Probiotics in Neonates, Infants and Children: Exploring the Evidence, Benefits, Risks, and Future Directions

Simrita Kaur Khurana, Amudha Jayanthi Anand, Victor Samuel Rajadurai

Abstract

Probiotics in fermented foods have long been part of traditional diets, but their scientific basis has been understood only in the past 2 decades. The human microbiome plays a critical role in human health and well-being, influencing immune development, metabolic regulation, and cognitive function from early life. Disruptions to this microbial ecosystem can have consequences extending far beyond the gut. This recognition has driven interest in probiotics as a tool for restoring microbial balance and preventing or treating diseases.

This review focuses on 2 biological pathways linking gut dysbiosis to systemic disease. The first pathway involves disruption of intestinal barrier integrity (leaky gut), contributing to allergic sensitization and immune dysregulation. The second is the gut–brain axis, through which microbial imbalance may influence conditions such as autism spectrum disorder and attention deficit hyperactivity disorder. Accordingly, the review evaluates probiotics across neonatal and pediatric conditions, with emphasis on strain specificity, safety in vulnerable popula¬tions, and the gap between biological plausibility and clinical evidence.

Current evidence indicates that probiotics possess a therapeutic potential as primary interventions for the prevention of necrotizing enterocolitis and infantile colic, and as adjunct for other conditions, including antibiotic-associated diarrhea and allergic disease. However, probiotics represent a heterogeneous group of strains with distinct mechanisms of action, host interactions, and clinical profiles. Future progress lies in personalized, strain- and patient-specific use that accounts for the individual’s microbiome, genetic background, diet, and clinical context. While the potential is substantial, effective utilization requires a high degree of precision.