The American Academy of Pediatrics (AAP) has released new guidance for pediatricians regarding the use of fecal microbiota transplantation (FMT) in children. This guidance is detailed in a clinical report titled “Guidance for the Clinician in Rendering Patient Care Fecal Microbiota Transplantation: Information for the Pediatrician,” published in the December 2023 issue of Pediatrics.
Key points from the AAP’s guidance include:
- Specific Use for Clostridioides difficile Infection: The AAP recommends FMT specifically for treating moderate to severe or recurrent infections of Clostridioides difficile (also known as CDI or C-diff) in children. This infection can be particularly serious in children with chronic health conditions.
- Procedure and Effectiveness: FMT involves transferring stool from a healthy donor to a patient to replenish beneficial gut bacteria. In adults, this method has shown an approximately 80-90% cure rate for Clostridioides difficile infection, with similar results observed in some pediatric studies.
- Limitations and Cautions: The AAP does not endorse FMT for treating other medical conditions in children at this time due to inconclusive evidence. It strongly discourages do-it-yourself transplants at home for safety reasons.
- Procedure Settings and Standards: FMT should always be performed in medical centers with experience in the procedure. Currently, there is a lack of regulatory standards for fecal preparations used in this treatment.
- Unknown Long-Term Effects: The long-term effects of FMT are not yet known, and the field of microbial therapies is expected to advance rapidly.
The AAP’s clinical report supports the joint society statement by the North American Society for Pediatric Gastroenterology, Hepatology and Nutrition and the European Society for Pediatric Gastroenterology, Hepatology and Nutrition.