Children get sick. It's one of those facts of life, as unavoidable as paying taxes. Kids also are sick more often than most adults. For instance, a child will contract on average six to eight colds a year, versus four colds a year for an adult-unless that adult spends lots of time in close contact with sniffling children.
Fortunately, most of the run-of-the-mill childhood illnesses are self-limiting and viral in origin. This means two things. One, such illnesses resolve on their own, without any intervention. Two, antibiotics-the most commonly used pediatric medication-won't help. Antiviral medications treat specific illness, such as influenza A viruses or herpes simplex viruses and are usually reserved for more severe cases or for children with weakened immune systems who are at risk for serious disease.
This is where herbs come in. Some herbs, such as echinacea and astragalus, can boost immune function. Other herbs can act to reduce symptom severity or hasten the healing process. In other words, while we still don't have a cure for the common cold, we have tools to shorten its duration and severity.
The Herbal Solution
Not all herbs are safe. And not all adult herbs are appropriate for children. Products designed specifically for children need to fulfill several goals:
1) They must contain herbs that are safe for children. This begs the question of how to know which herbs are safe for kids. Traditional use counts for a lot here. An herb that's gentle and has been used for thousands of years without reported ill effects counts, in my book, as safe. I also rely on books by experts to provide safety guidelines. Examples include: Phytotherapy in Paediatrics by Heinz Schilcher, the American Herbal Products Association's Botanical Safety Handbook edited by Michael McGuffin, et al, Herb Contraindications and Drug Interactions by Francis Brinker and the Complete German Commission E Monographs recently released in English by the American Botanical Council. These books may not specify which herbs are appropriate for children, but mention of potential serious side effects and contraindications is a good tip that kids shouldn't take this herb.
Fortunately, a large number of herbs fall into the pediatric herbal materia medica. In treating my own children, I've yet to feel stymied that I could find an appropriate herb to ease a particular condition. Botanicals I often use include astragalus, catnip, California poppy, cleavers, chamomile, dandelion, echinacea, elder, eyebright, feverfew, garlic, ginger, horehound, hyssop, lemon balm, licorice, marshmallow, meadowsweet, mullein, nettle, Oregon grape root, passionflower, peppermint, reishi and shiitake mushrooms, thyme, usnea and yarrow.
2) The herbs you select should be effective for the condition in question. Here we're limited by the limited number of clinical trials. More trials involve adults than children, but some herbs have been proven safe and effective for kids. Nevertheless, you should gather whatever evidence you can find: test tube studies, clinical trials and the test of historical use. In order for the general public and the medical establishment to accept herbal medicines, we will need many more well-designed clinical trials. Studies will also help practitioners know more about potential side effects, drug interactions and optimum dosing.
3) Herbs included in formulas should be either ethically wildcrafted or organically cultivated. I prefer the latter. Special attention should be paid to herbs considered threatened in the wild. If you're not sure which herbs these might be, contact United Plant Savers at P.O. Box 420, Barre, VT 95649 or check out its website at www.plantsavers.org.
4) The herbs should be of good quality and made into forms such as glycerites before volatile ingredients have been lost. If the final product fails to capture the active ingredients, then efficacy falls to zero. Product testing prior to release on the market can insure adequate levels of market constituents. I'd like to see fewer media reports on how someone tested a batch of the herb and found it contained little to no active constituents. Poor quality products waste consumers' money, disillusion everyone, give people suspicious of herbs ammo and ultimately hurt manufacturers' sales.
5) The preparation should come in a form appropriate for children. Whether or not children should take alcoholic extracts is a murky issue. No one knows for certain the effects of small amounts of alcohol on kids. Some experts note that a single ripe banana contains as much alcohol as an adult dose of an alcoholic extract. Others prefer to play it safe and instead give children glycerites. Glycerine has the advantage of tasting naturally sweet. Most pediatric herbs extract well into glycerine. Some, such as California poppy and usnea, do not. Children over the age of seven can usually swallow small tablets and capsules. Toddlers and preschoolers run the risk of choking on or aspirating them.
