Microbiota and Pediatric Health: Highlights from LASPGHAN 2025
By Prof. Natascha Sandy
Clínica Levy, Condomínio Atlantis, Sao Paulo, Brazil
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Created
21 April 2026
Updated
24 April 2026
The 25th Congress of the Latin American Society for Pediatric Gastroenterology, Hepatology and Nutrition (LASPGHAN), held in Mérida, reinforced the central role of the microbiota in pediatric health and disease. The discussions emphasized a rigorous, evidence-based and strain-specific approach to probiotic use, aligned with the most recent ESPGHAN position paper and the forthcoming LASPGHAN consensus. The focus has shifted from empirical supplementation to indications supported by randomized clinical trials and meta-analyses, highlighting how microbial modulation can influence gastrointestinal, immune and metabolic outcomes across different stages of childhood. There is increasing recognition that early-life microbiota imprinting may have lifelong consequences for metabolic programming and immune tolerance, emphasizing the importance of perinatal nutrition, breastfeeding, and the avoidance of unnecessary antibiotics as key determinants of microbial resilience.
Acute infectious diarrhea
Current guidelines recommend certain strains of Saccharomyces and Lacticaseibacillus as the best-documented strains for acute gastroenteritis and prevention of antibiotic-associated diarrhea in children 1-4. Randomized controlled trials and meta-analyses consistently demonstrate a clinically relevant reduction in illness duration and stool frequency when these probiotics are used together with oral rehydration therapy. For antibiotic-associated diarrhea, both strains maintain moderate-quality evidence and favorable safety profiles, making them the most reliable options in routine pediatric care. Some Limosilactobacillus may also be considered in acute diarrhea and infantile colic, reflecting the increasing understanding that early-life microbial modulation supports immune tolerance and intestinal barrier maturation 5. Beyond probiotics alone, emerging studies presented at LASPGHAN explored how combinations with prebiotic substrates can accelerate the restoration of microbiota diversity after infection or antibiotic exposure. This synergistic “biotic” approach may represent a new frontier for preventing recurrence and enhancing gut recovery in children.
Functional gastrointestinal disorders and colic
Beyond acute settings, the role of probiotics in functional gastrointestinal disorders is being more cautiously defined. Some strains of Lacticaseibacillus have shown potential to reduce the frequency of abdominal pain and improve quality of life in functional abdominal pain and irritable bowel syndrome when combined with dietary and behavioral measures 1, 3. The overall strength of evidence remains modest, but emerging data suggest a role for specific strains as adjuvants within a multimodal management approach. In functional constipation, Lacticaseibacillus may also be used as an adjunct to standard therapy, while in infantile colic it remains the most consistently recommended
strain. Preventive use of Lacticaseibacillus from birth to four months has been associated with lower incidence of colic in high-risk infants 2. Strain selection should always consider patient phenotype, symptom pattern, and concomitant interventions such as fiber intake or behavioral therapy. Integrating probiotics or synbiotics into a holistic management strategy—rather than using them as isolated supplement —emerges as a key principle for optimizing outcomes in functional gastrointestinal disorders.
Food allergy and mucosal immunity
Increasing attention has been directed to the interaction between microbiota and immune development. Lacticaseibacillus administered for at least three months may help promote tolerance and clinical improvement in cow’s-milk protein allergy 1 ,2. These findings are biologically plausible given the immunomodulatory properties of the strain and its capacity to influence epithelial and cytokine responses. Nevertheless, further studies are needed to validate the magnitude and durability of these effects in long-term allergic outcomes.
Necrotizing enterocolitis prevention
Prophylactic use of certain strains of Lacticaseibacillus greater than or equal to 30 days remains supported for reducing necrotizing enterocolitis and mortality, provided that product quality, strain identity and clinical surveillance are ensured in preterm infants 1. The benefit appears to be strain-dependent, underlining the need for standardized formulations and microbiological traceability in neonatal care. Recent evidence highlights how early microbial exposure—through vaginal delivery, breastfeeding, and dietary diversification— modulates mucosal immunity and oral tolerance. The concept of the “first 1,000 days” remains a crucial window for interventions aiming to prevent allergic and inflammatory diseases. Growing data on postbiotics, non-viable microbial products with signaling and anti-inflammatory potential, are opening new therapeutic perspectives in allergy prevention and immune education.
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