I've been interested in essential oils for a while now, beginning with a Facebook post where I sought out questions that might come up regarding essential oils and their use in children. Well, after much consideration, study and investigation, I think it’s time to release some of those results.

Whether you agree with my conclusions or not, I think you’ll find the information helpful and interesting…so here goes!

The slippery assumptions of oil supporters

We all have pre-conceived ideas about things. We can’t help ourselves. We were brought up in a particular culture or educated in a certain way or have friends that believe certain things. One of my primary goals as a person is to constantly challenge what to believe to see if there are holes in my thinking or understanding of things that are not logical.

I’m going to go ahead and put some of my pre-conceived notions and assumptions out there so that we can all be on the same page:

1.I have a strong trust in science, the scientific method and organized medicine. I can’t blindly follow any of those things, but I’m going to rely on them most of the time to make decisions for myself, my children and my patients. If the science proves that something works, I’m willing to use it or at least allow it to be used by my families.

2.I am very skeptical of anecdotal stories and advice. I often have to say, “I can’t contradict what you are saying, but it goes against what I know about this condition.”

3.I am generally very nervous about new treatments or new uses for old treatments. I often say, “I don’t want to be the first to try something nor the last. Somewhere in between is where I feel comfortable.” I want to weight risk vs benefit for everything.

4.I believe that the overwhelming percentage of parents (99.9999 percent) want the best for their child and would never intentionally harm their children in any way.

Because of these assumptions, I may evaluate oils in a different way than most people who use them do. I get that. But my patients who use them will tell you that when we talk about them, I am not judgmental (at least, I try not to be) and I am willing to listen to how they are using them as long as they will listen in return when I provide suggestions or push-back. (Most of them pretend to listen, at least, ha!)

I thought as we move through all the evidence about oils I have discovered, it would be helpful to challenge some statements made by my oily friends that imply false assumptions about me:

1.“I just don’t want to give them medicine for every little thing.”

That’s awesome, me neither. When patients leave my practice, it’s most commonly because I don’t give them a medicine or test that they want. The four most common examples are medicine for colds (cough and congestion), reflux, colic or antibiotics. If medications are not indicated for those conditions, I’m not going to be writing for them. If the decision is on the fence or unclear, I’ll engage the parents to help make a decision. The three little kids running around my house rarely get any medicine, especially for those symptoms for which I see oils being used. They rarely get medicine for fever or runny nose, never for cough and certainly never because their behavior is bad that day. Most of you probably don’t use oils for this-but some of you do…I’ve seen it. I’m not trying to single out a child with special needs or developmental problems, I’m more referencing a kid/parent who just aren’t quite getting along that day. In many of these cases, the use of oils is not in place of a medication, it is often additional to what I would do.

2.“You are a medical doctor so I’m sure you don’t like alternative medicine.”

Not exactly but this one is closer to true. Traditional medicine, to me, means tried, tested and proven. Alternative medicine might be old, might be tried but in my mind the definition means that it is unproven. In fact, through my studies the last few weeks, I have come across a couple of ideas that I am considering incorporating into my practice. But, at that point, if I begin to recommend it based on review of the scientific literature, is it alternative? Or, if the oils work like some claim they do, then eventually won’t we all be using them? Are they still alternative? This assumption is partially true but only because I want to be clear with my patients on what we absolutely know about oils, not what some have claimed.

3.Patients don’t tell me about their oils because they are scared of my reaction or assume I don’t want to know.

Incredibly wrong. I have to know what medication your child is on, period. If there is information about drug interactions or negative outcomes as a result of any medication use, I need to know who’s taking it so I can get in touch with people who are using them. We do the same thing for vaccines and everything else we use in the office so that if there is a recall or another issues, we can get the word out to our patients and tell them what to be on the lookout for.

Now we can move on to some research…

The Research on Essential Oils in Kids

These are the oils for which I found some research. I’m sure I left some off but I thought these were a representative list from a Facebook question I saw come across my timeline and would give us enough information to start the discussion.

Lavender

Tea tree

Chamomile

Peppermint

Eucalyptus

Where did I look?

