CBD and Kids: What Do We Know?
And three important updates.
Before I take a diversion from all-things-Pandemic, I want to start this week’s letter with three important updates.
COVID-19 rates are higher than they have ever been in our Kansas City area, and in most parts of the country. The crisis we anxiously awaited in March (hospital surges, redistribution of care, lack of bed space, and staff shortages) is now emerging. Understanding this current situation is important because throughout the Pandemic the results of our behavior has been painfully predictable. Every American holiday since March has triggered a formulaic increase in COVID-19 cases, hospitalizations and deaths after these events. But this Holiday week is different. We don’t have the capacity or safe ability to repeat this perilous pattern.
As a Nation, we are going into this holiday week already overtaxed, outstretched, and on a thin edge. As a result, public health leaders have been urging every American to modify traditional Thanksgiving plans. Celebrate quietly. Don’t travel. Stay home. I am in great hopes that you have all have heeded these warnings. If not, I am urging you to reconsider. In my opinion, there is not one non-refundable ticket, cancellation fee, or missed tradition that is worth flirting with COVID-19’s wrath. I want all my families to be safe and healthy into the brilliance that will be 2021. That means making tough decisions. Please, celebrate well and with your own household.
Many families have asked for rapid antigen tests prior to traveling or visiting relatives. We have repeatedly declined these requests. It’s important to understand that rapid antigen testing is currently NOT meant to be used as a screening test for COVID-19. One negative rapid antigen test does NOT ensure you will not get sick, nor does it imply you will not transfer the virus to others. Currently, this test is meant to be used after developing significant COVID-19 symptoms and is used to confirm those symptoms are due to coronavirus. In other words, a positive test is helpful to confirm an illness and a negative test does NOT prove lack of infection. Of course, this science is emerging and use of this type of testing will increase once we understand how frequently to test and how to best use the results. Please talk to your doc about testing details and what he or she may recommend for your family’s circumstance.
The recent news of COVID-19 vaccine success from Pfizer and Moderna has provided all of humanity a wink of hope. We now know with greater confidence that a vaccine can be created to increase community immunity and stop this Pandemic. Many questions still exist, more vaccines are on the horizon, and we will continue to know more every passing week.
I plan to be fully transparent about the vaccine choices I recommend for my patients, if/when I vaccinate my own children, and the vaccine I choose for myself. In this time of uncertainty and sacrifice, I believe I owe my patients (and all of you) that level of honesty. However, as it sits today, this vaccine news does not change our current safety choices of masking, distancing, and hygiene. But I am hopeful this scientific milestone will soften some of the stress and sadness that canceling Holiday plans is bringing to every family across the US and the world. Next year will be better. I’m counting on it.
Okay, let’s take a collective breath and turn to a hot topic, CBD-containing products and their use in children.
During the last few months, more families have been asking about this supplement. Many parents had heard claims of CBD’s ability to help with anxiety, pain, or sleep; so they tried a tincture or two themselves and found the supplement helpful. When a child begins to struggle with a similar issue, it’s reasonable to wonder if CBD could be a solution. But what do we really know about CBD and its use in children? Is it safe? Does it work?
Author’s note: To be clear, remember that I’m a pediatrician. My focus is entirely on the health and safety of kids. I am not interested in any debate addressing adults who freely choose to use cannabinoids for personal use, nor the legal status of these activities. I am simply here to share a bit of what we know about CBD and guide families who are considering this supplement for their children.
Hemp, marijuana and CBD all come from the oldest known psychoactive plant, cannabis sativa. Most of us are familiar with the psychoactive effects of the cannabis plant caused by a chemical called THC. THC is one of the many cannabinoids, or chemicals derived from the cannabis plant, that interact with the body’s endocannabinoid system (ECS). Whew, say that 5 times fast.
CBD is also a cannabinoid that interacts with the ECS, but without the hallucinogenic effects. Today, it seems CBD has found its way into every type of product. From edibles and energy drinks to lotions and candles, CBD-containing products have been touted as treatment for just about everything. Mental wellness, enhanced libido, immunity boost, pain relief, exercise recovery… You name it and I bet there’s a CBD product marketed to help.
The reason you hear about the wide variety of symptoms that CBD can improve is primarily two-fold. First, claims of CBD’s effectiveness are the result of our immature and incomplete understanding of the ECS. This is a very new realm of science. Currently, we know the ECS’ function is to maintain homeostasis, or that cozy feeling of your body being in perfect balance. Like, when you have your first PSL of the season and you sit in your car, turn on your fave podcast, enjoy some stillness, and sip… Oh, sorry. I digress.
All cannabinoids act as a “key,” interacting directly with the ECS through binding receptors or “locks.” When the cannabinoid-key turns the receptor-lock, you activate ECS’ biological ability to achieve homeostasis.
Although it is accurate to say the ECS interacts with CBD, it’s not sexy to say that we really don’t know how it works. ECS receptors are so prevalent throughout nearly every body system, that when triggered by any cannabinoid, humans experience very broad downstream psychological and physical effects. This broad effect makes it very easy to market CBD for all sorts of conditions that may involve the ECS like poor sleep, chronic pain, crappy diet, depressed mood, and low energy.
