Research on CBD and Child Anxiety
As a parent, it's one of the hardest things to watch.
Intense anxiety in your own child.
We've personally been there and you're in a constant state of worry and waiting for the next shoe to drop.
We've covered related topics in depth from CBD and teenage anxiety to CBD and autism anxiety but what about anxiety for children?
This gets trickier.
Safety is paramount and a child's brain is developing!
We need to look at research from this framework first.
What about the effects of:
- Parental anxiety
- Early infection, stress, and trauma
- Maternal infection
- Brain area functions
- Gut biome issues
We'll look at all of it and spend the back half researching ways to offset these effects.
Ultimately, it sometimes comes down to comparing CBD versus other anxiety medications prescribed for children.
That's primarily benzos and SSRI's.
We'll get into that as well.
Anecdotally, we've seen lots of results for children with anxiety but what about research?
We'll see what's available as well as look at the pathways for childhood anxiety.
We'll cover the following:
- The causes of childhood anxiety
- What does research show for CBD and child anxiety
- CBD versus anti-anxiety medications for childhood anxiety
- Safety and developmental concerns with CBD in children
- How much mg of CBD for child anxiety
- What's the best CBD for child anxiety
Let's get started.
The causes of childhood anxiety
Let's zero in on how child anxiety might be different.
First, a voice of reason.
For age 5-12, anxiousness is a common trait regardless.
There are different levels of risk and aversion among all people including children.
A little bit of anxiety keeps us safe!
Most parents don't realize that the little 5 year old who is so bold and outgoing may translate to the 15 year old who is more likely to engage in risky behavior.
Take it from a parent of a 15 and 17 year old with two-way communication on what their peer groups are doing.
There can be an upside to a cautious child.
The issue is when anxiety becomes overwhelming.
Here are pretty good summaries of signs that it may be child anxiety and not just being young:
The most common types of child anxiety are:
- General anxiety disorder or "trait" anxiety
- Separation anxiety
- Social anxiety
The typical causes generally shown in literature revolve around the following:
- Biological - brain structure, genetics, and neurotransmitters
- Environmental - parenting style, trauma, experience
Temperament and coping mechanisms likely result from a combination of the above two factors.
Let's dig a little deeper into the above categories since there's new research out which is fascinating.
As depressing as past insults might be, we'll look at ways to offset these effects and even reverse them below (according to research...always!).
We're going to focus on a few key factors:
- The primary anxiety circuit by brain area
- Stress/anxiety in mother during pregnancy and after
- Early adolescent trauma/stress
- Exposure to infection and/or antibiotics (which brings up the next one)
- Gut biome issues and anxiety (notice how stomach issues tend to accompany anxiety in children??)
Let's start with brain structure and work our way down.
We've covered the primary anxiety circuit in our CBD and anxiety or CBD and general anxiety disorder but a quick refresher of the key players.
Anxiety generally reflects an imbalance among three key players:
- Amygdala - our fear and emotional center
- Prefrontal Cortex - our rational counterbalance to the Amygdala
- Hippocampus - seat of memory which acts as a moderator of our fear response
Needless to say, this is all in flux in a child's brain.
So...how do these areas play into childhood anxiety?
Much the same way as in adults!
If the amygdala is too strong, anxiety can result:
They found that the larger the amygdala and the stronger its connections with other parts of the brain involved in perception and regulation of emotion, the greater the amount of anxiety a child was experiencing.
In fact...just by looking at the size and connectivity (think of this as activity) of the amygdala, they could determine anxiety levels in children:
Now, Stanford University School of Medicine researchers have shown that by measuring the size and connectivity of a part of the brain associated with processing emotion — the amygdala — they can predict the degree of anxiety a young child is experiencing in daily life.
What about the countering force to our emotional and fear center…..the prefrontal cortex?
Where is it during childhood?
