CBD for Children: Is It Safe?
CBD, short for cannabidiol, is a substance extracted from either hemp or marijuana. It’s available commercially in many forms, from liquid to chewable gummies. It’s become very popular as a treatment for multiple conditions, including some that occur in children.
CBD doesn’t get you high. Although CBD is usually obtained without a prescription, Epidiolex , a medication made from CBD, is available with a prescription from your doctor.
Epidiolex is prescribed for two severe, rare forms of epilepsy in children: Lennox-Gastaut syndrome and Dravet syndrome.
Parents sometimes use commercially manufactured CBD to treat some conditions in children, such as anxiety and hyperactivity. Caregivers may also use it for children on the autism spectrum to try to reduce certain symptoms of autism.
CBD hasn’t been tested extensively for safety or for effectiveness. While there’s promising research about CBD, especially for seizure control, much is still not known about it. Some parents are comfortable giving it to their children, while others are not.
CBD is a chemical component inherent in both marijuana (Cannabis sativa) plants and hemp plants. CBD’s molecular makeup is the same, once it has been extracted from either plant. Even so, there are differences between the two.
One of the main differences between hemp and Cannabis sativa is the amount of resin they contain. Hemp is a low-resin plant, and marijuana is a high-resin plant. Most CBD is found within plant resin.
Resin also contains tetrahydrocannabinol (THC), the chemical compound that gives marijuana its intoxicating properties. There is much more THC in marijuana than there is in hemp.
The CBD derived from marijuana plants may or may not have THC in it. This is also true of hemp-derived CBD, but to a lesser extent.
In order to avoid giving THC to your children, always opt for isolate CBD rather than full-spectrum CBD, whether it’s hemp derived or marijuana derived.
However, other than Epidiolex, which is a prescription medication, there’s no way to be certain a CBD product is THC-free.
CBD oil is available in a wide range of forms. One popular form is commercially prepared baked goods and beverages. This can make it difficult to know how much CBD is in any product.
Other than using prescription products like Epidiolex, it’s difficult, if not impossible, to control the amount of CBD administered to any child using these products.
Other forms of CBD include:
- CBD Oil. CBD oil may be labeled in multiple potencies. It’s typically administered under the tongue, and can also be purchased in capsule form. CBD oil has a distinctive, earthy taste and an aftertaste that many children may dislike. It’s also available as a flavored oil. Before giving CBD oil to your child, discuss all the possible risks with their pediatrician.
- Gummies. CBD-infused gummies can help you override taste objections to the oil. Since they taste like candy, make sure that you store the gummies somewhere your children can’t find them.
- Transdermal patches. Patches allow CBD to penetrate the skin and enter the bloodstream. They may provide a consistent level of CBD over a period of time.
CBD oil is used for several conditions in children. However, the only condition it’s been approved by the Food and Drug Administration (FDA) for is epilepsy.
The FDA approved a medication made from CBD to treat difficult-to-control seizures in children with Lennox-Gastaut syndrome and Dravet syndrome, two rare forms of epilepsy.
The medication, Epidiolex, is an oral solution made from purified CBD that’s derived from Cannabis sativa.
Epidiolex was studied in three randomized, double-blind, placebo-controlled drug trials , which included 516 patients that had either Dravet syndrome or Lennox-Gastaut syndrome.
The medication was shown to be effective at reducing seizure frequency, when compared with placebo. Other research has yielded similar results.
Epidiolex is a carefully manufactured and administered medication. There’s no scientific evidence to indicate that store-bought CBD oil in any form will have the same effect on seizures. However, any CBD oil product you buy may have the same risks as Epidiolex.
This medication can cause side effects and is not without risk. You and your child’s doctor should discuss the benefits of Epidiolex versus its potential risks.
Side effects may include:
- feeling lethargic and sleepy
- elevated liver enzymes
- diminished appetite
- feeling weakness in the body
- issues with sleep, such as insomnia and poor sleep quality
Serious risks are less likely, but they may include:
- suicidal thoughts or actions
- aggressive behavior
- panic attacks
- injury to the liver
Several studies that have analyzed the use of medical cannabis or CBD oil in children with autism have suggested there could be an improvement in symptoms of autism.
