. Dinleyici EC, Szajewska H, Hojsak I, et al. Journal of Pediatric Gastroenterology and Nutrition. 2025;. doi:10.1002/jpn3.70068.
13. Use of Probiotics in Preterm Infants. Poindexter B. Pediatrics. 2021;147(6):e2021051485. doi:10.1542/peds.2021-051485. Practice Guideline
14. Probiotics for the Management of Pediatric Gastrointestinal Disorders: Position Paper of the ESPGHAN Special Interest Group on Gut Microbiota and Modifications. Szajewska H, Berni Canani R, Domellöf M, et al. Journal of Pediatric Gastroenterology and Nutrition. 2023;76(2):232-247. doi:10.1097/MPG.0000000000003633.
15. Probiotics in Pediatrics. A Review and Practical Guide. Depoorter L, Vandenplas Y. Nutrients. 2021;13(7):2176. doi:10.3390/nu13072176.
16. Probiotics and Prebiotics in Pediatrics. Thomas DW, Greer FR. Pediatrics. 2010;126(6):1217-31. doi:10.1542/peds.2010-2548.
17. Nutraceuticals and Biotics in Pediatric Gastrointestinal Disorders. Corsello A, Scatigno L, Fiore G, et al. European Journal of Clinical Nutrition. 2023;. doi:10.1038/s41430-023-01362-z.
