Pharmacology Consult

Essential oil use in pediatrics: Safe and effective?

Essential oils are increasingly available in pharmacies, health food stores and grocery stores, and because they are often viewed as “natural,” parents may easily believe that their use is safe and effective for a wide variety of indications. Parents and caregivers of your patients may ask you: “Are essential oils safe to use, and are they effective?”

Defined as volatile oils — hydrophobic liquids that can easily be vaporized or evaporated — essential oils are derived from plants and impart a characteristic and identifiable aroma or flavor of the plant, such as peppermint. The term “essential” relates to the “essence” of the plant’s aroma or fragrance. Essential oils are produced from steam distillation processes, and they are often added to a carrier oil for use in a specific product, such as a massage lotion or aromatherapy to be vaporized and inhaled. Essential oils are naturally produced by plants and perform various functions, such as attracting pollinators.

Essential oils are relatively inexpensive, impart a pleasant aroma and are often deemed “natural.” Advocates of essential oils for children suggest that they can be used for many conditions, including relief of anxiety and depression, improvement of sleep and relaxation, enhancement of immunity, relief of pain and treatment of head lice, among others. Commonly used essential oils include tea tree, lavender, eucalyptus, lemongrass, rosemary, clary sage, lemon, peppermint and cinnamon bark. Products are available in a variety of dosage forms, including vaporization and inhalation, topical (lotions, creams, soaps, etc.), bath and shower products and oral administration. Inhalation and topical administration are most commonly used. Essential oils can be inhaled using an aroma diffuser, or by placing a small amount of the liquid close to the nose, in a bowl of hot, steaming water or in a bath or shower.

Edward A. Bell

Essential oils have been studied for a wide variety of uses in adults and children. Most studies have included only adult participants and have significant methodological limitations, including lack of masking or placebo control, small enrollment numbers or lack of description of specific product purity, concentration or the plant species used. The lack of identification and description of specific product purity or content is important because essential oil active ingredient content and activity may vary significantly by the plant species or the part of the plant that was used. Useful data are available from a small number of studies that used gas chromatography-mass spectrometry (GC-MS) to identify and describe potential active ingredients in the essential oils.

It is also important to consider that essential oil products are not regulated as therapeutic drugs by the FDA, and thus are not assessed for efficacy and safety before marketing. Nor are essential oil products regulated for purity. Products are evaluated by their intended use and are regulated as cosmetics or supplements. Thus, essential oil products may contain varying amounts of the oil. Scientifically evaluated efficacy data to support product labeling claims and uses may be nonexistent for some oils. Supplement products cannot claim to “diagnose, treat, cure or prevent any disease.” If a manufacturer claims an essential oil has specific therapeutic benefits, the FDA does have authority to potentially limit or halt the manufacture and availability of the product.

Current evidence

Advocates of essential oil use for children may claim the products have a variety of benefits, but few data from controlled trials are available to support these claims.

Aromatherapy with lavender and ginger was evaluated in 94 children in a single-blind, placebo-controlled study conducted in a perianesthesia setting to assess distress relief. Lavender and ginger were evaluated because anecdotal evidence indicates that these essential oils may have calming and anti-nausea effects, respectively. Researchers used a validated tool to measure pain and distress. They found no difference between the treatment and control groups regarding distress relief, nor did they identify differences in caregiver satisfaction.

In a study to evaluate the topical application of several combined essential oils for the treatment of dysmenorrhea, 48 young adults (mean age, 24.9 years) were randomly assigned to treatment or placebo-control groups. The prepared active-treatment cream product contained lavender, clary sage and marjoram, and it was massaged into the participant’s lower abdomen from the end of the last menstruation to the beginning of the next menstruation. Researchers used validated numerical and visual rating scales to assess treatment effects. Significant differences were demonstrated, with the active treatment group experiencing greater relief of dysmenorrhea symptoms and a reduced duration of discomfort (P < .05). This study is notable for its use of GC-MS to identify active ingredients in the treatment (eg, linalyl acetate) that have analgesic and anti-inflammatory effects.

In a recently published systematic review of inhaled essential oils for sleep, the authors evaluated 15 studies, with lavender the most commonly assessed product. Eleven of these studies were randomized, and all studies included adult participants only (n = 409). Most of the studies demonstrated some benefit of inhaled essential oil use on sleep. However, study data were limited by methodological flaws, including variances in dose, method of administration and lack of identification of essential oil composition.

Several published studies have evaluated the potential analgesic actions of essential oils in children. A randomized controlled trial of 48 post-tonsillectomy children aged 6 to 12 years compared inhaled lavender (rubbed onto the subjects’ hands and then inhaled for 3 minutes) with a control group for potential analgesic benefits. Both groups additionally received acetaminophen. Researchers used a nonvalidated visual analog scale to measure pain intensity and nocturnal awakening due to pain for 3 days after surgery. No differences in pain intensity or frequency of nocturnal awakening were demonstrated between the treatment and control groups.