6) The preparation should taste good. If it does not, some harried parent will be trying to browbeat an already cranky child into taking a bitter medicine. Pleasant taste enhances compliance. You can often make a formula taste good by extracting the herbs into glycerine and blending in pleasant-tasting herbs such as peppermint, lemon balm, fennel and licorice. Honeyed syrups work too, but are not appropriate for children under the age of one year. In general, herbs aren't recommended for infants. Older infants who take solid foods can take small amounts of gentle herbs. Because babies can quickly become seriously ill, parents of sick infants should check in with their physicians.
7) The dose should be appropriate for children. To estimate dose, it is more accurate to use weight rather than age. Clark's Rule converts adult doses for a 150 pound person as follows: Divide the child's weight in pounds by 150, then multiply this fraction times the adult dose.
A big question is "Do we need more children's products on the market?" Sunny Mavor, founder of Herbs for Kids, a company that makes herbal formulations for children, said, "The kids' herbal niche is full." Her concern is that, after reading articles on the growth potential for children's products, "newcomers are flooding the market with mediocre products." The quality issue extends to adult products as well and is one the industry will have to deal with as more companies, particularly giant companies for whom herbs are a new venture, jump on the herbal products bandwagon. And as the herb industry grows, FDA will become more vigilant and more conventional medical professionals will become concerned about the efficacy and safety of the products their patients consume.
A Parent's Wish List
Issues of market capacity and quality aside, what do parents want in the way of children's formulas? Cold and flu remedies top the list here. Fortunately many of the herbs used here have undergone scientific research. Some studies, including a couple on echinacea and elderberry, have included children in the study population. You can subdivide the cold/flu category into herbal formulas that support the immune system and those that reduce specific symptoms such as nasal congestion, sore throat, cough and associated pinkeye. Not all of these remedies need be swallowed. For instance, herbs can be incorporated into nose drops or herbal steams for nasal congestion. Herbs can be used in sprays and gargles for sore throats or used as an eyewash for pinkeye.
After respiratory ailments come gastrointestinal ailments: colic, stomachache, nausea, vomiting and diarrhea. Several studies have shown that ginger can combat nausea. Peppermint and chamomile also help quell queasy stomachs. A study on colicky infants found a tea of chamomile, vervain, licorice, fennel and lemon effective in relieving symptoms. Again, you have to be very careful in recommending herbs to infants. Berberine has activity against a variety of bacteria and some of the studies have included children. Oral rehydration drinks could potentially marry the benefits of water, sugar and electrolytes with herbs that ease vomiting and diarrhea.
And don't forget that children don't have to take herbs by mouth to reap some of the benefits. Many herbal constituents cross the skin and can be used externally for children's conditions. This could include first aid salves for cuts and scrapes, gels for burns, diaper rash ointments, gels for chicken pox or herpes that contain herbs active against these viruses and herbs to relieve the discomfort, eczema creams, acne cleansers and gels. Herbal bath salts and oils designed for kids could contain combinations that alleviate cold and flu symptoms, chicken pox, stomachache, headache and sleeplessness. The same goes for massage oils.
This brings me to the issue of essential oils, which I find useful for children as additions to baths, steams and massage oils. But they need to be used in lower concentrations for kids and with caution. These concentrated volatile oils are extremely dangerous to children if swallowed or applied near the nose and mouth of infants and toddlers. Safety precautions must be taken by way of label warnings and childproof caps.
On the whole, I think that good quality, gentle herbal products have much to offer children and their parents. Formulation and manufacturing of these products must be done with scrupulous regard to quality, efficacy and safety. NW
About the author:
Linda B.White, M.D., is a freelance writer and editor and the mother of two children. She co-authored Kids, Herbs, and Health, released this year from Interweave Press.
