Are Essential Oils Safe for Kids?

This story was originally published on July 23, 2019 in NYT Parenting.

When Eva Sheie walked into her daughter’s new day care classroom in Austin, Tex., in December, she instantly noticed the floral aroma emanating from an essential oil diffuser.

Ms. Sheie, who is sensitive to fragrance, didn’t like the smell, but she also didn’t complain: “I don’t want to be that parent, you know?”

But after a few weeks, she noticed that her toddler and several other students had developed nagging coughs that lingered well into January. And when the teacher switched to an oil blend that was supposed to “disinfect” the air, Ms. Sheie said she felt “headachy and like I was going to throw up for an hour or longer” after dropping off her daughter each morning. Finally, after a few days of feeling ill, Ms. Sheie convinced the day care to turn off the diffuser. “The relief was immediate,” she said. Her symptoms went away, and her daughter quit coughing.

Dr. Justin Smith, a pediatrician at Cook Children’s Health Care System in Fort Worth, Tex., said that in recent years, more and more parents have been inquiring about whether inhaling, consuming or rubbing essential oils onto the skin can treat a variety of their children’s ailments, including cough, congestion, fever and more.

But little, if any, evidence back up claims about the healing properties of essential oils, Dr. Smith said. And more worrisome evidence exists on the risks of using them.

Ms. Sheie can’t prove whether the diffused essential oils were responsible for her or her daughter’s symptoms, for instance, but the oils’ tiny particles are “really good at infiltrating the upper and lower airways, which can cause irritation, especially in people with underlying chronic medical conditions such as asthma or allergies,” said Dr. David Stukus, an associate professor of pediatrics at Nationwide Children’s Hospital in Columbus, Ohio.

Additionally, rubbing too-potent potions onto the skin can lead to chemical burns or irritation; and if they’re swallowed, they can be deadly.

“There are claims that because they are natural, they can’t cause side effects,” Dr. Smith said, “but they definitely can and do.”

The new oil boom

Stroll through any department store, vitamin shop or farmers market and you’re bound to find little vials filled with strong-smelling oil. These pungent elixirs are extracted from fragrant botanicals, like lavender, citrus, peppermint and cloves. “If you think about when you squeeze a lemon, the very strong citrus smell that you get is the essential oil being released from the skin,” said Wendy Weber, chief of the clinical research branch at the National Center for Complementary and Integrative Health at the National Institutes of Health.

Sales revenue from these potent plant extracts in the United States increased by nearly 40 percent from 2014 to 2018. By 2025, they’re projected to reach more than $5 billion in total sales, according to market research firm Grand View Research.

But they’re not just being sold in shops and online. Ms. Sheie said that she’s increasingly had to politely sidestep sales pitches from people in her social circles who are selling the oils for two of the largest essential oil companies, doTerra and Young Living. These manufacturers use multilevel-marketing strategies, where the people who sell their products profit from their own sales as well as those of others they recruit (think Avon or Herbalife). “I most often run into it at church and on social media, especially in my mom groups,” she said.

But can they improve your health?

Some sellers — along with particular social media posts and websites that expound the oils’ benefits — attest with a kind of evangelical zeal that certain essential oils can help treat a range of ailments, from attention deficit disorder and depression to Alzheimer’s disease, cancer, skin abrasions, infections, teething pain and more. Companies commonly market essential oils to parents for their purported ability to boost kids’ immune systems and to improve focus, mood and sleep.

But the bulk of the research done on essential oils has been performed in petri dishes and on rodents. “There are few human studies, and they are mostly small and of low quality,” Dr. Smith said.

And of the research that has been done on humans, said Dr. Smith, the bulk of the studies on essential oils’ effectiveness and safety has been performed on adults. A few studies in children suggest that inhaling lavender oil can have a calming effect; that topical applications of tea tree oil may be useful against acne, lice and warts; and that peppermint oil capsules may help with irritable bowel syndrome and abdominal pain.

However, there’s no evidence to support essential oils’ more common uses, such as for treating “fever, cough, congestion, allergies, teething symptoms and (the one that makes me the most frustrated) behavior problems,” Dr. Smith wrote in a column for Cook Children’s Health Care System in 2015.

Unlike with prescription and over-the-counter drugs, the makers of essential oils do not have to prove to the Food and Drug Administration that their products are safe and effective for certain conditions, or even that they contain what they say they do on the label. And by law, oil makers are not allowed to advertise that their products can prevent or treat disease.

But that hasn’t stopped some sellers from making druglike claims. Within the past five years, the F.D.A. has issued more than half a dozen warning letters to companies marketing cosmetic products containing essential oils, or the oils themselves. In 2014, for example, the agency stated that paid consultants for both doTerra and Young Living were claiming, without evidence, that some of their essential oils could be useful against conditions such as autism, cancer, Alzheimer’s disease, viral infections (including Ebola) and more.

In response to the F.D.A.’s letter, a spokeswoman for doTerra told The New York Times that the company has created a “compliance team” of more than 50 people that “crawls the web to ensure wellness advocates are not propagating noncompliant claims,” and that the company takes corrective action if needed. Young Living also has a strict compliance policy, according to a company spokeswoman. “Consequences for violating said policy are swift and consistent,” she said, “up to and including the revoking of membership and its privileges.”

Are they safe?

Little is known about how these oils might affect young, growing bodies, but there is some evidence that they can cause harm.

One trap parents may fall into is thinking that these oils are replacements for evidence-based treatments, according to Dr. Smith. He told me that the parents of one of his young patients had tried treating their child’s croup (a respiratory infection that causes difficulty breathing and a barking cough) with a variety of oils. Eventually, the illness progressed so much that they needed to take the child to the emergency room.

