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.”
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.”