Updated September 2013 365It was Black Friday and, in observance of my sanity, it was time to bond with my computer for a bit. My family was busily getting ready to shop. Aware of my love of shopping (0 on a scale of 1-10 with 10 being the most love ever), they left me alone to geek-out and explore my tabbed research articles. Headphones in while listening to my podcasts, I spaced out a bit to the world around me.

They excitedly waved goodbye to me as I was diligently cross-referencing sources of a blog that I found fascinating in order to make sure the science added up before posting it on Facebook.

You may be thinking, “Why does she spend time checking source references for her postings or tweets?”

Well, I don’t do this for EVERYTHING I post, such as opinion or experiential pieces, but I do this for most blogs and newsletters. This is in case an author took a source out of context. It can be easy to do, as sometimes titles in studies can be misleading and not match the actual conclusion. This can lead to some serious misguided information on the World Wide Web!

Back to my story…

I was smiling contently, ready to hit “post now”, when I got a notice of a new question that popped up from the interview I did with Ben Greenfield on essential oils. The question was on the use of essential oils with children and safety. (If you go to the podcast, you can scroll down and see my answer to Daniel in the comment section).

After I got another question on the same topic from another father on the same day, I thought the Universe might be nudging me a bit for the subject of my next blog. My brain wasn’t going to rest until I got some information down on my website for those who were interested. (Nor was my body! I’m up too late writing this in my nerdy red glasses ;-D).

Before I get started, I have to warn you that I did go a little heavy into quotes and statistics.

 

For those in a hurry, here’s the summary:

SUMMARY

The bottom line is that a lot of the safety concerns stem from improper use of essential oils that aren’t standardized the way that Young Living and other ISO and AFNOR standardized oils are. Furthermore, please don’t let this general guideline scare you from the power of this gentle yet powerful wellness tool. The point is to use them as indicated and not go too heavy handed. Respect their power.

Also, note that I have various blogs with studies which document their mechanisms and various peer-reviewed references. You can find them here.

 

Common Sense Safety Rules 101:

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1. Dose for size (of little bodies)

As with any herbal remedy or medication, pediatric dosage should be used for little ones. Never give a child the dose you would give an adult. Err on the side of caution and dilute the oils with an organic carrier oil such as almond, coconut, olive oil, etc.

Essential oils are concentrated and powerful. If one drop works for you, than diluting the oil and using a carrier oil for someone 1/8 your size makes sense. Also, why would you want to waste your oils!

 

2. Quality counts

As I’ll get into later on, there are a lot of conflicting reports on essential oil safety. One reason is because there is no standardization for purity in the United States and any essential oil could technically be considered “therapeutic” here. So, make sure you are using quality genuine essential oils.

Here’s the cliff notes version of tests to look for from a reputable essential oil company, such as Young Living. Third party verification and in-house testing would be optimal as well:

Tests for Quality Essential Oils

  • Gas chromatography with GC/MS
  • Heavy metals analysis
  • Microbial analysis
  • Flash Point
  • Optical Rotation (Fake oil check)
  • Refractive Index
  • Specific Gravity
  • Fourier transform infrared spectroscopy

 

Not So Common Sense Caveats on Safety Reports

PageLines- services_icon.png1.  Be aware of conflicts of interest

Here’s one of the reasons I began looking for peer reviewed articles on efficacy of essential oils…conflicts of interest. Obviously, I use one company because it is the one which has proven to be reliable in results for my family, my clients, and myself. Still, I strive to make sure that I’m not blindly following a suggestion without backing it up. My true love is the science of essential oils, and I want to know why they work!

So, here’s some helpful tips for making a decision about a topic or when reading any article on essential oils, including mine:

  • check for the references for peer-reviewed studies
  • check who funded the study (biases)
  • try to read the full abstract to see if conclusions match the author’s opinion or if they did a great job explaining why the conclusions in the study were biased

I strive to provide full source reference in all my blogs for this reason. Although this makes them look quite lengthy, it so you can access the full picture and decide for yourself!

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2. There are different applications and different schools of aromatherapy…

THIS IS THE BIGGIE!!

