An update on probiotics in paediatrics.

PURPOSE OF REVIEW: Probiotics are widely used in paediatrics, but efficacy varies by strain and indication. In 2023, the European Society for Paediatric Gastroenterology, Hepatology and Nutrition (ESPGHAN) Special Interest Group on Gut Microbiota and Modifications issued strain-specific recommendations for gastrointestinal disorders. This review summarises studies published since 2024 to assess whether new evidence warrants changes to these recommendations. RECENT FINDINGS: Lacticaseibacillus rhamnosus GG (LGG) and Saccharomyces boulardii are recommended for preventing antibiotic-associated diarrhoea. LGG, S. boulardii, Limosilactobacillus reuteri DSM 17938, or the combination of L. rhamnosus 19070-2 and L. reuteri DSM 12246 may be considered in acute gastroenteritis. For infant colic, recommendations include L. reuteri DSM 17938 or Bifidobacterium lactis BB-12 in breast-fed infants; for functional abdominal pain, L. reuteri DSM 17938 or LGG. No probiotics are recommended for constipation. For prevention of necrotising enterocolitis, weak recommendations include LGG or a combination of B. infantis BB-02, B. lactis BB-12 and Streptococcus thermophilus TH-4. There is no recommendation for or against probiotic-supplemented formulas. SUMMARY: Recent trials have not provided sufficient evidence to justify changes to the ESPGHAN recommendations. Evidence for probiotic use in paediatrics is confined to a few strains and indications. Larger multicentre studies with standardised preparations and clearly defined outcomes are still needed.