One study looked at 188 children on the autistic spectrum, aged 5 to 18 years old. Study participants were given a solution of 30 percent CBD oil and 1.5 percent THC, placed under the tongue, three times daily.
An improvement was seen in most of the participants, for symptoms including seizures, restlessness, and rage attacks, after 1 month’s use. For most study participants, symptoms continued to reduce over a 6-month period.
Reported side effects included sleepiness, lack of appetite, and reflux. During the study, the children continued to take other prescribed medications, including antipsychotics and sedatives.
The researchers indicated that their results should be interpreted with caution, as there was no control group in place. This prevented them from determining causality between the use of cannabis and the reduction of symptoms.
Other studies are currently underway around the world, which may help to determine if there are safe and effective doses of CBD for children with autism.
Some animal and human studies indicate that CBD oil may help reduce anxiety, although this claim hasn’t been tested sufficiently in children.
Preclinical evidence indicates that CBD oil may have a place in the treatment of anxiety disorders, including social anxiety disorder, obsessive-compulsive disorder (OCD), and post-traumatic stress disorder (PTSD).
A study of one 10-year old patient with PTSD found that CBD oil improved her feelings of anxiety and reduced insomnia.
Attention deficit hyperactivity disorder (ADHD)
There’s little research on CBD oil’s benefits or risks for children with ADHD. Anecdotally, some parents report a reduction in their children’s symptoms after CBD oil use, while others report no effect.
Currently, there isn’t enough evidence to confirm whether CBD oil is an effective treatment for ADHD.
Marijuana has been used for hundreds of years, but CBD oil use is relatively new. It hasn’t been extensively tested for use in children, and no longitudinal studies on its effects have been done.
It also may produce significant side effects, such as restlessness and issues with sleep that may be similar to the conditions you’re trying to treat.
It may also interact with other medications your child is taking. Much like grapefruit, CBD interferes with some of the enzymes needed to metabolize drugs in the system. Don’t give CBD to your child if they’re taking any medication that has a grapefruit warning.
CBD oil is unregulated, making it difficult, if not impossible, for parents to have complete confidence about what’s in the product they’re purchasing.
A study published in JAMA revealed labeling inaccuracies among CBD products. Some products had less CBD than stated, while others had more.
The laws around CBD purchase and use can be confusing. CBD oil that’s derived from hemp is legal to buy in most places — as long as it has less than 0.3 percent THC. Even so, some states restrict possession of hemp-derived CBD.
CBD that’s derived from marijuana plants is currently illegal on the federal level.
Since any product containing CBD oil could contain some amount of THC, and giving THC to children is illegal, the legality of giving CBD oil to children remains a gray area.
The laws about marijuana use and CBD oil use are constantly changing, and they continue to vary from state to state. However, if your doctor prescribes Epidiolex for your child, it’s legal for them to use, no matter where you live.
Is CBD Legal? Hemp-derived CBD products (with less than 0.3 percent THC) are legal on the federal level, but are still illegal under some state laws. Marijuana-derived CBD products are illegal on the federal level, but are legal under some state laws. Check your state’s laws and those of anywhere you travel. Keep in mind that nonprescription CBD products are not FDA-approved, and may be inaccurately labeled.
CBD oil is manufactured by many companies around the world, and there’s no easy way for consumers to know exactly what’s in a particular product. But here are a few tips to help you find a reputable CBD product:
- Read the label. Look for the amount of CBD per recommended dose.
- Find out where the product is manufactured. If the CBD comes from hemp, ask if it’s grown in organic soil that’s free of pesticides and toxins.
- Search for CBD oil that’s undergone third-party testing and has lab results you can verify. These products will have a certificate of analysis (COA). Look for COAs from labs with certifications from one of these organizations: the Association of Official Agricultural Chemists (AOAC), the American Herbal Pharmacopoeia (AHP), or the U.S. Pharmacopeia (USP).
CBD oil has been shown to be effective for the treatment of seizures in children with certain rare types of epilepsy. But it isn’t FDA-approved for any other health condition in children.
CBD oil is manufactured by a vast number of companies. Since it isn’t federally regulated, it’s hard to know whether a product is safe and providing an accurate dose. CBD oil can sometimes contain THC and other toxins.
