By: Maria Oliva-Hemker, MD, FAAP
Inside the lower part of the digestive system, trillions of tiny microbes help us get nutrients from food, fight off infection and much more. Together, these organisms form the
gut microbiome that regulates our health at every stage of life.
Unfortunately, many things can disrupt this microbial ecosystem, including the antibiotics we sometimes take for bacterial infections. This can cause serious issues for children, especially those who have chronic health conditions. These kids are vulnerable to an infection known as
Clostridioides difficile (also called CDI or C diff).
When antibiotics don't work to get rid of C. diff
As its name suggests, C diff can be extremely hard to cure. Typical symptoms include diarrhea and abdominal pain. Although children are less likely to have severe C diff infection, serious cases can be life-threatening, causing symptoms such as high fever, diarrhea, severe abdominal pain and bloody stools.
Standard treatments, which include specific antibiotics, work for many kids who get C diff. But others face stubborn infections that keep coming back. For them, a treatment known as fecal microbiota transplantation (FMT) may be the answer.
Helping the gut microbiome heal itself
When parents hear about FMT, some can't quite imagine how this procedure can help kids get well. After all, we spend a lot of time teaching kids to wipe carefully and wash their hands after using the bathroom, since the harmful bacteria in feces (poop) can make us sick!
As it turns out, stool taken from a healthy donor can help restore the "good" bacteria in your child's gut microbiome—the ones that antibiotics may have wiped out. These bacteria can also be killed when children undergo chemotherapy or gastrointestinal surgery, or if they have serious gut health issues.
How effective is FMT?
In a report examining the evidence behind FMT the American Academy of Pediatrics (AAP) confirms it is a viable treatment option for kids with severe or recurrent C diff. Decades of evidence show that FMT is highly effective in adult cases of C diff, with success rates of 80% to 90%. Findings from hundreds of pediatric cases suggest that FMT works equally well for kids.
Is FMT safe and comfortable for children?
If FMT has been recommended for your child, you may have lots of questions. Here are some helpful things to know.
- The stool used in FMT comes only from healthy donors who are thoroughly screened for communicable diseases and chronic health problems. Several rounds of lab tests are conducted before the stool is approved for transplantation.
- Though some medical centers have their own sources, many work with stool banks that operate under regulations set by the Food and Drug Administration.
- Most transplants are done as outpatient procedures so your child can go home the same day.
- Kids usually experience no side effects. Some notice gurgling sounds in their abdomen or have mild gas.
- There is little to no odor, even when a nasogastric (NG) tube is used to infuse the healthy microbes into your child's system. In this case, the medical team may let your child pick out a scent—such as a favorite candy—that is rubbed on their upper lip to mask any minor traces of odor.
- Other transplant methods use the same tools and procedures as a colonoscopy or enema. Kids are sedated (under anesthesia) during a colonoscopy to make the procedure easier for them.
How much does FMT cost?
Standard treatments for C diff involve antibiotics that can be very expensive. Surprisingly, many families find that FMT costs less than these medicines. Your family's health insurance plan may cover FMT procedures for children. Ask your medical team for help navigating the financial aspects of FMT so you know what to expect.
Why do-it-yourself fecal transplants are NOT safe for your child
A surge of interest in FMT has motivated some people to try doing their own fecal transplants, using information from the internet and social media. Many believe this is a "natural" cure they can do at home with stool from someone they know. But this means the donor and stool have not been thoroughly screened and tested to reduce the risks of passing on a communicable disease or chronic health problem.
The AAP strongly urges families to trust their children's health to medical centers and professionals who have in-depth experience with fecal transplants. DIY transplants are NEVER a safe option for kids.
Talk with your pediatrician
Your child's doctor is ready to talk with you about all aspects of your child's gut health, including symptoms that might point to a C diff infection. If you have questions about FMT or any aspect of your child's digestive health, get in touch with your pediatrician today.
About Dr. Oliva-Hemker
Maria Oliva-Hemker, MD, FAAP is Division Director of Pediatric Gastroenterology, Hepatology and Nutrition, Stermer Family Professor of Pediatric Inflammatory Bowel Disease and Vice Dean for Faculty at the Johns Hopkins University School of Medicine.