Do no harm: CBD should be used with caution in kids

Given the growing interest from patients and parents, it is important to be aware of the potential dangers of CBD use in kids.

Editor’s note: This is an opinion piece; the views expressed are the author’s own and do not necessarily represent the views of The DO or the AOA.

As a child neurology resident, I see many patients with seizures. Recently in clinic, I saw a 5-year-old boy with a new diagnosis of epilepsy. Almost immediately, the conversation about treatment options shifted to cannabidiol (CBD) oil, which the family had found online.

Despite all the attention given to medical marijuana and related products, using CBD oil for most types of epilepsy is unproven and may even cause harm. Given the growing interest from patients and parents, it is important for osteopathic physicians to be aware of the potential dangers of CBD use in kids.

Pharmaceutical vs. supplement

Last year, the FDA approved Epidiolex, a purified, plant-based form of CBD oil, for the specific indication of refractory epilepsy due to Dravet syndrome or Lennox-Gastaut syndrome in children over the age of two. This is the first and only product derived from the marijuana plant to receive FDA approval.

But not all CBD oil is the same. Nor is CBD beneficial for all forms of epilepsy. Helping your patients understand the difference between the FDA-approved medication and the unregulated CBD oil sold in some states is a first step in shared decision making.

Other critical considerations include:

  • Concentration–Several studies have found that many artisanal CBD oils sold online have minimal CBD content. A 2017 JAMA study showed 69% of 84 products tested were mislabeled; 26% contained less CBD than the label claimed.

    The FDA sent warning letters in 2016 to eight retailers regarding their “CBD” oils because some contained less than 1% CBD. Due to the lack of quality control and regulation, there can also be variation in CBD content within the same product.

  • Intoxication–In addition to variable CBD content, impure products present a danger to pediatric patients because some mislabeled oils contain delta-9-tetrahydrocannabinol (THC), the main psychoactive ingredient of marijuana.

    The 2017 JAMA study found 21% of the CBD oils contained THC. A child taking a CBD oil with a high THC content could become intoxicated and potentially develop significant symptoms and require hospitalization.

  • Long-term safety–There is also the risk that a child could be exposed to low levels of THC over a long period of time by using mislabeled CBD oil. The long-term effects of THC exposure on the pediatric brain are well-known and include memory, attention, and other cognitive impairments that persist even after THC use is stopped.

    Furthermore, there is a correlation between chronic THC use and increased risk of psychotic disorders, including schizophrenia.

Natural and healthy aren’t the same

Although CBD oil is natural, it still has side effects. Clinical trials have shown that patients taking the FDA-approved, pharmaceutical-grade CBD oil experienced more gastrointestinal issues and sleepiness than patients in the placebo group.

In one of the largest trials looking at seizure reduction in patients with Lennox-Gastaut syndrome, seven patients had to leave the study due to adverse events.

Natural does not mean harmless. Botulinum toxin is one of the deadliest natural poisons in the world, but when botulinum toxin is safely diluted and regulated, it becomes an effective, FDA-approved treatment for various medical conditions.

Beware the buzz

Many patients report anecdotal benefits from taking CBD oil. Currently, there is compelling evidence that pharmaceutical-grade CBD oil can help some children with severe epilepsy syndromes who did not respond to other therapies.

This data cannot be extrapolated to children like my clinic patient with other types of epilepsy or other medical conditions. Moreover, mislabeled CBD oil with variable CBD content and the presence of other contaminants could cause harm, particularly to pediatric patients.

With any natural supplement there are potential side effects from the pharmacological properties of the components. As an osteopathic physician, I encourage you to be aware of these potential dangers and help patients separate science from speculation.

Related reading:

A career in medical cannabis: DO treats children with epilepsy, cancer patients and others

What to know before prescribing cannabis


  1. Pingback: Reactions of Child Taking CBD for Epilepsy | Childhood Epilepsy

  2. Keen Rostova

    In Speed Greens, we always remind both our workers and consumers to keep our children away from CBD as much as possible.

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