So, you want to know how to really cause the downfall of anything? Make people on the same side argue and forget their vision so divisions are created internally. Unfortunately, this is happening in the world of essential oils. Instead of honoring our differences, many are attacking their fellows if their applications and standards differ.

Aromatherapists differ in their schooling and mode of application. They don’t agree on safety or application; hence, the migraine-producing differing opinions on Dr. Google. Furthermore, they aren’t all using the same standardized or quality oils.

Here’s an excerpt from the National Cancer Institute, with bold emphasis being mine for your skimming pleasure of my point:

Practitioners of aromatherapy apply essential oils using several different methods, including (1) indirect inhalation via a room diffuser or drops of oil placed near the patient (e.g., on a tissue), (2) direct inhalation used in an individual inhaler (e.g., a few drops of essential oil floated on top of hot water to aid a sinus headache), or (3) aromatherapy massage, which is the application to the body of essential oils diluted in a carrier oil. Other direct and indirect applications include mixing essential oils in bath salts and lotions or applying them to dressings. Different aromatherapy practitioners may have different recipes for treating specific conditions, involving various combinations of oils and methods of application. Differences seem to be practitioner-dependent, with some common uses more accepted throughout the aromatherapy community. Training and certification in aromatherapy for lay practitioners is available at several schools throughout the United States and United Kingdom, but there is no professional standardization in the United States, and no license is required to practice in either country. Thus, there is little consistency in the specific treatments used for specific illnesses among practitioners. This lack of standardization has led to poor consistency in research on the effects of aromatherapy, because anecdotal evidence alone or previous experience has driven the choice of oils, and different researchers often choose different oils when studying the same applications. However, there are now specific courses for licensed health professionals that give nursing or continuing medical education contact hours, including a small research component and information on evaluating/measuring outcomes.

Although essential oils are given orally or internally by aromatherapists in France and Germany, use is generally limited to inhalation or topical application in the United Kingdom and United States. Nonmedical use of essential oils is common in the flavoring and fragrance industries. Most essential oils have been classified as GRAS (generally recognized as safe), at specified concentration limits, by the U.S. Food and Drug Administration (FDA). (See the International Federation of Aromatherapists [www.ifaroma.org/] for a list of international aromatherapy programs.)

Aromatherapy products do not need approval by the FDA.(1)

 

Here’s another excerpt on a conclusion about conflicting results from a review on lavender essential oil and the conflicting study results (I’m bolding again):

  1. Critical Overview and Conclusion

A recent increase in the popularity of alternative medicine and natural products has renewed interest in lavender and their essential oils as potential natural remedies [2]. This review may be useful to increase our knowledge of lavender pharmacological effects and improve our future experimental and clinical research plans. Although it is shown that lavender may have a significant clinical potential either in their own right or as adjuvant therapy in different disorders, however, due to some issues, such as methodological inadequacies, small sample sizes, short duration of lavender application, lack of information regarding dose rationale, variation between efficacy and effectiveness trials, variability of administration methods, the absence of a placebo comparator, or lack of control groups more standard experiments and researches are needed to confirm the beneficial effect of lavender in the neurological disorders [109]. Methodological and oil identification problems have also hampered the evaluation of the therapeutic significance of some of the research on lavender. The dried lavender flowers used in some trials were sourced from a local herb store (i.e., [62]). Although taxonomic identification was confirmed in these studies, without quantification of key constituents the quality of the herbal product may be questionable [110]. Although some studies defined the contents of lavender, it is essential that all future clinical studies specify the exact derivation of the oils used in the study and, preferably, include a profile of the liquid or the percentage composition of the major constituents. In addition, several factors, such as temperature, skin type and quality, and the size of area being treated, which may affect the level and rate of lavender absorption after massage or aromatherapy, were not considered in several investigations. Many discreet compounds in lavender oil have shown a myriad of potential therapeutic effects, and researchers continue to seek novel treatments to different ailments [2].

