Parent perspectives on CBD use in children
CBD is short for cannabidiol, a chemical compound naturally found in marijuana and hemp. CBD is sold as oils, balms, gummies and other products. The C.S. Mott Children’s Hospital National Poll on Children’s Health asked a national sample of parents of children 3-18 years about the use of CBD in children.
Most parents say they either don’t know much about CBD use in children (46%) or they never heard of it prior to this poll (34%); 17% report knowing some, and only 3% say they know a lot about CBD use in children. Most parents (71%) have never used a CBD product themselves, while 24% have tried CBD and 5% use a CBD product regularly.
Parents say the factors that would be very important in deciding whether to give their child a CBD product are side effects (83%), if it was tested for safety in children (78%), how well it works in children (72%), recommendation of their child’s doctor (63%), approval of the US Food and Drug Administration (58%), and product reviews (41%).
Three-quarters of parents (73%) think CBD may be a good option for children when other medications don’t work. Most parents (83%) think CBD products should be regulated by the FDA, and three-quarters (74%) say CBD for children should require a doctor’s prescription. One-third of parents (35%) think taking CBD is basically the same as using marijuana.
Over 90% of parents have never given or considered giving their child a CBD product. Only 2% have given their child a CBD product, while 4% have considered CBD for their child; 1% say their child has used CBD without their permission.
Among parents who have given or considered giving CBD for their child, only 29% say they talked with their child’s healthcare provider about CBD use. Parents’ most common reasons for giving or considering CBD for their child include anxiety (51%), sleep problems (40%), ADHD (33%), muscle pain (20%), autism (19%), and to make their child feel better in general (13%).
- 3 in 4 parents say CBD for children should require a doctor’s prescription.
- Among the 7% of parents who have given or considered giving their child a CBD product, only one-third talked with their child’s healthcare provider about CBD use.
- While 83% of parents think CBD products should be regulated by the FDA, only 58% say FDA approval would be very important to their decision about whether to give a CBD product to their child.
Products containing cannabidiol (CBD) are sold online and in stores that specialize in CBD products, as well as in supermarkets and drugstores. CBD products come in many forms, including oils, topical ointments, tinctures, vaping, edibles and gummies. Some CBD products are marketed for children.
This Mott Poll demonstrates that even though CBD products are widely available, parents have limited knowledge about them and most have not even considered having their child use a CBD product. However, three-quarters of parents appeared to be open-minded about CBD products as an option when other medications don’t work.
Parents also demonstrated some inconsistencies in their attitudes about CBD products for children, including the regulation of these products. For example, 83% indicated CBD products should be regulated by the US Food and Drug Administration (FDA), yet only 58% rated FDA approval as very important to their decision about using CBD for their child. Currently, only one CBD product has received FDA approval for use in children, as a treatment for a rare form of epilepsy. It’s unclear if parents recognize that none of the CBD products they see in stores are regulated by the FDA.
Parents indicated that side effects were their top consideration in determining whether they would have their child use a CBD product. There have been some reports of CBD’s side effects, including sedation and generalized fatigue, insomnia, and gastrointestinal disturbances. However, because CBD products have not undergone rigorous testing to achieve FDA approval, the rate and severity of side effects is unclear — both for short-term side effects like nausea, vomiting and abdominal pain, as well as potential long-term effects like liver toxicity. Other side effects may occur if CBD causes an interaction with other medications the child is taking. Because of the relatively low use of CBD products in children, their side effects in children are even less known or understood.
One-third of parents in this Mott Poll believe that taking CBD is basically the same as using marijuana, which is consistent with parents’ overall limited knowledge about CBD products. Marijuana contains a psychoactive substance, tetrahydrocannabinol (THC), that produces the “high” effect. To be legal under the federal Controlled Substances Act, CBD must have less than .3% of THC. Many CBD products purport to contain close to 0.0% THC. However, the lack of regulation of CBD products calls into question whether there is sufficient quality control in the production of various products to ensure that the amount of THC is consistent with what is reported on the product labeling. Thus, it is difficult for parents to know exactly what they are buying and how much THC their child may be exposed to.
A small but not negligible proportion of parents have given or considered giving their child a CBD product. Parent report of CBD use for children reflected the conditions noted in many CBD promotional materials, including anxiety, sleep problems, ADHD, autism, and seizures. A subset of parents considered CBD products to make their child feel better in general, not targeting any particular symptom or condition.