I started by looking myself and then had our staff librarian follow up with a PubMed search. Because I knew that would not be enough for some, I also reviewed the following websites at the suggestion of the followers of my Facebook page (The Doc Smitty): aromaticscience.com, Dr. Robert Pappas Essential Oil University and airase.com (cost me $75). I also used the NIH Center for Complimentery and Integrative Health, the MedLine Encyclopedia & Natural Medicines Comprehensive Database and the Sloan Kettering Integrative Medicine Database.

First, I’ll summarize what we found from the more traditional medical research on each oil (PubMed, NIH Complimentary and Integrative Health, MedLine and Sloan Kettering):

Lavender

• One study shows use of lavender associated with decreased use of acetaminophen after children had their tonsils out but did not show decrease in pain intensity or nighttime awakenings. (48 patients)
• Several adult studies showing calming effect of lavender.
• Another very small study showed that lavender use in babies had a calming effect.
• These and other published research involve small sample sizes (less then 50 subjects) and often the study design is lacking or flawed in other ways.

Tea tree oil

• Some fair quality studies that included children showed some possible benefit for lice, acne and warts.
• A small study in adults showed possible improvement in toenail fungus.
• Many reports of side effects from accidental overdose are pretty common with tea tree oil (confusion, drowsiness and possibly coma). Just a reminder (just like other medicines, I’m not singling out oils) that we should keep these oils out of the reach of children. I have seen people make comments like, “These are natural so you can’t possible overdose on them.” This is simply not true.

Chamomile

• A review of the use of alternative methods for treating colic (including chamomile) was published in Pediatrics in 2011. The conclusion of the reviewers was that a further look into the issue was warranted.
• Colic studies are difficult because defining what is colic is difficult, if we can agree, deciding what constitutes improvement is even harder as most “cases” resolve on their own without treatment.

Peppermint Oil

• Some studies (some including children) have shown benefit for use in irritable bowel syndrome and recurrent abdominal pain.
• Other possible uses have been studied in adults (including headache), which has shown some promise but no definitive answers have been found at this point.

Eucalyptus

• Studies have shown that use of eucalyptus and lemon can work as an insect repellant although there have been case reports of toxicity from widespread application on the skin.
• There are multiple reports of severe toxicity after excess ingestion in children.
• Some studies have shown benefit for treating head lice.

We tried to research some other oils (thieves and frankincense) but found any evidence for their use in children to be lacking or unavailable.

Of note, you’ll see that there is no evidence for the use of these oils for some of the common uses I see them touted as being beneficial for: fever, cough, congestion, allergies, teething symptoms and (the one that makes me the most frustrated-see above) behavior problems.

Other Sources

At the suggestion of readers I also reviewed the literature from aromaticscience.com and discovered one article for which I had not previously found and only discovered 11 studies when searching for children.

I also reviewed Dr. Robert Pappas’ website but could not find further information about studies in children.

The gist of most of these websites is to list tons of articles of test tube and animal models with adult studies mixed in but they have very little to no information on children.

An example of this is the Facebook page of Scott Johnson who is “one of the world’s leading experts on evidence-based, therapeutic use of essential oils and natural products.” I looked back over 6 months of his postings on Facebook. There are roughly 2-3 posts per day. I found four posts related to children: one about probiotic use for colic, one about mother/baby skin-to-skin contact, one promoting increased physical activity in kids, and one about exercise during pregnancy promoting brain growth in children. None that truly show evidence of the efficacy or safety of the use of essential oils in kids.

Finally, I signed up for a website so that I could review a study that got a lot of buzz last year in the essential oil community. It was looking at the use of oils in autism spectrum disorder (ASD). You can read more about ASD in my post here. There are many issues with the study that limit its ability to be used as proof of effectiveness: the sample size is small (12) and there is no control group (even a group that used a different concoction of oils would be helpful). It’s not that this type of study should not prompt further thinking into the issue, it’s just that the number of children and parents who started using oils for autism based on it is inappropriate. For more traditional investigations into the use of medications for autism, this would be one of the most preliminary studies and would need to be followed up by significant further studies to test for effectiveness and safety of the regimen that was recommended. Why do I care so much? Because my parents of children with developmental concerns are desperate for something that might help. I’m desperate to have something more to offer them, but I am very protective of them when it comes to those who might take advantage of them.