Only few clinical investigations on lavender are available using diverse administration methods (i.e., oral, aromatherapy, and as a massage oil). The evidence for oral lavender is promising; however, until independent studies emerge with long-term follow-up data, it remains inconclusive [109]. The use of more widely used forms of lavender administrations (aromatherapy, inhalation, massage, etc.) is not currently supported by good evidence of efficacy. Future clinical trials, well-reported and adopting rigorous standard methodology, in combination with experimental pharmacological research, would help to clarify the therapeutic value of lavender for neurological and psychological disorders [109, 110].

The apparently low reporting of adverse reactions could imply tolerability and safety [110]. However, most studies failed to provide details which may have masked these and the studies only involved small numbers of participants. It is crucial to get good tolerability and safety data for all modes of lavender application. Thus longer-term follow ups would be required especially for oral lavender before it is recommended for treatment of neurological and/or psychological disorders.…(2)

My note: Please see examples of randomized studies and trials on my website which do support the use of lavender for enhancing health.

 

A Critical Look at Some of the Toxicity Reports

Almost twins

Noting the controversy that exists, I read an article online that would have even scared me if I didn’t look into it more closely or if I didn’t have knowledge on how to accurately assess peer-reviewed journals.

After reading the actual study, this is what I found:

I. After swallowing a full bottle of a commercial product of tea tree oil (to my knowledge, not standardized or quality controlled as I discussed above), a boy was brought to the hospital.

The boy had NO symptoms after 5 hours:

A 23-month-old boy became confused and was unable to walk thirty minutes after ingesting less than 10 mL of T36-C7, a commercial product containing 100% melaleuca oil. The child was referred to a nearby hospital. His condition improved and he was asymptomatic within 5 hours of ingestion. He was discharged to home the following day. Melaleuca oil, extracted from the Melaleuca alternifolia, contains 50-60% terpenes and related alcohols. Clinical experience with products containing melaleuca oil is limited. This case report suggests that ingestion of a modest amount of a concentrated form of this oil may produce signs of toxicity.

Side effects: Tea tree oil can sometimes irritate the skin, especially in higher concentrations. It has also caused allergic skin reactions. There is a single report of breast enlargement in a young boy who used products containing lavender oil and tea tree oil; laboratory studies of the oil itself indicated that tea tree oil may have hormonal effects. (It’s likely that if this were a common effect it would have been noted long ago; the authors published the information so that physicians could consider essential oils when treating boys with breast enlargement.)

My excerpt: This “breast enlargement” was not related to genuine essential oils but products containing synthetics- check out this article.

Poisoning: Tea tree oil is known to be poisonous if swallowed. A child who swallowed a small amount given to him by mistake went into a coma (from which he recovered). Tea tree oil should NOT be taken by mouth for any reason, even though some traditional uses include tea tree oil as a mouthwash, treatment for bad breath, and treatment of toothache and mouth ulcers.

Jacobs MR1, Hornfeldt CS. Melaleuca oil poisoning. J Toxicol Clin Toxicol. 1994;32(4):461-4. http://www.poison.org/poisonpost/winter2010/teatreeoil.htm

Bottom Line: Don’t let your children swallow essential oil bottles. Would you really want to drink tea tree oil anyway?

 

II. Here’s another imbibing-happy little on. This time, the incident report was from swallowing 30 ml of eucalyptus which is 2 full bottles of a typical 15ml essential oil (the equivalent of 350-750 servings). Now, note that 2 out of the 4 children who did this had NO symptoms and the other 2 ended up ok. This is why the author concluded what he did (see the last sentence in the abstract):

Forty-two cases of oral eucalyptus oil poisoning in children under 14 years of age were identified in a defined population between 1 July 1984 and 30 June 1991, and 41 were subjected to retrospective case note analysis. Thirty-three children (80%) were entirely asymptomatic. This group included all of the four children reported to have ingested more than 30 mL of eucalyptus oil. Only two of the remaining children had symptoms or clinical signs on presentation to hospital. No child required advanced life-support. There was no correlation between the amount of eucalyptus oil taken and the presence of symptoms. If the estimated volume ingested is large, or symptoms are evident, on presentation at hospital gastrointestinal decontamination should lead to a good outcome with few clinical problems. Eucalyptus oil may be a less toxic compound than has previously been believed.

