In typical U.S. fashion, when we hear something is good for you suddenly it’s good for everyone. Support for medical cannabis and CBD (or cannabidiol) in the U.S. is enjoying an all-time “high.” We are seeing the huge influx of CBD everywhere in the country. But what about CBD for children?
Cannabis, Hemp, and the "Entourage Effect"
Cannabidiol (CBD) is the second most commonly known chemical and THC is the most commonly known chemical, but there are over 180 known chemicals in cannabis. Both hemp and cannabis (aka pot/marijuana) come from the same plant – just different parts and cultivation.
Cannabis rivals broccoli, green tea, and cacao for its rich flavonoid content. The healing interplay of all these various compounds is sometimes referred to as “entourage effects.” Whole plant medicine has the advantage of harnessing the full spectrum of a plant’s therapeutic agents. 1 When Cannabis Sativa is bred for high THC, it’s referred to as cannabis and often called Cannabis Indica. However, when that same species is bred for industrial purposes (paper, food, clothing, oils, topical ointments, etc.), it’s called hemp.
Hemp contains CBD along with approximately 0.3 percent or less THC, but medical cannabis is cultivated to contain 5-20 percent THC, with some strains going up to 30 percent. Originally Cannabis Sativa was not about getting high, but during our “prohibition and legality issues” growers created higher and higher THC varieties for recreational use. Many professionals feel that CBD will always be more important than THC but the full spectrum effect of all the substances in these plants is just now being studied.
CBD and the Farm Bill
CBD is labeled biologically active but not psychologically active (doesn’t get you high) whereas THC is biologically and psychologically active but dose dependent as low doses do not get people high. With the passage of the Farm Bill recently, the U.S. has clarified hemp’s options in the country, and we will see more of it on the shelves of every store as it’s now legal to grow anywhere. Legalization of medical cannabis is expanding with every election.
CBD and Safety
Specific questions by the public often come later such as “is it safe for everyone?” and part of that question gets more complicated when you ask “is it safe for kids?” Many medical professionals get uncomfortable when the topic of cannabis and children is broached.
Other questions parents ask are “will my child get high, or when is it right to give my child CBD, how do I know how much to give, what is a good brand, is there a special kind for kids?” These are just some of the questions people raise when weighing whether to give their children CBD hemp oil supplements.
Yes, it’s true that parents have been giving cannabis/ hemp CBD to their young children for years now. CBD has garnered the international attention that it has, largely due to its use in children with seizures. Dr. Sanjay Gupta made CBD use for children famous in 2013 on his CNN special “Weed.” What is still up for grabs, is the question“ is CBD good for all children for any reason?” What about ADD/ ADHD, growing pains, and is it good for kids for sleep, anxiety, and appetite issues, etc. This article will not answer every question. We are just starting to do the proper research that has some long-term outcomes associated with it too, but we will examine what do know so far.
Children are exposed to human cannabinoids for the first time through their mom’s endocannabinoid system (endocannabinoids are human cannabinoids produced by the body) found in their mother’s breast milk. The endocannabinoid system (ECS) is responsible for maintaining balance within the body by modulating functions like appetite, sleep, and immune response in adults and children alike. It is our way of maintaining “homeostasis” or balance in our environment day to day.
The doses that are released into our system changes based on the stressor, but there are receptors in every organ and system in the human body except the brainstem, which is why breathing, and heart rate aren’t detrimentally affected, and for cannabis and hemp CBD there is no known overdose. That doesn’t mean that CBD is not biologically active and interactive with other substances and the liver’s ability to clear them.
The Endocannabinoid System
We don’t know how to assess the level of development or “health” of the endocannabinoid system in humans, but we can make some assumptions. We know for a fact that if a child is not breast-fed that there might be issues affecting their immune system and they will not get endocannabinoids without breast milk. In the same way, we know that a C-section changes how a child’s gut flora develops versus a vaginal delivery, with the exposure to the bacteria that starts the gut working. We know that an infant’s immune system takes almost a full two years to develop as they grow, and the assumption is that it takes a while for the ECS to mature but we don’t know how long.
The ECS and Child Development
A child’s growth depends on many variables, which is one of the reasons that how, and when, we use substances like CBD need to be assessed carefully, because we don’t know how or even if it will affect their development in any way. One neuropsychiatric researcher said “endocannabinoid signaling is an important determinant of maturation of the human brain… it seems quite likely that disruption of normative endocannabinoid signaling during adolescence may have long standing consequences on the adult brain function.” These concerns have been slanted more towards THC vs CBD, but we don’t have lots of hard data on either.
