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.
What You’ll Learn
- Is CBD safe for kids?
- What are the risks of giving kids CBD?
- Can CBD help kids who have mental health disorders?
- Quick Read
- Full Article
- What do we know about CBD?
- Concerns about CBD
- Is CBD safe?
- CBD oil for anxiety
- CBD and autism
- Research boom
These days, you can find CBD everywhere. Some people believe that it can treat everything from chronic pain and cancer to anxiety and ADHD. But is it safe for kids?
CBD is still pretty new, so there’s very little research about its safety or how well it works, especially for children. So far, there’s only one marijuana-derived medication that has been approved by the Food and Drug Administration. It’s called Epidiolex, and it’s used to treat a rare form of epilepsy in patients who are at least two years old.
Because CBD is so new, there also aren’t a lot of rules about what can and cannot be included in CBD products. So, there’s a huge variety in the quality of products. You may even find different amounts of CBD in different packages of the same product.
Since there isn’t a lot of research about CBD, doctors say there are some risks with using CBD for kids. For example, CBD products may contain things other than CBD, and those things could be harmful. Plus, we don’t yet know if CBD works well with other medications or how much you should give your child.
Although a few studies have found that CBD oil might work for anxiety, they only looked at healthy people who were put in situations that made them anxious. There are no studies yet on people with chronic anxiety. Researchers are also exploring CBD for kids with autism spectrum disorder. The results are good so far, but more research needs to be done before we can know if it’s safe and effective.
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 Paul Mitrani, MD, a clinical psychiatrist 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 Adi Aran, MD, 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.”
Should You Give Your Kid CBD?
More Americans are using the hemp (or marijuana) extract on their kids, but experts aren’t sold on its efficacy.
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Priscilla Batista is stuck at home in Charlotte, N.C., with a highly emotional 4-year-old.“Every toddler obviously is emotional, but she’s a pretty constant, volatile child,” she said. “It doesn’t allow her to focus. She’s just struggling.” Batista doesn’t yet have an official diagnosis for her daughter, but, suspecting an attention deficit disorder, she has turned to CBD (cannabidiol) for help.
CBD is one of the more well-known components of cannabis, along with THC (tetrahydrocannabinol). Both chemicals affect the brain, but while THC makes users feel high, CBD doesn’t, though it does make some users feel more relaxed. CBD products have become hugely popular around the world, from oils that can be eaten or rubbed on skin, to soaps, gummy candies and even pet treats.
A 2019 Gallup poll found 14 percent of more than 2,500 Americans surveyed use CBD products, mostly for pain, anxiety and sleep problems. Statistics for kids are much harder to come by, but there are Facebook groups with thousands of followers where parents discuss giving CBD to their kids for conditions including the autism spectrum and attention deficit hyperactivity disorder. In April, a cannabis-focused magazine published a survey of more than 500 parents and found that 40 percent had given CBD products to their children for behaviors related to the autism spectrum.
Very little controlled research has been done with CBD and kids. There is only one approved drug based on CBD for any age group, and that’s for rare kinds of epilepsy in children. There are promising hints — but little proof thus far — that the compound might work on some other conditions in children too, including other kinds of seizures, autism and anxiety.
“When you’re desperate, you want options,” said John Mitchell, clinician at Duke ADHD Clinic in Durham, N.C. “I’m a parent myself. I get it.” But, he cautioned, for now the enthusiasm is running ahead of the science. “I’m very hesitant to say anything promising about it. It’s an open question.”
The medical community considers pure CBD relatively safe: The World Health Organization, for example, has said there’s no evidence of anyone abusing CBD recreationally, or of any public health problems. But there are still some risks, especially for kids.
Last year, the Food and Drug Administration wrote that CBD has the potential to cause liver injury (in users of any age), and suggested it might affect the developing brains of children. No one knows the long-term effects of giving CBD to kids, said Arno Hazekamp, Ph.D., a pharmaceutical researcher and cannabis consultant in the Netherlands. “Those kids are still kids,” he said. Researchers will have to wait until they are older to assess long-term effects. Also, since most CBD products aren’t regulated, he added, they can be tainted with dangerous additives.
Hints of help
The only drug containing CBD that has been approved for adults or children is Epidiolex, which is currently the only known treatment for two rare and devastating forms of childhood epilepsy: Dravet syndrome and Lennox-Gastaut syndrome. Epidiolex, approved in 2018, was developed after the high-profile case of Charlotte Figi, whose desperate mother used CBD to dramatically control her debilitating seizures.
The way that CBD acts on the brain makes it a good candidate for controlling seizures caused by other conditions too. The Epilepsy Foundation said that early evidence from animal studies, anecdotal reports and small clinical trials suggest that CBD could potentially help with seizures. Dozens of trials are underway to test if, why and how CBD might work for kids and adults suffering from seizures of various kinds.