Malachowska and colleagues studied 73 children (mean age, 12.2 years) with insulin-dependent diabetes in a hospital setting for benefits of orange or lavender aromatherapy while patients conducted self-tests of blood glucose concentrations. Researchers used a validated visual analog scale to measure pain intensity over a 4-week period (no intervention for weeks 1-2, orange aromatherapy for week 3 and lavender aromatherapy for week 4), for a total of 647 individual pain intensity measurements. No differences in pain intensity were demonstrated during the study period among the active and control groups.

Essential oils have been suggested for the treatment of a common pediatric condition — head lice infestation. In the AAP’s 2015 review of head lice treatment, several specific essential oils are discussed as potential treatments, including Andiroba oil, tea tree oil and lavender. Because of variances in product content and purity, as well as a lack of safety and efficacy data, use of these essential oils is not recommended in this clinical report.

In a recently published study describing in an vitro analysis of five essential oils (bergamot, clove, lavender, tea tree and Yunnan verbena) on head lice viability (n = 1,239), Candy and colleagues found clove oil and Yunnan verbena oil to have significant effects on lice mortality (>75%), and tea tree oil exhibited low lice mortality. Because the study evaluated the in vitro effects of several oils, additional research is needed to establish any direct clinical benefit they may have.

Conclusions

Data from controlled scientific studies do not support many of the benefits that essential oil use is claimed to have. The dose of an essential oil is important to consider because effects may differ. For example, lavender oil may impart calming effects with smaller doses and stimulating effects with larger doses. Although essential oils may be viewed as natural and safe, significant adverse effects have been reported from their use, including skin rash and contact dermatitis from topical use (including worsening of eczema in one study), and accidental oral ingestion. Lavender and tea tree oils were suspected to result in prepubertal gynecomastia in three boys in a published report. More data from controlled studies are needed before essential oils can be widely recommended for use in the pediatric population. Pleasant aromas from essential oils may be beneficial for some children, although, as with all products and practices used in pediatrics, caution for the potential of ingestion, toxicity and adverse effects is warranted.

Disclosure: Bell reports no relevant financial disclosures.

Essential oils are increasingly available in pharmacies, health food stores and grocery stores, and because they are often viewed as “natural,” parents may easily believe that their use is safe and effective for a wide variety of indications. Parents and caregivers of your patients may ask you: “Are essential oils safe to use, and are they effective?”

Defined as volatile oils — hydrophobic liquids that can easily be vaporized or evaporated — essential oils are derived from plants and impart a characteristic and identifiable aroma or flavor of the plant, such as peppermint. The term “essential” relates to the “essence” of the plant’s aroma or fragrance. Essential oils are produced from steam distillation processes, and they are often added to a carrier oil for use in a specific product, such as a massage lotion or aromatherapy to be vaporized and inhaled. Essential oils are naturally produced by plants and perform various functions, such as attracting pollinators.

Essential oils are relatively inexpensive, impart a pleasant aroma and are often deemed “natural.” Advocates of essential oils for children suggest that they can be used for many conditions, including relief of anxiety and depression, improvement of sleep and relaxation, enhancement of immunity, relief of pain and treatment of head lice, among others. Commonly used essential oils include tea tree, lavender, eucalyptus, lemongrass, rosemary, clary sage, lemon, peppermint and cinnamon bark. Products are available in a variety of dosage forms, including vaporization and inhalation, topical (lotions, creams, soaps, etc.), bath and shower products and oral administration. Inhalation and topical administration are most commonly used. Essential oils can be inhaled using an aroma diffuser, or by placing a small amount of the liquid close to the nose, in a bowl of hot, steaming water or in a bath or shower.

Edward A. Bell

Essential oils have been studied for a wide variety of uses in adults and children. Most studies have included only adult participants and have significant methodological limitations, including lack of masking or placebo control, small enrollment numbers or lack of description of specific product purity, concentration or the plant species used. The lack of identification and description of specific product purity or content is important because essential oil active ingredient content and activity may vary significantly by the plant species or the part of the plant that was used. Useful data are available from a small number of studies that used gas chromatography-mass spectrometry (GC-MS) to identify and describe potential active ingredients in the essential oils.