Webb NJ1, Pitt WR. Eucalyptus oil poisoning in childhood: 41 cases in south-east Queensland. J Paediatr Child Health. 1993 Oct;29(5):368-71.

Bottom Line: Please don’t keep your oils in a place where a child could drink the whole bottle and use the general safety guidelines above.

 

III. Skin Health Study- Evaluation of Essential Oil Massage on Childhood Eczema

This is the abstract that didn’t notice a significant improvement in eczema and also a possible contact dermatitis from repeated use. However, the study used a strange combination of essential oils, including benzoin and “spike” lavender (compare this to lavendula angustifolia).

Childhood atopic eczema is an increasingly common condition in young children. As well as being irritating to the child, it causes sleepless nights for both the child and the family and leads to difficulties in parental relationships and can have severe effects on employment. A group of eight children, born to professional working mothers were studied to test the hypothesis that massage with essential oils (aromatherapy) used as a complementary therapy in conjunction with normal medical treatment, would help to alleviate the symptoms of childhood atopic eczema. The children were randomly allocated to the massage with essential oils group and both counselled and massaged with a mixture of essential oils by the therapist once a week and the mother every day over a period of 8 weeks. The preferred essential oils, chosen by the mothers for their child, from 36 commonly used aromatherapy oils, were: sweet marjoram, frankinsence, German chamomile, myrrh, thyme, benzoin, spike lavender and Litsea cubeba. A control group of children received the counselling and massage without essential oils. The treatments were evaluated by means of daily day-time irritation scores and night time disturbance scores, determined by the mother before and during the treatment, both over an 8 week period; finally general improvement scores were allocated 2 weeks after the treatment by the therapist, the general practitioner and the mother. The study employed a single case experimental design across subjects, such that there were both a within-subject control and between-subjects control, through the interventions being introduced at different times. The results showed a significant improvement in the eczema in the two groups of children following therapy, but there was no significant difference in improvement shown between the aromatherapy massage and massage only group. Thus there is evidence that tactile contact between mother and child benefits the symptoms of atopic eczema but there is no proof that adding essential oils is more beneficial than massage alone. Further studies on the essential oil massage group showed a deterioration in the eczematous condition after two further 8 week periods of therapy, following a period of rest after the initial period of contact. This may have been due to a decline in the novelty of the treatment, or, it strongly suggests possible allergic contact dermatitis provoked by the essential oils themselves. The results of this study indicate the necessity of prolonged studies with novel plant extracts as short-term beneficial results could be overturned by adverse effects after repeated usage.

Anderson C1, Lis-Balchin M, Kirk-Smith M. Evaluation of massage with essential oils on childhood atopic eczema. Phytother Res. 2000 Sep;14(6):452-6.

Bottom line: These were essential oils of different species then what I generally use. Also, I am interested in knowing how they standardized their oils and tested for quality and how to base conclusions on a sample of 8 children.

 

Let’s keep it in context

Girl on phone

 

 

 

 

 

 

A recent review article collected 71 cases of patients of aromatherapy experiencing adverse effects up to date. Here’s what the authors wrote (bold emphasis mine):

A complete review of the available literature has collected 71 cases of patients who experienced adverse effects of aromatherapy. Adverse effects ranged from mild to severe and included one fatality. The most common adverse effect was dermatitis. Lavender, peppermint, tea tree oil, and ylang-ylang were the most common essential oils responsible for adverse effects, possibly because they are the most commonly used [50]. A case report of seizure related to rosemary EO, possibly secondary to loss of tissue sodium/potassium gradient leading to increased cellular hyperexcitability, must be taken into particular account [51] as well as a case of coma induced by oral long-term abuse and intoxication from methol contained in cough droplets [52].

Finally, it should also be taken into account that there is a trend to use uncommon EOs, often derived from wild plants which have a tendency to produce numerous cultivars with different chemical compositions. Often the different chemotypes have not been tested toxicologically, and possible further problems could derive from this in an uncontrolled market [53].