The role of child health providers in directing CBD use is another area of inconsistency highlighted in this Mott Poll. Although three-quarters of parents felt CBD for children should require a doctor’s prescription, only 63% rated the recommendation of their child’s doctor as a very important factor in deciding whether to give their child a CBD product. Moreover, among parents who tried or considered CBD for their child, only 29% discussed the topic with their child’s healthcare provider. It’s important for parents to inform their pediatrician or other healthcare providers about use of CBD products so that any potential side effects can be addressed.
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.”
CBD and parents’ attitudes about giving it to children
Most parents say CBD for kids should require a doctor’s prescription, while 7% have given or considered giving it to children for medical reasons.
Products containing cannabidiol, or CBD, a chemical compound naturally found in marijuana and hemp, have been used in recent years to help adults manage medical issues like chronic pain and mood disorders.
While its use is much more limited in children, some CBD products have been marketed for minors as well.
But despite the wide availability of CBD, parents have limited knowledge about it, with a third thinking it’s the same as using marijuana, suggests the University of Michigan Health C.S. Mott Children’s Hospital National Poll on Children’s Health .
And while the majority haven’t even considered having their child use a CBD product, three in four parents appeared open-minded about the possibility, saying it may be a good option for medical care when other medications don’t work.
“There is very little data on how CBD may impact children’s developing brains and only certain types of situations when it’s considered for pediatric medical reasons. Still, CBD has become much more accessible and widely advertised, with some companies claiming benefits for kids,” said Mott Poll co-director Sarah Clark, M.P.H.
The nationally representative poll report is based on responses from 1,992 parents of children 3-18 years surveyed in October 2021.
Seven percent of parents have given or considered giving their child a CBD product, with the most common reasons including anxiety (51%), sleep problems (40%), attention deficit hyperactivity disorder, or ADHD, (33%), muscle pain (20%), autism (19%) and to make their child feel better in general (13%).
Among parents who say they’ve given or considered giving CBD to their child, less than a third have talked with their child’s health care provider about CBD use.
And while three quarters of parents felt CBD for children should require a doctor’s prescription, only 63% rated the recommendation of their child’s doctor as a strong factor in deciding whether to give their child a CBD product.
“Anecdotal stories of children benefiting from CBD may sound alluring but just because it’s a plant product doesn’t necessarily make it safe or effective in children.”
“Our poll suggests most parents have very limited knowledge about CBD products,” Clark said. “It’s important for parents to inform their pediatrician or other healthcare providers if they’re considering CBD use in kids so that they can discuss potential risks.”
Most parents cited side effects as the most important factor in deciding whether to give their child a CBD product. Other considerations included whether it was tested for safety in children, how well it works in children, approval of the U.S. Food and Drug Administration and product reviews.
The majority of parents have never used a CBD product themselves, while 24% have tried it and 5% use a CBD product regularly, according to the poll report.
Many unknowns on side effects
CBD products are sold online and in stores that specialize in CBD products, as well as in supermarkets and drugstores and come in many forms, including oils, topical ointments, vaping, edibles and gummies.
The FDA has only approved one purified form of the drug substance CBD for children to treat rare seizures that don’t respond to medication. Studies have also looked at CBD use in children with hyperactivity, anxiety, sleep problems and depression but research remains limited.
Side effects could include sleepiness, fatigue, and diarrhea, and experts have raised concerns about CBD’s potential to interact with other medications and adversely impact the liver. But since CBD products have not undergone rigorous testing for FDA approval, the rate and severity of side effects remain unclear, particularly for children.
To be legal, CBD must have less than .3% of tetrahydrocannabinol, commonly referred to as THC, the chemical that produces most of marijuana’s psychological and “high” effects. Many manufacturers purport to contain close to 0% THC, but the lack of regulation of CBD products also raises questions about quality control in the production of various products, experts say.
“Parents who see promotional content claiming CBD benefits kids with certain conditions should be aware that products seen online or in stores are not regulated by the FDA and may be mislabeled,” Clark said. “This makes it difficult for parents to know exactly what they’re buying and what their child may be exposed to.
“Anecdotal stories of children benefiting from CBD may sound alluring but just because it’s a plant product doesn’t necessarily make it safe or effective in children. We need more evidence to understand CBD’s short- and long-term side effects in kids.”