Mesquite Pediatrics Blog

People often ask about the uses of probiotics in children. There are many conditions for which probiotics are often used, but the scientific evidence supporting their use is incomplete. Below are several conditions for which there does seem to be a benefit; also, we list the probiotic species that have been studied and shown to be of most benefit. This is not a comprehensive list, but the conditions with the most research showing the greatest benefits are included here. Generally, a dose of 10-20 billion colony forming units per day is necessary to have an effect for an adult. A good rule of thumb for children’s dosing is to use one quarter the recommended adult dosage for children up to 6 years of age, half the adult dosage for children 6 to 12 years of age, and a full adult dosage for teens.

It is important to recognize that probiotics are not as tightly regulated as medications. There really is no way to assure the purity of any particular preparation or the accuracy of what’s on the label. Your safest bet is to go with a well-known brand, if possible. Also, probiotics are often sold as combinations of species. How these combinations will work is not necessarily clear, so you may want to look for those preparations that are only a single species if you can.

Probiotics are not necessarily safe for all people and in all situations. People with the following conditions should probably not use them: chronic diseases (such as congenital heart disease or kidney disease), immune deficiencies (either from an immune disease or from medications such as chemotherapy), and those with indwelling catheters. If you have questions about whether it would be safe to use probiotics with your child, please check with us first.

Antibiotic-associated Diarrhea
Many of our patients realize that antibiotics can cause diarrhea by killing off the body’s normal intestinal bacteria. The use of probiotics can help replace these “healthy” bacteria and make it less likely that a person taking antibiotics will develop the diarrhea. Three probiotics have been shown to be helpful: Lactobacillus rhamnosus GG, Streptococcus thermophilus, and Bifidobacterium lactis (which is available in some infant formulas).

Acute infectious diarrhea
Also known as the stomach flu, stomach viruses, and viral gastroenteritis, acute infectious diarrhea if extremely common. Probiotics are not a cure for this, but can sometimes shorten the course by up to 2 days. Strains that may be of benefit are Streptococcus boulardii, Lactobacillus rhamnosus GG, Lactobacillus acidophilus, and Lactobacillus bulgaricus.

Infantile Colic
A study published in August 2010 showed a decrease in colic symptoms in infants given 10 billion CFU of Lactobacillus reuteri. It definitely is not a cure for all cases of colic, but it is a safe intervention that can be tried.

Inflammatory Bowel Disease (Crohn’s Disease and Ulcerative Colitis)
There is little research done in children and teens with these conditions. In adults a stain of E. coli (strain Nissle 1917) has been shown to be of some benefit in lengthening the time between relapses. The usual dosage is 250mg three times a day for 4 weeks.

Irritable Bowel Syndrome
This condition is poorly defined and difficult to treat. A study was recently completed (in 2010) that seems to show that Lactobacillus rhamnosus GG has some benefits.

Allergic Diseases (Eczema, Allergic Rhinitis, and Asthma)
There have been a number of studies to look at whether probiotics can either prevent or treat any of these conditions. It does appear that probiotics can make it slightly less likely that these conditions will develop, but studies on whether probiotics can actually treat these conditions have had mixed results. Eczema is the condition on this list most likely to benefit from probiotics. Most studies have used Lactobacillus rhamnosus GG, though there is no consistent recommendation.

This is a technique of giving fluids to a young child who has been vomiting that often will allow you to get some fluids into their system and thereby alleviate the vomiting and avoid dehydration (and the emergency room). It does not work for every child, but it does work for most.

If your child has been vomiting repeatedly for a long time, appears dehydrated, is lethargic or poorly responsive, or just looks to you like he or she is very sick and worrisome, please seek medical attention (come see us or go to an emergency room) instead of trying this vomiting cure.

However, if your child is not very ill, try following the instructions below. Don’t be tempted to use Gatorade or other sports drinks instead of Pediatlyte (or a generic equivalent). Sports drinks contain too much sugar and not enough salt to hydrate appropriately so they don’t work as well and they also can cause diarrhea, which is a problem you probably don’t want right now.

• Give 1 teaspoon of Pedialyte (or a generic equivalent) every 10 minutes for 1 hour.
• Then give 2 teaspoons every 10 minutes for 1 hour.
• Then give 4 teaspoons every 10 minutes for 1 hour.

If your child tolerates this without vomiting:

• You can now give 2 to 3 ounces at a time in a cup or bottle for your child to work on at their own pace with some encouragement to take frequent sips.

If your child is able to take another 8-12 ounces of Pedialyte without vomiting:

• You can start with some bland foods and a little bit of milk, and increase what you give him or her over the next day or so.

If your child vomits:

• Wait 30 minutes without giving anything and start over.
• If you have to start over 3 times and your child is still vomiting, then call us.
• If your child does not urinate at least 4 times in 24 hours, then call us.