To conclude, we confirm the need of rigorous clinical trials to disprove the false belief of essential oils as a panacea, and we believe it is necessary that these substances are used at therapeutic level with the same degree of precautions normally followed by the use of pharmacologically active substances. (3)

Bottom line: When used appropriately, essential oils appear pretty darn safe! The two big cases in which one involved a seizure couldn’t be linked directly to the oil and the other was due to methol cough droplets. But let’s say, “Ok, 71 cases total.”

Let’s compare those cases to reports from adverse effects in pharmaceuticals, for example, in which 114 people die a day as a result of overdose. Here’s what the Center for Disease Control (CDC) writes (bold emphasis mine):

Deaths from drug overdose have been rising steadily over the past two decades and have become the leading cause of injury death in the United States.1  Every day in the United States, 114 people die as a result of drug overdose1, and another 6,748 are treated in emergency departments (ED) for the misuse or abuse of drugs.2 Nearly 9 out of 10 poisoning deaths are caused by drugs.3

The Problem

  • Drug overdose was the leading cause of injury death in 2012. Among people 25 to 64 years old, drug overdose caused more deaths than motor vehicle traffic crashes.1
  • Drug overdose death rates have been rising steadily since 1992 with a 117% increase from 1999 to 2012 alone.1
  • In 2012, 33,175 (79.9%) of the 41,502 drug overdose deaths in the United States were unintentional, 5,465 (13.2%) were of suicidal intent, 80 (0.2%) were homicides, and 2,782 (6.7%) were of undetermined intent.1
  • In 2011, drug misuse and abuse caused about 2.5 million emergency department (ED) visits. Of these, more than 1.4 million ED visits were related to pharmaceuticals.2
  • Between 2004 and 2005, an estimated 71,000 children (18 or younger) were seen in EDs each year because of medication overdose (excluding self-harm, abuse and recreational drug use).4
  • Among children under age 6, pharmaceuticals account for about 40% of all exposures reported to poison centers.5 (4)

 

What About Side Effects?

According to the CDC (I’m bolding again):

Adverse drug events are a large public health problem.

Adverse drug events cause over 700,000 emergency department visits each year. Nearly 120,000 patients each year need to be hospitalized for further treatment after emergency visits for adverse drug events. As more and more people take more medicines, the risk of adverse events may increase.

As people age, they typically take more medicines. Older adults (65 years or older) are twice as likely as others to come to emergency departments for adverse drug events (over 177,000 emergency visits each year) and nearly seven times more likely to be hospitalized after an emergency visit.

 

And Now, a Few Abstracts of the Use of Essential Oils & Children

So now that we know that when used with common sense, essential oils appear pretty darn safe, let’s look at some studies in children. (You can also check out the full article reference of #2 which lists other studies with children in the review).

 

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1. Efficacy & Safety of Essential Oils for Respiratory Health

Bummer that this article was in Russian. I can’t read Russian!! But, here’s the abstract, if any of you can read Russian, can you please tell me what oils they used!! Notice that these little children where in a country were oils are standardized more readily?

The efficacy and safety of the application of essential oils for the prevention of acute respiratory diseases and alleviation of clinical manifestations of rhinitis was evaluated in a group of children aged 3-4 years. It was shown that inhalation of a mixture of essential oils resulted in a 42.5% decrease of the prevalence of the above pathologies. Specifically, they developed only in each third child from the group of frequently ill children. No side effects of the treatment were documented. 25% of the children suffered only from mild acute respiratory diseases, fever was absent in 5%. The severity and duration of the symptoms of rhinitis decreased in more than 80% of the children. Simultaneously, the requirement of decongestants and local (intranasal) antibiotics was reduced.

Kilina AV, Kolesnikova MB. [The efficacy of the application of essential oils for the prevention of acute respiratory diseases in organized groups of children]. Vestn Otorinolaringol. 2011;(5):51-4.

 

2. Citrus Oil and Stress Response Study

Check out the conclusion. Cool, huh?

Essential oils have been used as an alternative and complementary treatment in medicine. Citrus fragrance has been used by aromatherapists for the treatment of anxiety symptoms. Based on this claim, the aim of present study was to investigate the effect of aromatherapy with essential oil of orange on child anxiety during dental treatment.