“While the essential oils didn’t hurt the child,” Dr. Smith said, “the delay in care allowed the condition to get worse.”

But by far, the greatest danger to children occurs when highly concentrated oils are accidentally swallowed, spilled onto the skin or splashed into the eyes. In 2018, poison control centers in the United States recorded 17,178 such incidents in children under 12 — an 85 percent increase over the number of cases reported in 2014. (This is according to an analysis that the American Association of Poison Control Centers conducted for The New York Times for this story.)

A teaspoon of camphor oil, a type of oil extracted from the wood of a camphor tree, for instance, can cause seizures in children under 5 if swallowed, according to Nena Bowman, managing director of the Tennessee Poison Center.

A similar dose of wintergreen oil, a cousin to aspirin, can cause rapid labored breathing, fever and — in severe cases — organ failure and death. Even as little as half a teaspoon of commonly used essential oils such as eucalyptus, lavender and tea tree oils can cause sedation and difficulty breathing in little ones, Dr. Bowman said.

“The exposures we see are almost all in children and almost all accidental because essential oils aren’t always stored properly,” Dr. Bowman said, “they need to be kept up and out of the reach of children.”

Applying concentrated oils to the skin are common causes of adverse reactions too, said Robert Tisserand, an aromatherapy expert and author of the textbook “Essential Oil Safety.” In nature, oils with antioxidant and antimicrobial properties such as clove, oregano and thyme kill invading bacteria by rupturing their cell membranes, Tisserand said. “And they do a similar thing to your skin cells and the mucous membranes that line and protect the inside of your body,” he said. “If you put undiluted oregano oil on your skin or in your mouth, you’ll have an irritant reaction — a very nasty one. The skin will go red and burn like crazy.”

Children are more likely to have side effects from essential oil exposures than adults are, said Dr. Weber from the N.I.H. “They are still developing, which makes their brains and other systems more sensitive to potential toxicity from essential oils.” Their livers and kidneys, for instance, are likely to be less efficient at processing the compounds.

Young Living provides safety information to consumers and asks its sales distributors to share that information with their customers, according to a company spokeswoman. “It’s important that all things are done in moderation — specifically where children are concerned,” she noted, adding that Young Living offers product lines where the essential oil is already diluted in a carrier oil, making it safer for kids.

How to safely use essential oils around your children

Because there’s no solid evidence on the efficacy and safety of essential oils, major medical organizations such as the American Academy of Pediatrics and the American Academy of Family Physicians have not issued recommendations for using them with children.

If you still want to use the oils on or around kids, discuss it with your child’s doctor first, advised Dr. Anna Esparham, a board-certified pediatrician at Children’s Mercy Hospital in Kansas City, Kan., who has been trained in aromatherapy. And heed the following advice.

• In general, diffusing essential oils into the air is safer than using them on the skin. (But even then, it can be irritating to some. Never diffuse them in classrooms or in public spaces.)

• Don’t diffuse essential oils around infants under 6 months old. For older babies and children, it’s reasonably safe to diffuse certain oils such as cedarwood, ginger or sweet orange for up to an hour while monitoring your child, said Dr. Esparham.

• You can apply certain oils — such as chamomile, cypress and helichrysum — to the skin of children 3 and up, Dr. Esparham said, but you should dilute them first (using about 3 to 6 drops of oil per 1 ounce of a “carrier oil,” such as jojoba or almond oil). Or, use a product specifically formulated for children.

• Even diluted oils can cause irritation, so always do a patch test: Rub the oil on a small area of skin and wait 24 hours to see if there’s any redness, swelling or rash. (If there is irritation, stop using the oil immediately.)

• Always keep oils away from the eyes, nose and mouth. And do not apply essential oils to children with sensitive skin, eczema or other chronic skin conditions, as they can be irritating, Dr. Stukus said.

• Avoid applying citrus oils — such as those made from grapefruit, lemon or orange — to the skin, as they can react with ultraviolet radiation from the sun to cause burns, rashes or skin discoloration.

• Never add undiluted essential oils to bath water. Oil and water don’t mix, so undiluted drops could irritate the skin. You can, however, add diluted drops, said Dr. Esparham. Use 2 drops of oil to 1 ounce of liquid Castile soap or a carrier oil.

• Don’t flavor food or drink with essential oils, even if they are labeled “food safe.” They can be harmful if swallowed, and could damage the lining of the mouth or digestive tract.

• Avoid using synthetic oils, Dr. Esparham said, because the chemicals are more likely to cause side effects such as nausea or headache, skin irritation or breathing problems than more “pure” oils. Nonsynthetic oils are typically more expensive than synthetics — around $12 to $25 per vial. You can spot them by looking for their Latin names on their labels, like “100 percent Cedrus atlantica oil” for cedar oil, she said.

• Store essential oils in a cool, dry place away from direct sunlight and out of the reach of children. Dr. Esparham advised keeping oils for no longer than a year as rancid oils are more likely to irritate the skin or trigger allergic reactions.

If your child develops a rash or skin irritation; headaches; nausea or vomiting; coughing, wheezing or difficulty breathing; or any other symptoms while using oils, stop using them immediately and call your doctor. Never use oils as a replacement for medical care.

(If you or someone you know may have been exposed to a dangerous substance, contact poison control immediately at 1-800-222-1222 or go to poisonhelp.org for assistance.)

Teresa Carr is an award-winning journalist based in Texas who specializes in science and health. She is a former Consumer Reports editor and writer, a 2018 Knight Science Journalism Fellow at the Massachusetts Institute of Technology, and she pens the Matters of Fact column for Undark.