After having fluoride varnish applied, you may be able to see a thin coating of the varnish on the surface of the teeth. For it to be most effective, it needs to stay on the teeth for approximately 4 to 6 hours. Please follow the directions below:

• Do not brush or floss the teeth for at least 6 hours after treatment
• Have your child eat only soft food for at least 2 hours after treatment
• Do not give your child hot drinks for at least 6 hours after treatment
• Wait until the next day to brush the teeth
• A thorough brushing the next day will easily remove any remaining varnish.

Download these care instructions.

Information About Flu Vaccines

Flu vaccination is recommended for all people 6 months of age and older. The flu vaccine is offered in injectable and nasal spray forms.

Those who are at highest risk from the flu (and therefore for whom we most strongly recommend the vaccine) are:

• children aged 6 months to 5 years
• children and adolescents who are receiving long-term aspirin therapy and, therefore, might be at risk for experiencing Reye syndrome with influenza virus infection
• women who will be pregnant during the influenza season
• adults and children who have chronic disorders of the pulmonary or cardiovascular systems, including asthma (hypertension is not considered a high-risk condition)
• adults and children who have required regular medical follow-up or hospitalization during the preceding year because of chronic metabolic diseases (including diabetes mellitus), renal dysfunction, hemoglobinopathies, or immunodeficiency (including immunodeficiency caused by medications or by human immunodeficiency virus [HIV])
• adults and children who have any condition that can compromise respiratory function or the handling of respiratory secretions or that can increase the risk for aspiration (e.g., cognitive dysfunction, spinal cord injuries, seizure disorders, or other neuromuscular disorders).
• residents of nursing homes and other chronic-care facilities that house persons of any age who have chronic medical conditions
• persons aged > 65 years

Also, a flu vaccine is strongly recommended for any household contact of any of the people listed above and for anyone who works in health care.

Children under 9 years of age who have not received at least 2 doses of flu vaccine in the past are recommended to get 2 doses this year, at least 4 weeks apart.

Nasal Flu Vaccine (Flumist)

There are certain people who absolutely should not get the nasal vaccine and others for whom it may not be a good idea (these people should consult with their physician).

This year we have a limited supply of the nasal flu vaccine (Flumist). But there are certain people who absolutely should not get the nasal vaccine and others for whom it may not be a good idea (these people should consult with their physician).

Those who definitely should not get the nasal flu vaccine are people in the following categories:

• Children under 2 years of age
• Children under 18 years of age currently receiving aspirin- or salicylate-containing therapy
• Children under 5 years of age who have had wheezing or asthma in the past 12 months
• People who have had a serious allergic reaction to a flu vaccine or flu vaccine ingredient (including gentamicin, gelatin, or arginine)
• People who have a weakened immune system (immunosuppressed, immunocompromised, or on long term oral steroids)
• People who live with or care for a person who is immunocompromised
• People without a functioning spleen
• Pregnant women
• People with a cerebrospinal fluid (CSF) leak into the nose, mouth, ear, or other part of the skull
• People with a cochlear implant
• People who have taken flu antiviral drugs within the last 17 days

Those for whom it may not be a good idea and consultation with a physician is recommended include:

• People over 4 years of age who have asthma
• People with lung, heart, kidney, or liver disease, neurological or neuromuscular disease, or a metabolic disorder (including diabetes)
• People who currently have a fever or are otherwise sick
• People who have been diagnosed with Guillain-Barre Syndrome within 6 weeks of a previous flu vaccine

Care after a circumcision is really very simple. For the first few days we need to keep the healing circumcision site from being irritated by the diaper. We do this by applying petroleum jelly (Vaseline) to the penis with every diaper change and closing the diaper nice and tight to avoid friction. It’s easiest if you buy the petroleum jelly that comes in a tube and use it to apply a swirl over the entire penis (like a Dairy Queen ice cream cone). Do this for the first 7 days.

We also need to keep the site from being irritated with cleaning. So, for the first week, you should only use a wet washcloth to clean him in his diaper area. Baby poop cleans very well with just water, so soaps and wipes really aren’t necessary and they might cause irritation of the healing area.

Most babies do not have much pain, but if he seems very fussy today you can give him acetaminophen (Tylenol) infant drops. You can give it to him every 4 hours, up to 5 times a day. His dose is 1.25 ml (the first line on the dosing syringe) as long as he is at least 6 pounds. Ask us how much to give him if he is less than 6 pounds.

Complications or Reasons to Call Us

• Bleeding: If you see a little blood in a few of his diapers over the next couple of days, don’t worry. But if you see blood actually coming from the site of the circumcision, hold pressure on it with some gauze or a piece of tissue for 10 minutes. If it doesn’t stop with pressure, please call us.

• Infection: It is normal to see a yellow crust or film over the area of the circumcision for the first week or two. This is just a part of the healing process. If you see yellow liquid (like pus) leaking from the area, redness and swelling traveling up the penis toward his body, or if your baby develops a fever (temperature of 100 or higher), you should call us right away.

Download these care instructions.