MATERIALS AND METHODS:

Thirty children (10 boys, 20 girls) aged 6-9 years participated in a crossover intervention study, according to the inclusion criteria, among patients who attended the pediatric department of Isfahan Dental School in 2011. Every child underwent two dental treatment appointments including dental prophylaxis and fissure-sealant therapy under orange aroma in one session (intervention) and without any aroma (control) in another one. Child anxiety level was measured using salivary cortisol and pulse rate before and after treatment in each visit. The data were analyzed using t-test by SPSS software version 18.

RESULTS: The mean ± SD and mean difference of salivary cortisol levels and pulse rate were calculated in each group before and completion of treatment in each visit. The difference in means of salivary cortisol and pulse rate between treatment under orange odor and treatment without aroma was 1.047 ± 2.198 nmol/l and 6.73 ± 12.3 (in minutes), which was statistically significant using paired t-test (P = 0.014, P = 0.005, respectively).

CONCLUSION: It seems that the use of aromatherapy with natural essential oil of orange could reduce salivary cortisol and pulse rate due to child anxiety state.

Jafarzadeh M1, Arman S, Pour FF. Effect of aromatherapy with orange essential oil on salivary cortisol and pulse rate in children during dental treatment: A randomized controlled clinical trial. Adv Biomed Res. 2013 Mar 6;2:10. doi: 10.4103/2277-9175.107968.

 

General Guidelines for Safety from the University of Maryland & Summary

So, keep in mind that the common sense precautions and caveats with the use of genuine essential oils are important, because, they are powerful!

I found this online from the University of Maryland. I thought it was a good summary.

So, at the risk of repeating myself, you can see that when using quality essential oils appropriately for yourself and your little one, you can be assured they are “pretty darn safe.” I have used them for 7 years in my practice with little ones and with my niece since she was a baby. I have seen incredible results but, as a caution, remember quality and what kind of oil you are using counts!

If you want to learn more about safety and applications, you can listen to my interviews and teleseminars under “Essential Oils and Wellness In the Media”.

 

 

Sources:

(1) National Cancer Institute – PDQ Cancer Information Summaries. Aromatherapy and Essential Oils (PDQ®) Health Professional Version. Last Update: October 16, 2012. http://www.ncbi.nlm.nih.gov/pubmedhealth/PMH0032645/

(2) Peir Hossein Koulivand, Maryam Khaleghi Ghadiri, Ali Gorji. Lavender and the Nervous System (Review Article). Evidence-Based Complementary and Alternative Medicine. Volume 2013 (2013), Article ID 681304, 10 pages. http://dx.doi.org/10.1155/2013/681304

(3) Susanna Stea, Alina Beraudi, & Dalila De Pasquale. Essential Oils for Complementary Treatment of Surgical Patients: State of the Art. Review Article-Evidence-Based Complementary and Alternative Medicine. 2014 (2014), Article ID 726341, 6 pages. http://dx.doi.org/10.1155/2014/726341

(4) CDC. Prescription Drug Overdose in the United States: Fact Sheet. October 17, 2014. http://www.cdc.gov/homeandrecreationalsafety/overdose/facts.html

Aromatherapy. University of Maryland Medical Center. http://umm.edu/health/medical/altmed/treatment/aromatherapy#ixzz3KW2NBkP6
Toxicology and Efficacy Critique:

Arch Dis Child 2002;87:403-406 doi:10.1136/adc.87.5.403

Lee, M. S., Choi, J., Posadzki, P., & Ernst, E. (2012). Aromatherapy for health care: an overview of systematic reviews. Maturitas, 71(3), 257-260.


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Disclaimer: This information is applicable ONLY for therapeutic, Grade A essential oils. This information DOES NOT apply to essential oils that have not been AFNOR and ISO standardized. There is no quality control in the United States and oils labeled as “100% pure” need only contain 5% of the actual oil. The rest of the bottle can be filled with fillers and sometimes toxic ingredients that can irritate the skin. This information is for information purposes only and is not intended to diagnose, treat, or prescribe for any illness.

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