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It is also important to consider that essential oil products are not regulated as therapeutic drugs by the FDA, and thus are not assessed for efficacy and safety before marketing. Nor are essential oil products regulated for purity. Products are evaluated by their intended use and are regulated as cosmetics or supplements. Thus, essential oil products may contain varying amounts of the oil. Scientifically evaluated efficacy data to support product labeling claims and uses may be nonexistent for some oils. Supplement products cannot claim to “diagnose, treat, cure or prevent any disease.” If a manufacturer claims an essential oil has specific therapeutic benefits, the FDA does have authority to potentially limit or halt the manufacture and availability of the product.

Current evidence

Advocates of essential oil use for children may claim the products have a variety of benefits, but few data from controlled trials are available to support these claims.

Aromatherapy with lavender and ginger was evaluated in 94 children in a single-blind, placebo-controlled study conducted in a perianesthesia setting to assess distress relief. Lavender and ginger were evaluated because anecdotal evidence indicates that these essential oils may have calming and anti-nausea effects, respectively. Researchers used a validated tool to measure pain and distress. They found no difference between the treatment and control groups regarding distress relief, nor did they identify differences in caregiver satisfaction.

In a study to evaluate the topical application of several combined essential oils for the treatment of dysmenorrhea, 48 young adults (mean age, 24.9 years) were randomly assigned to treatment or placebo-control groups. The prepared active-treatment cream product contained lavender, clary sage and marjoram, and it was massaged into the participant’s lower abdomen from the end of the last menstruation to the beginning of the next menstruation. Researchers used validated numerical and visual rating scales to assess treatment effects. Significant differences were demonstrated, with the active treatment group experiencing greater relief of dysmenorrhea symptoms and a reduced duration of discomfort (P < .05). This study is notable for its use of GC-MS to identify active ingredients in the treatment (eg, linalyl acetate) that have analgesic and anti-inflammatory effects.

In a recently published systematic review of inhaled essential oils for sleep, the authors evaluated 15 studies, with lavender the most commonly assessed product. Eleven of these studies were randomized, and all studies included adult participants only (n = 409). Most of the studies demonstrated some benefit of inhaled essential oil use on sleep. However, study data were limited by methodological flaws, including variances in dose, method of administration and lack of identification of essential oil composition.

PAGE BREAK

Several published studies have evaluated the potential analgesic actions of essential oils in children. A randomized controlled trial of 48 post-tonsillectomy children aged 6 to 12 years compared inhaled lavender (rubbed onto the subjects’ hands and then inhaled for 3 minutes) with a control group for potential analgesic benefits. Both groups additionally received acetaminophen. Researchers used a nonvalidated visual analog scale to measure pain intensity and nocturnal awakening due to pain for 3 days after surgery. No differences in pain intensity or frequency of nocturnal awakening were demonstrated between the treatment and control groups.

Malachowska and colleagues studied 73 children (mean age, 12.2 years) with insulin-dependent diabetes in a hospital setting for benefits of orange or lavender aromatherapy while patients conducted self-tests of blood glucose concentrations. Researchers used a validated visual analog scale to measure pain intensity over a 4-week period (no intervention for weeks 1-2, orange aromatherapy for week 3 and lavender aromatherapy for week 4), for a total of 647 individual pain intensity measurements. No differences in pain intensity were demonstrated during the study period among the active and control groups.

Essential oils have been suggested for the treatment of a common pediatric condition — head lice infestation. In the AAP’s 2015 review of head lice treatment, several specific essential oils are discussed as potential treatments, including Andiroba oil, tea tree oil and lavender. Because of variances in product content and purity, as well as a lack of safety and efficacy data, use of these essential oils is not recommended in this clinical report.

In a recently published study describing in an vitro analysis of five essential oils (bergamot, clove, lavender, tea tree and Yunnan verbena) on head lice viability (n = 1,239), Candy and colleagues found clove oil and Yunnan verbena oil to have significant effects on lice mortality (>75%), and tea tree oil exhibited low lice mortality. Because the study evaluated the in vitro effects of several oils, additional research is needed to establish any direct clinical benefit they may have.

Conclusions

Data from controlled scientific studies do not support many of the benefits that essential oil use is claimed to have. The dose of an essential oil is important to consider because effects may differ. For example, lavender oil may impart calming effects with smaller doses and stimulating effects with larger doses. Although essential oils may be viewed as natural and safe, significant adverse effects have been reported from their use, including skin rash and contact dermatitis from topical use (including worsening of eczema in one study), and accidental oral ingestion. Lavender and tea tree oils were suspected to result in prepubertal gynecomastia in three boys in a published report. More data from controlled studies are needed before essential oils can be widely recommended for use in the pediatric population. Pleasant aromas from essential oils may be beneficial for some children, although, as with all products and practices used in pediatrics, caution for the potential of ingestion, toxicity and adverse effects is warranted.

Disclosure: Bell reports no relevant financial disclosures.