Let’s clarify the term “biologically active.” It doesn’t mean that it doesn’t have any adverse effects, which is how it often is viewed, as harmless. It interacts in the body and has to be processed through the liver just as any chemical substance does. We also don’t know how much stronger or weaker that CBD is than a human cannabinoid, of which there are several that are being researched, 2AG and anandamide. We also don’t know exactly how CBD interacts with our human cannabinoids but we are learning.
The growing brain is different from the adult brain, the way the neurotransmitters and structure are changing and have an increased sensitivity to changes and exposures in the environment, which result in a vulnerability that is lessened as the child reaches adulthood. What we do know is that currently, the effects of CBD have not been a major problem in adults and for many children with serious disease. Using it in children really comes down to is: Are CBD and cannabis, with or without higher levels of THC, a better answer than giving pharmaceutical drugs.
Giving CBD to a child should be carefully discussed in relationship to the other therapies that can be used or offered. Because we don’t know long term how this will affect a child’s ECS, or even if it will cause any major issues. However, looking at all the other options and pursuing those that have the best potential effect is crucial.
Sayer Ji a spokesperson for cannabis legalization and creator of Green Med Info, one of the largest medical databases for natural substances, was asked about research and cannabis. He said:
“Due to regulatory barriers, lack of access, absence of funding, and overall ‘cannaphobia,’ scientific studies about cannabis lag well behind anecdotal accounts, although things are slowly moving in the desired direction. In the United States, scientists must get approval from the Drug Enforcement Agency (DEA) and Food and Drug Administration (FDA) to perform medical cannabis research, which is often an insurmountable hurdle. Even in states where medical marijuana has been decriminalized, federal regulations still prevent researchers from using that same product.”
He goes on to the core of the issue in the United States saying
“Sadly, any natural substance that supports our innate ability to heal faces adamant opposition because it offers no promise of profit for our government or medical industries. The U.S. government is deplorable in its dishonesty about medical marijuana, clinging to its patents for medical use while at the same time claiming it has no medical value. (The government has the only patent allowed for medical cannabis for its neuroprotective effect against most known diseases as of 2003.) For a government that loves denying weed’s medicinal uses, it sure boasts an abundance of scientific studies about the health benefits on its prime research database, PubMed (more than 16,000 references come up under the term ‘cannabis.’)”4
Cannabis Studies in Children
Cannabis/CBD studies in children have been difficult to perform for reasons mentioned above and because it’s about everchanging small humans, so keeping study variables consistent in children is much more difficult. And there are more ethical considerations with children.
Researchers have not been allowed to research these compounds because they are Schedule I drug which says there are “no medical reasons or uses for these compounds and high potential for abuse” according to the U.S. government. This is even though it’s been proven that it is NOT a gateway drug and according to integrative physician Dustin Sulak, DO, about 10 percent of marijuana smokers become addicted (similar to sugar addiction).
Of course, this must be weighed against potential health benefits on a case by case basis. For example, if you’re suffering from cancer and you’re near death, and cannabis offers the potential for tumor-shrinkage, addiction may not be your most immediate concern.
There have been many observational and interview studies. For example: a descriptive study of kids 13-23 years old seen between December 2015 through June 2017, at Children’s Hospital Colorado for Inflammatory Bowel Disease (IBD). The information was obtained from chart review, electronic and interview self-report, and serum cannabinoid levels. The results of the 99 participants, was cannabis use by adolescents and young adults with IBD is common and perceived as beneficial. It was suggested that guidelines for screening, testing, and counseling of cannabis use should be developed for patients with IBD.6
This brings us to how CBD first gained attention via a young child with a severe seizure disorder. After Charlotte Figi was born, she had her first seizure that lasted a full 30 minutes. As she got older, her seizures increased in frequency and severity, up to the point where she was having multiple seizures a day, each lasting up to four hours. By age two, she started showing signs of severe cognitive decline and Autistic type behavior. She would have aggressive outbursts, injure herself, and be reluctant to make eye contact with people around her. By age three, Charlotte was wheelchair bound, stopped talking, and couldn’t eat. She was finally diagnosed with Dravet’s Syndrome – an extremely rare and debilitating form of epilepsy.
Charlotte was getting increasingly worse, despite at one time being on seven different types of heavy-duty medications. By age five, she was suffering from up to 300 grand mal seizures a week and her heart stopped several times during seizures. They put her in a medically induced coma to give her body a chance to rest and recuperate but doctors told her parents that there was not much more that can be done.
Charlotte’s grandfather had read about several success stories and testimonials from other parents that were using cannabis to help treat their children. They succeeded in getting some R4 extract cannabis oil for Charlotte and the results were almost immediate, from seizing 300 times a week to NO seizures that entire first week. After that Charlotte seized less frequently. Her parents started looking for someone that could supply them with cannabis oil on a longer term basis.