CBD oil hasn’t been significantly researched for its use in children. It may show promise for conditions such as autism. However, the products you buy online or off a shelf doesn’t necessarily parallel those supplied medically or used in research.
Anecdotally, many parents have reported that CBD oil is beneficial for their children. However, when it comes to your child, take a buyer beware approach. Always talk to your child’s pediatrician before starting any new supplements or medications.
CBD comes from the hemp plant, does not contain THC, and has been used by some parents to treat seizures in children. Always consult a doctor before giving CBD to a child.
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CBD: What Parents Need to Know
Parents are giving it to kids to combat anxiety and other problems. But there are risks, and little research to support it.
CBD is everywhere. From corner stores and bars to medical marijuana dispensaries, it’s being offered for its reputed ability to relieve pain and make people feel better.
Though CBD — full name cannabidiol — is extracted from marijuana or hemp, it doesn’t contain THC, the chemical in marijuana that has psychoactive effects, so it doesn’t make you feel high.
Available in the form of vaping, oils, lotions, cocktails, coffee, gummies — you name it — CBD has been touted as a treatment for complaints as far-reaching as chronic pain, cancer, migraines, anxiety and ADHD. You know it’s gone mainstream when even Consumer Reports has issued guides on how to shop for CBD and tips for safe CBD use.
Not only are adults experimenting with CBD for whatever is bothering them, increasingly parents are turning to CBD to help their kids focus, sleep, calm down and more.
But popular use of CBD is blowing up with very little research into its safety or its efficacy, especially in children. The first and only marijuana-derived drug approved by the Food and Drug Administration, Epidiolex, is used to treat a rare, severe form of epilepsy in patients two years of age and older. And since cannabis is in the early stages of legalization and regulation, there is a huge variety in the quality and dosage of products — risks associated with using products that have not been vetted by the FDA.
What do we know about CBD?
For millennia, hemp plants have been used for medicinal purposes around the world. In 1851 marijuana was classified by the United States Pharmocopeia as a viable medical compound used to treat conditions like epilepsy, migraines and pain. But since marijuana and cannabis-related products were made illegal in the US in 1970, there has been a dearth of research about either marijuana or CBD. Its classification as a Schedule 1 drug made it nearly impossible to get federal funding to study cannabis.
“The biggest problem is there’s a lot that we still need to know, especially in kids,” says Dr. Paul Mitrani, clinical director at the Child Mind Institute. “In regards to treating mental health disorders in children and adolescents, there’s a lack of evidence to support its use.”
Dr. Mitrani, who is a pediatrician and child and adolescent psychiatrist, says it’s an area worthy of investigation but recommends that parents wait until further research is done before giving a child CBD.
Concerns about CBD
While anecdotal evidence of the benefits of CBD is common, there are risks associated with using these products, especially in children. Some of the concerns:
- Products are unreliable in delivering a consistent amount of CBD. They could have less, or more, than advertised, and most do not offer independent verification of active contents. Analysis of products for sale show that many do not have the amount of CBD that they advertise. “So you can’t depend on the quality of what you’re getting,” notes Dr. Mitrani.
- How much is absorbed? Very little is known about how much CBD is actually delivered to the brain in a given product. Various delivery systems — vaping, taking it orally, eating it in baked goods, etc. — have different rates of delivery. Even the oils that the CBD is dissolved in can result in varying effects. “Effects can vary a lot based on the delivery system used and the amount people are exposed to can be inconsistent,” Dr. Mitrani says.
- Products may contain things other than CBD, and they could be harmful. Lab testing — which provides information about CBD levels, THC levels (if any), and contaminants in the product — isn’t mandatory for CBD products in every state. Without a CoA (Certificate of Analysis) it’s that much harder to verify the safety of the product. Bootleg CBD may be connected to recent lung illnesses and deaths that have been attributed to vaping. The CDC and the American Medical Association recommend avoiding vaping entirely while the cause of these illnesses is determined.
- CBD may be safe itself, but it may interact with other medications a child is taking, that are also metabolized in the liver.
