Ask the Pediatrician: Can probiotics help children with stomach issues after taking antibiotics?

Q: My daughter had to take antibiotics and they seem to have given her some tummy issues. Can probiotics help restore gut balance?

A: Antibiotics can kill both good and bad bacteria in your child's gut. This may throw your child's gut microbiome out of balance. The microbiome is made up of the microscopic organisms—bacteria, fungi, viruses and parasites—that live in our bodies. That's why it's important to only use antibiotics when they're really needed.

If your child's gut microbiome is disrupted from antibiotics, your doctor may recommend boosting the probiotics in their diet. Signs that your child's microbiome is off-balance include:

• Diarrhea
• Abdominal cramping
• Nausea
• Gas
• Vomiting

Probiotics are made up of the good bacteria that live in our bodies. After your child has been on antibiotics, probiotics can help get the gut microbiome back to a healthy balance by putting beneficial bacteria back in. Studies also suggest that probiotics may help relieve the diarrhea, gas, and cramping caused by antibiotics.

A balanced microbiome may even support your child's immune system to help fight future infections, research suggests. Our gut microbiome plays a big part in how our immune system functions. In fact, our gut contains 70% of the immune system.

There are hundreds of bacteria that are considered to be probiotics. A few of the most commonly used strains are Lactobacillus, Bifidobacterium, and Saccharomyces.

Many fermented foods have probiotics in them. Examples include:

• Yogurt
• Kefir (a yogurt-like beverage)
• Sauerkraut and pickles (raw and refrigerated)
• Kimchi (made from fermented cabbage)
• Tempeh and miso (made from fermented soybeans)
• Buttermilk
• Sourdough bread

You also may have heard of prebiotics. These foods or supplements contain complex carbohydrates, which can't be digested. The carbs ferment in the digestive system, feeding the good bacteria in the gut and helping them grow and thrive. Prebiotics are like fertilizer for the microbiome.

Prebiotics are found in many foods, especially those with a high fiber content. Examples include:

• Asparagus
• Snow peas
• Whole grains
• Bananas
• Onions
• Soybeans
• Garlic

Probiotics and prebiotics are also sold as supplements, in capsule, tablet, powder and liquid form. But keep in mind that these supplements are not approved by the FDA before being sold and there aren't any official guidelines on how much to take or for how long. Be sure to talk to your pediatrician before giving your child any supplement, including probiotics or prebiotics.

Probiotics are also found in kombucha, a carbonated drink made with fermented sweetened tea. But drinking kombucha can be risky for kids because it may contain alcohol. Children shouldn't drink home-brewed kombucha because it may contain harmful bacteria. This is especially true if your child has a health condition that weakens their immune system. Ask your pediatrician if you have questions about kombucha.

Your child's microbiome should recover on its own after taking antibiotics, as long as your child is eating healthy foods. You can add foods with prebiotics or probiotics to help get that balance back, too.

Worried about overdoing it? When you have prebiotics in your diet, the bacteria consume the amount they need to stay healthy and active and the rest passes through the digestive system into the stool. The same goes for probiotics. If you get too many, there's nowhere for them to go, so they also pass into the stool.

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