The second reason CBD is everywhere is that CBD has flown under the radar with the FDA. Through various legal/social/political issues that are well above my pay grade, commercially-available CBD is not regulated by this governing body. As a result, CBD manufactures do not have to supply robust evidence to defend the claims made on the package. This lack of regulation makes it very easy to use our immature knowledge of the ECS and its relationship with CBD for financial gain.
Here’s a bit of what we know:
Pharmaceutical-grade CBD is available and is used in children. Epidiolex is an FDA-approved medication used for refractory epilepsy syndromes. This medication is the first of its kind, leading the way for additional research evaluating CBD’s medical uses.
Although CBD is generally safe to use on its own, it does interact with prescription medications, especially drugs that are metabolized by the liver. Many of the drugs that CBD will interact with are commonly used in kids; such as antibiotics, antihistamines, oral steroids, acid-blockers, ADHD medications, and anti-anxiety/depression medications.
There is evidence of CBD-induced male reproductive toxicity in animal models.
THC gets you high, and CBD does not… until it does. Meaning, due to the lack of regulation of commercially available CBD products, THC is a commonly found “contaminant.” This is a bigger deal in kids simply because their body mass is smaller. The relative dose of any contaminant is going to be more dramatic in children. It is possible that the level of THC contamination in CBD products will be high enough to cause psychoactive symptoms in kids. This has been shown in medical literature.
Cut to the chase, Dr. Natasha. Do you recommend CBD for kids?
Maybe a better question is what evidence-based interventions I recommend for the problem you are seeking to correct. Because when parents ask about CBD, I worry there is a bigger issue at hand that may have a better solution than an unregulated supplement.
In my experience with families who have tried CBD, the effect of the product was significant at the onset of therapy, but waned very quickly. Most of my families who start using commercial-CBD products do not continue to use them for very long. This limits my enthusiasm for long-term therapeutic benefits in kids.
However, if families are interested in exploring CBD supplements, I do encourage a few things.
First, define the problem you are trying to solve. Since the ECS can influence so many body systems, it’s important to specifically define the symptoms you are trying to improve with the supplement. Defining this goal early in therapy makes it easier to determine if you are observing valuable effects.
Second, use CBD as a single agent only. There are a lot of drug interactions with cannabinoids. Talk with your doctor first, especially if your child is taking a routine medication.
Third, buyer beware. Due to lack of regulation, it’s hard to know what is really in the bottle you are purchasing, both in quality and quantity. Consider consumerlab.com as one source to help, and you can find a quality “checklist” in this piece from the Mayo Clinic.
Fourth, give yourself a deadline. In my experience, most families report seeing any change within two weeks of starting CBD supplements. If you have not seen an effect within that window, you may have to reconsider the dosage you are offering or the value of the product as a whole.
Fifth, stop immediately if you observe troublesome side effects. Be watching for any concerning symptoms, especially after first doses of new containers of product since concentration can dramatically vary from bottle to bottle.
I’m eager to hear about your child’s experience with CBD. Feel free to comment or reply.
Thanks to Dr. David Becker who spoke on this topic at our recent AAP conference, and who referenced much of the current research I used to create this letter.
Dr. Kevin and I are planning a quiet, intimate, and special Thanksgiving week at home with the kids. Our prayers of thankfulness for the health and safety of our family will have a newer and more urgent meaning. I extend this gratitude to all of you, and wish for you meaningful moments of rejuvenation as we prepare for the months to come. Thanks for reading.
What’s coming next:
I’m excited for a very special event happening on Instagram this Tuesday, November 24 at 7pm CST. Join me for an Insta Live with Argentinian pediatricians, Drs. Lolo Lynch Pueyrredon and Jose Luis Matozzi. Drs. Pueyrredon and Matozzi care for kids in Buenos Aires. Together, we are going to talk about our unique experiences as doctors from two different hemispheres, with appreciation for the connectedness we share as a global family. Spoiler alert: I don’t speak Spanish, so I’ll be leaning heavily on any of you that can help us through this international experience.
Then, hit Insta again on Wednesday, November 25th where I’ll begin the Holiday season with a special “Friendsgiving” episode of Masks Off Live. I’ll be hosting Dr. Nicole Baldwin at 7 pm CST as we have a real-life, non-scripted conversation between two friends who happen to be moms and pediatricians. MOL is best served with a glass of wine, and has proven to contain language not safe for little ears. If you have a topic suggestion that we just can’t miss, just reply to this email with your idea. You’ll find the last episode here.
Upcoming newsletters will discuss evidence on using probiotics in kids (with advice from some special guests), vaccine updates as they come, and the November edition of 3-2-1. (Here’s the October edition, if you missed it.) As always, if you are finding this helpful to your family, I’d appreciate you passing this along. If you are new to this letter, here’s more about me.