The investigators seek to conduct the first open-label trial of probiotics in young children to reduce their anxiety and abdominal pain. Likewise, the investigators aim to assess the feasibility and efficacy of this treatment and to elucidate the enteric microbiota in the middle-lower GI tract. Self-report measures and a laboratory task will be collected from children, ages 9-13 years of age, and self-report measures from their primary caregivers prior to and following a 30-day probiotic administration. Children who score above cutoff in anxiety and/or abdominal pain meet the inclusion criteria for this study. Because of limited sample size and the iterative nature of intervention development, criteria for success at the pilot phase are based primarily on clinical rather than statistical criteria. The study personnel will do their best to keep and ensure the privacy and confidentiality of our participants; however, some of the risks of this study may include psychological discomfort, legal risks, and loss of confidentially.
Study Type
INTERVENTIONAL
Allocation
NA
Purpose
TREATMENT
Masking
NONE
Enrollment
9
The investigators will use Culturelle®, a probiotic composed of the micro-organisms Lactobacillus GG. This formulation has been used for the treatment of gastrointestinal inflammation in numerous clinical trials. Dosing will follow the manufacturer's recommendation for children (1 capsule/packet per day), and will be monitored by the study Co-PI, Dr. Seed. Weekly side effects and clinical changes will be monitored by both study therapist and caregiver using the Children's Global Assessment Scale and the Clinical Global Impression Scale (Severity, Improvement, and Efficacy). The treatment duration is 30 days.
Duke Center for Developmental Epedimiology
Durham, North Carolina, United States
Change in Child Abdominal Pain Rating
Child and parent report is used to obtain ratings of pain intensity on a 0-12 scale. A lower score equates to lower pain intensity. Ratings are obtained for a one-week period pre and post intervention, and measured 3 times daily. Pre-treatment assessments took place days 1-7, participants were treated days 8-36, and post-intervention assessments were completed days 37-44. All time points will be averaged and combined across raters (child and parent) resulting in an average pain severity rating pre and post-treatment. The change in this average rating will be assessed as pain severity outcome. This measure was averaged with the pain frequency average score (see Primary Outcome 2) to result in one primary severity/frequency pain rating pre and post treatment. The change in this combined measure is our primary index of change.
Time frame: One week pre-intervention (Study Day 1), One week post-intervention (Study Day 44)
Change in Child Abdominal Pain Frequency
Child and parent report is used to obtain ratings of pain frequency, the number of distinct occasions that pain was reported. Frequency was obtained for a one-week period pre and post intervention, and measured 3 times daily during these intervals. During the 30-day intervention, end of day frequencies were made. Pre-treatment assessments took place days 1-7, participants were treated days 8-36, and post-intervention assessments were completed days 37-44. The average number of episodes across these time points will be calculated pre and post treatment. The change in this average frequency from pre to post treatment will be the measure of change.
Time frame: One week pre-intervention (Study Day 1), One week post-intervention (Study Day 44)
Change in Child Anxiety Symptoms
We report the change in magnitude of self-reported state anxiety derived from summed raw scores obtained through the six-item short-form of the state scale of the Spielberger State-Trait Anxiety Inventory at baseline and 30 days from baseline. Scores in the scale range from 6-24, with greater scores indicating worse anxiety. We obtained the summed raw scores after reverse scoring items 1, 4 \& 5.
Time frame: Baseline and 30 days
Percentage of Adherence to Treatment
Adherence was calculated as: ("the days probiotic was taken"/"total number of days of treatment") x 100, with results ranging from 0% (no probiotics taken at all) to 100% (probiotics taken 30 days out of the 30 day-treatment period). Researcher will subtract the number of pills/packets taken from the total amount.
Time frame: 30 days
Log Fold Change in Relative Quantities of Lactobacillus Among Groups Pre-treatment Relative to Post-probiotic Administration
Examination of the log fold change in relative quantities of Lactobacillus calculated from fecal samples gathered pre-probiotic administration and post-probiotic administration. Analyses represent the log-fold change from post-treatment - pre-treatment quantities.
Time frame: Baseline and 30 days
Log Fold Change in Alpha Diversity
Log Fold Change in the alpha species diversity from pre-treatment (prior to probiotic administration) to post probiotic administration.
Time frame: Baseline and 30 days
Log Fold Change in Beta Diversity
An examination of the pre-treatment to post-treatment log fold change in the regional and local changes in species characterized in the microbiome.
Time frame: Baseline and 30 days
Change in Salivary Cortisol (ug/dL)
A measure of cortisol based on the analysis of saliva samples collected throughout a Trier Social Stress Test.
Time frame: Baseline and 30 days
Change in Heart Rate
Beats per minute (Bpm)
Time frame: Baseline and 30 days
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