- If it’s used for sleep, Dr. Mitrani worries that while it may potentially help with sleep, “your child may become tolerant to it and possibly experience worsening sleep problems if stopped.”
- Since CBD use — especially for kids — is a still so new, few people are familiar with dosing for children, so determining how much to give your child would be tricky. Clinical doses versus what you might find at a coffeehouse could vary dramatically.
- The legality of cannabis products and CBD is still murky. CBD derived from hemp is federally legal, while CBD derived from marijuana plants is subject to the legal status in each state — and remains federally illegal. Meanwhile, the FDA issued a statement making clear that products that contain CBD — even if they are derived from legal, commercial hemp — cannot claim to have therapeutic benefits or be sold as dietary supplements unless they have been approved by the FDA for that use.
Is CBD safe?
Last year the World Health Organization, acknowledging the explosion in “unsanctioned” medical uses of CBD, reviewed the evidence for its safety and effectiveness. The WHO report concluded that “CBD is generally well tolerated with a good safety profile.” Any adverse effects could be a result of interactions between CBD and a patient’s existing medications, the WHO noted.
The report found no indication of potential abuse or dependence. “To date there is no evidence of recreational use of CBD or any public health-related problems associated with the use of pure CBD.”
As for effectiveness, the WHO noted that several clinical trials had shown effectiveness for epilepsy, adding: “There is also preliminary evidence that CBD may be a useful treatment for a number of other medical conditions.”
CBD oil for anxiety
In 2015 a group of researchers led by Esther Blessing, PhD, of New York University, investigated the potential of CBD for treating anxiety. In a review of 49 studies, they found promising results and the need for more study.
The “preclinical” evidence (ie from animal studies) “conclusively demonstrates CBD’s efficacy in reducing anxiety behaviors relevant to multiple disorders,” Dr. Blessing wrote. Those include generalized anxiety disorder, PTSD, panic disorder, social anxiety disorder and OCD.
The review notes that the promising preclinical results are also supported by human experimental findings, which also suggest “minimal sedative effects, and an excellent safety profile.” But these findings are based on putting healthy subjects in anxiety-producing situations and measuring the impact of CBD on the anxiety response. Further studies are required to establish treatment with CBD would have similar effects for those who struggle with chronic anxiety, as well as what the impact of extended CBD use may be.
“Overall, current evidence indicates CBD has considerable potential as a treatment for multiple anxiety disorders,” Dr. Blessing concludes, “with need for further study of chronic and therapeutic effects in relevant clinical populations.”
CBD and autism
A group of Israeli researchers have been exploring the use of CBD to reduce problem behaviors in children on the autism spectrum. A feasibility study involving 60 children found substantial improvement in behavioral outbreaks, anxiety and communication problems, as well as stress levels reported by parents.
The researchers, led by Dr. Adi Aran, director of the pediatric neurology unit at Shaare Tzedek Medical Center, went on to do a double-blind, randomized, placebo-controlled trial with 150 participants with autism. In this trial, just completed but not yet analyzed, patients were treated CBD for three months.
In the US, research has been given a boost by changing guidelines and laws. In 2015 the DEA eased some of the regulatory requirements that have made CBD, as a Schedule 1 substance, difficult to study. “Because CBD contains less than 1 percent THC and has shown some potential medicinal value, there is great interest in studying it for medical applications,” the DEA said in announcing the change.
And in approving the first CBD-based drug, Epidiolex, last year the FDA expressed enthusiasm for the research boom that is sure to come, paired with stern words for the flood of marketers of products claiming unsubstantiated health benefits.
“We’ll continue to support rigorous scientific research on the potential medical uses of marijuana-derived products and work with product developers who are interested in bringing patients safe and effective, high quality products,” the FDA pledged. “But, at the same time, we are prepared to take action when we see the illegal marketing of CBD-containing products with serious, unproven medical claims.”
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Katherine Martinelli is a journalist who has published internationally on a variety of topics including parenting, food, travel and education. She is also mom to an inquisitive toddler.
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CBD is everywhere. From corner stores and bars to medical marijuana dispensaries, it’s being offered for its reputed ability to relieve pain and make people feel better. Parents are giving CBD to kids to combat anxiety and other problems. But there are risks, and little research to support it.