The Stanley Brothers
The Stanley Brothers were medical marijuana growers and dispensers from Colorado. They created a Hybrid strain of medical cannabis (a mix between industrial hemp and low THC cannabis) which is unique in that it maintains a constant 30:1 of cannabidiol ( CBD) to tetrahydrocannabinol (THC) ratio. The low THC content combined with a high level of CBD that makes this strain helpful for use in children such as Charlotte.7
This story and others told by medical professionals using cannabis and CBD in children, are called anecdotal accounts and there are many thousands of stories. There have been more studies now but often they are done on pediatric cancer clients or complex seizure disorders in a “last resort” option by parents and the variables for each case are different.8 There are good results with pain, nausea, anxiety, and appetite control and anecdotal accounts of resolution of cancers, seizures and other conditions with THC/CBD and researchers are finally accumulating information in this country and in other countries that will help us know best how to use these compounds. This is a partial listing of the studies done, mostly on adults, for different conditions.9
When to Use CBD for Children
Which brings us to the question of how do you decide when and how to use CBD in children? When a child and parents are faced with a health challenge, a simple template can be used to help determine options for treatment.
Dr. Bonnie Goldstein is a specialist in cannabis medicine in Los Angeles. She is a pediatrician and worked in pediatric emergency medicine for many years and has successfully treated thousands of adult and pediatric clients with cannabis medicine.
Goldstein is author of the book, Cannabis Revealed, and is a lecturer around the world. She commented on the risks of cannabis (THC in particular) saying, “As a pediatrician, medical cannabis specialist, and the mother of a teenager, I am strongly opposed to healthy or otherwise ‘typically’ developing children and adolescents using cannabis. I am also opposed to cannabis use (and pharmaceutical use) in children and adolescents with mild illnesses, such as occasional anxiety or sleep disturbance, as other treatments modalities (talk therapy, exercise, proper diet, sleep hygiene, etc.) can and should be used in these instances.”
“However, children and adolescents with moderate to severe medical conditions that either significantly disrupt quality of life or are life-threatening or life-limiting should absolutely have the option of using cannabis under medical supervision.”11
There are a variety of application methods, like pure hemp oils, tinctures, liquids, topical salves, and should be raw, decarboxylated, and filtered hemp oil that lists the milligram per dose on the label. Because children are smaller than adults, it is advised to decrease serving sizes as appropriate for their weight. It is a good rule of thumb to start low and go slow. Working with a provider who can help you with options and microdosing (small low doses more frequently vs big doses infrequently) and help you with supplements and other options to optimize your child’s return to his or her best health.
There are many companies selling CBD rich oil from hemp that is legal in all states, but you must research it. Charlotte’s Web and other CBD products are available in many stores but you need to make sure that they have been grown free of chemical fertilizers, pesticides, and herbicides to keep residual contamination out of the hemp oil. To further ensure the safety of the product, the hemp oil supplements should be lab tested to check for mold, mildew, fungus, yeast, E.coli, salmonella, mycotoxins, heavy metals, and residual solvents to protect you and your children’s health from any contamination. The state where it’s been grown should have a certificate stating they meet the state standards. The products should have few, if any, additional ingredients beyond pure hemp oil.
STEPS TO GET YOUR CHILD HELP
Get as much information about the problem as possible. Take ADD/ADHD for example. There are seven different types of ADD/ADHD and there is a great book by Dr. Daniel Amen that will help determine what part of the brain is being affected. Perhaps getting an evaluation by a school psychologist to see where the child needs specific types of support might help.
Change what is in your control, and diet is the most important. Dr. Amen, in his book, goes into diet changes to support brain function. Sleep, exercise, hydration are all needing to be optimized for a developing brain. IF the desired change hasn’t been achieved, go to the next step.
Supplements are helpful and Dr. Amen goes over specific supplement depending on the type of ADD/ ADHD. Additionally non-invasive therapies, like sensory integration, cranial sacral therapy m:ay be helpful. At that point if nothing has helped then proceed to step four.
The issue of drugs or substances might be appropriate but often it’s the first thing reached for in a more conventional medical setting. Many people want to put CBD in a class with supplements but with children it would be safer to put it in the drug category until we know more and not equal to something like B vitamins and magnesium.
In Step 4 we are talking about pharmaceutical intervention that will change the child’s brain and behavior and using CBD may be much more supportive than Adderall or Ritalin. But unless steps 1-3 have been tried and sustained for more than a couple weeks, moving to meds are not the answer until necessary. Obviously, if the situation is more urgent and serious, like seizures, then this template changes but going back to step 1-3 when time and situation permits may determine long term outcome as those steps are essential.