There are also hints CBD might work for some autistic kids. Dr. Gal Meiri, M.D., clinical director of the National Autism Research Center of Israel at Ben Gurion University of the Negev, has studied CBD oils and autism. In a study that Meiri co-authored in 2019, 155 autistic kids aged 18 years and younger tried CBD oil for at least six months. More than 80 percent of the parents reported significant or moderate improvement in their kids. “Some of the parents reported benefits not just with seizures but also behaviors, like self-harm,” he noted.
Most such studies are based on parents’ perceptions, rather than measured changes in comparison to placebo groups. The placebo effect can be strong, since parents typically want to see improvements. A placebo-controlled trial of CBD for autistic children has been completed at the Shaare Zedek Medical Center in Israel, but the results aren’t yet published. Another is underway at the University of California, San Diego.
“I’m trying to be very cautious about it,” said Meiri with regards to CBD and autism. “We still don’t have enough research about safety and efficacy.”
Similarly, many parents are trying CBD products for children with A.D.H.D., for which there are no reported controlled trials with kids. One small trial on 30 adults with a mouth spray containing both CBD and THC had inconclusive results.
With no scientific proof that CBD works and is safe for children, Mitchell said stimulant-based medications like Adderall are a better option than CBD. “We know much more about one than the other, so the choice is simple,” he said. But he understands why a parent might consider CBD as an alternative, he said, given that it is typically seen as a gentle drug with few side effects.
That matches Batista’s experience. “My daughter has a beautiful personality; she’s sweet, she’s spunky. I don’t want to medicate her with something that’s going to turn her into a zombie,” she said, referring to parent complaints that some stimulant-based drugs can make their kids seem spacey.
“I don’t want her to fall behind,” she said. Batista has seen other kids with A.D.H.D. struggle academically. “It can really swallow a kid whole; then you have a failure to launch.”
Mitchell added there are signs CBD might help with anxiety: a symptom that sometimes accompanies autism and A.D.H.D. In a 2018 study of CBD for kids with autism, for example, anxiety improved in more than a third of the 60 patients.
Surprisingly, there’s not much evidence that CBD helps with sleep — despite its reputation for causing drowsiness in recreational users. “Something can make you sleepy and have no effect on your sleep quality,” said Hazekamp.
No silver bullets
Even if CBD is someday approved for use against other kinds of seizures, autism or A.D.H.D., it is unlikely to work for everyone.
Kelly Cervantes, a mother and health activist in Chicago, gave CBD to her daughter Adelaide, who suffered from an unidentified neurodegenerative condition with severe infantile spasms. “We were desperate, and we wanted to try anything we could,” said Cervantes. That was when her daughter was about a year and a half old, and before Epidiolex, so she says she got the product online rather than though her doctor. Sadly, Adelaide’s symptoms got worse. “It entirely depends on the child. There is no one pill, one oil, one treatment that is going to cure everyone,” she said.
In addition, Adelaide’s doctors began to see signs of liver failure. Cervantes took her off the CBD. She said CBD, “does not come without side effects, which I think is a major misconception about it.” In trials of Epidiolex, a moderate dose caused side effects in at least 10 percent of the children, including elevated liver enzymes, decreased appetite, diarrhea, fatigue, sleep problems and malaise.
Furthermore, it’s impossible to know what’s in a CBD product without independent testing. One of Hazekamp’s studies in the Netherlands analyzed 46 cannabis oils made by patients or sold online. Only 21 products even advertised the ingredient concentrations and many of those were wildly wrong. Seven didn’t contain any cannabinoids at all. One of them had more than 50 percent more THC in it than the product claimed.
“There can be pesticides, heavy metals and microbes in the plants,” said Hazekamp. It isn’t clear if those are making it into CBD oils, he said.
It’s impossible to overdose on pure CBD, but synthetic knock-offs can be poisonous. In 2019, the American Association of Poison Control Centers put out an alert noting “growing concern” about CBD products, with national calls about CBD rocketing from just over 100 in 2017 to more than 1,500 last year.
“The labels aren’t always right,” said Hazekamp. “If you try it, make sure it is what you think it is.”
Talk to your doctor
When Cervantes tried CBD, she bought it online from what she believed to be a reputable company, but she can’t be sure what was in it. It would help parents of suffering children, she said, if CBD products were more regulated and parents felt they could talk to their doctors about it, rather than worrying about its association with marijuana.
“I had a patient start taking CBD and I only found out a month in,” said Mitchell. “Parents may assume that a doctor will respond in a negative way.” It’s a doctor’s responsibility, he said, to be open to discussing options. “If you shut a patient down, it doesn’t mean you won the argument, it means they’re not going to talk about it.”
Batista said her daughter’s doctors told her to be careful with CBD and didn’t recommend it.
Still, she’s been using it for several months, getting it from a company that advertises independent testing to confirm their product’s contents, and starting with a low dose. She said she can’t tell if it’s doing anything, but holds out hope that a gentle drug with few side effects will be effective for her little girl. “I want to think that it’s helping.”