Summary of Research

There’s just not much out there. What is out there is small studies or case reports and other poor study designs. This effectively turns their current use by consumers into the study of essential oils. The problems is that, with no oversight, no one is systematically watching for effectiveness or safety so we may not know until much later.

My interest began with a report from the Tennesee poison center that said reports of toxic exposures to oils doubled from 2011 to 2015. Of those reported cases, four out of every five were in children.

As I began my research on essential oils, I asked what you guys wanted to know. I asked on Facebook what you all wanted to know and you guys had some great questions.

Most indicated that they “really wanted to hear my opinion.”

I will take the questions and try to divide them up by category as best as I can.

I feel like I owe it to you, and your children, to give my candid answers on the subject.

Safety

Q: What harm have you seen from patients choosing oils over modern medicine?

A: I’ve seen two examples of this. The first were parents using oils for their child’s eczema. They came to me after one month of attempts (including multiple different regimens) to treat with oils and the child ended up having a secondary staph infection of their eczema because the skin was open. In fairness, severe eczema happens and secondary skin infections happen, but most of my patients with eczema do not get that severe with the medications I typically recommend. The second patient was one who had an upper respiratory infection that led to croup (noisy, barky cough). The parents were trying oils at home for three days (again multiple different attempts to get the “right” oil) before they ended up in the emergency room and admitted for two days for difficulty breathing. The theme here has three components:

1.The oil itself did not hurt the child.

2.The ambiguity as to which oil should be used led to multiple different regimens and oils being tried.

3.The biggest problem with these two is the delay in receiving appropriate care.

Q: What is the best way to explain proper dilution to others?

A: Ummmm…I don’t know. Based on what I have seen regarding research this has not truly been studied, at least in children.

Q: Are there any that are harmful for use topically?

A: There are case reports of severe toxicity with topica application that uses eucalyptus and tea tree oil from those that I studied. These are mainly due to extensive application. Toxicity to any treatment is always related to dose. The more area you cover, the more likely it is to be toxic. There are also some reports of reactions with very small applications. The other concern I have (for which we don’t know the answer yet) is how does the toxicity change when these oils are being applied hourly (as I’ve seen recommended) or when multiple oils are being used at once.

Q: Can I use them in my child with asthma?

There are no studies that show effectiveness for asthma. Any inhaled substance with a small particle size that can get into the lungs could theoretically lead the airways to constrict which would actually cause more problem in children with asthma.

Q: What happens when oil are ingested (purposefully or accidental)?

Even most pro-oil websites don’t recommend ingestion of oils in children and to use extreme caution in adults. Because we do not have studies that evaluate the safety and appropriate dosing for ingestion by children, this is the one hard line I take with my patients who are using them. Please do not use them in this way.

Q: Have you seen allergic reactions?

The allergic reactions I have seen are mostly related to the skin. Application of anything topically can flare a child who has eczema or cause contact irritation of the skin.

Q: Are they really good for you or are you you doing more harm than good?

I don’t think we know the answer to this question on a global scale. If they do have all the anti-bacterial, anti-viral and all other properties, and will actually work for those uses (which are not proven in humans), would we go on to see essential oil-resistant-bacteria? I believe we would. Especially with the way they are currently being used. Basically applying whatever oil for whatever infection (I am basing this on the fact that anytime I see someone requesting help with which oil to use, they routinely get 5-10 suggestions). That is exactly the way resistance to antibiotics occurs - too many antibiotics for non-specific indications and next thing you know a certain antibiotics doesn’t work for certain infection any longer.

Q: Is it safe to use oils along with modern medicines?

We know that these oils can affect the liver and cause the liver to metabolize other medications faster or slower. This could lead to medications not being as effective or potentially be more toxic. Some information is being gathered in adults to try to figure this out but kids are not “little adults” and we’ll likely need research in children before we can answer this for sure.

More from Doc Smitty on this topic:

New York Times Report: Are Essential Oils Safe For Kids?

Essential oils and their use on children

Essential oils and children - more questions answered