Probiotics and children: who, what and why, and what’s next?

Abstract

Background
Probiotics are increasingly used around the world to prevent or manage a range of acute and chronic health problems in children. Two key areas of interest are respiratory tract infections (RTIs) and acute gastroenteritis (AGE), as the impact of these two ubiquitous infections is substantial. Despite the growing body of literature focusing on possible indications for probiotics in children, probiotic use at the community level is poorly understood.
Methods
In this thesis I used a scoping review methodology to map and identify gaps in the literature concerning probiotic use in healthy children, paying particular attention to prevalence. I quantified the burden of paediatric RTI and AGE on the acute care system by analysing 10-years of hospital admissions data in one Australian jurisdiction. I described the prevalence and associated issues concerning probiotic supplementation in young children through an observational, cross-sectional study of parents of pre-school-aged children.
Results
The scoping review identified several gaps in the literature, and informed the design of the observational study. Increasing hospital admission rates for paediatric RTI confirmed an ongoing burden on the acute system, with little in the way of new strategies for amelioration. Relatively low and stable admission rates for paediatric AGE in the post-rotavirus vaccination era point to a sustained and meaningful impact of good public health strategy. Observation of probiotic supplementation among young children in the community revealed that probiotic exposure is common (47% had lifetime exposure), often occurs in the first year of life, and is strongly predicted by parental use (OR 13.34; 95% CI 7.40–24.06). Importantly, I described the species and strains of probiotics most commonly consumed.
Conclusions
Probiotics are safe, acceptable and accessible, positioning them as a good candidate for intentional strategies to decrease the burden of RTI and AGE in children. There is a great deal to learn, and future research should aim to support clinically relevant recommendations, including how to identify children for whom probiotics are likely to be of most benefit.

Date of Award	2024
Original language	English
Supervisor	Deborah DAVIS (Supervisor) & Marian CURRIE (Supervisor)