Great questions and there's an amazing walkthrough here:
We know that the prefrontal cortex has this task in adults:
Specifically, in adulthood (but not earlier), increases in mPFC activity are associated with a decrease in the amygdala’s activity— these two regions are anti-correlated with each other in response to emotional stimuli (such as fear faces).
Not so in children. The PRC is not fully developed yet and won't be till early adulthood (see CBD and teenage anxiety).
For parent-dependent species (like us!), children reference their surrounding adults:
Children routinely look to the parent for guidance in navigating the emotional and physical landscape. Social referencing is a powerful means of regulating emotions and has been used to explain the intergenerational transmission of emotional knowledge, including the transmission of anxious behaviors and reactions
This points to our first source of child anxiety.
It's estimated that roughly 1/3rd of childhood anxiousness has a genetic root which is passed down.
That reflects the likelihood of anxious parents.
By studying nearly 600 young rhesus monkeys from a large multi-generational family, Drs. Andrew Fox, Kalin, and colleagues found that about 35 percent of variation in anxiety-like tendencies is explained by family history.
In light of how long-lived species like humans with slow developing prefrontal cortexes look to parents on how to "perceive" the world and threats:
Prior work has indicated that both biological/genetic (Gregory and Eley 2007) and environmental mechanisms (e.g., maternal anxious attachment perceptions; Costa and Weems 2005; maladaptive parenting practices; Wood et al. 2003; parental modeling of anxiety and avoidance; Fisak and Grills-Taquechel 2007), may account for the observed association between parent and child anxiety.
A parent's cues on how to manage stress has even been shown to reduce cortisol in children:
As has been described extensively in other sources, 54,57,58 stimuli related to a (regulated) parent can modulate a physiological response to threat, namely that parental cues can dampen elevations in the stress hormone cortisol (in humans) and corticosterone (in rats).
Put a check mark next to cortisol for later.
Parental cues have also been shown to decrease amygdala activity in both humans 55 and in rats. 60
Not to rub it in further...there can even be effects during pregnancy and shortly after from mother.
However, children of mothers reporting increased anxiety during pregnancy showed slower growth of both the left and right hippocampus over the first 6 months of life.
We promise we'll have better news in the second half of the article..stay with us!
But definitely put a check mark next to hippocampus.
What about early trauma?
Think of trauma as a burst of stress:
Childhood maltreatment experiences may lead to poorer communication between the hippocampus and prefrontal cortex in girls and boys, but poorer communication between the amygdala and prefrontal cortex in girls only,
There are lots of studies to this effect and the results are very similar to PTSD.
The net effect is this…
Stress on the developing brain (either chronic or acute) is intimately tied to childhood anxiety.
One more key piece...neurotransmitters.
The two most intimately linked to anxiety are GABA (our calming "brake" in the brain) and serotonin (workhorse in the brain tied to synaptic connections, growth, and repair).
We'll look at these later but GABA is the main lever for benzos and serotonin is the main lever for SSRI's.
Those are the two most common medications for anxiety (check out CBD versus anti-anxiety medications here).
What about infection and its fix, antibiotics?
Most of the interesting news today is on immune response and mental health.
As for childhood anxiety, the first clue came from so-called PANDA's.
pediatric autoimmune neuropsychiatric disorder associated with streptococcal infection
Basically, roughly 1 out of 1000 children who come in contact with strep (as in strep throat) can see sudden onset of mental health issues such as anxiety.
It can be very scary:
It's amazing how quickly the kids go from functioning pretty well to being devastated with motor tics and symptoms of O.C.D.
Interestingly, it's not the strep that causes this onset but our immune system's improper response to it.
This is really at the heart of all autoimmune diseases (everything you see on TV these days from Pharma).
In fact, they're looking at antibiotics reducing the neurological symptoms of PANDA.
But that brings up the next question.
Can antibiotics themselves affect child anxiety?
Recurrent antibiotic exposure is associated with increased risk for depression and anxiety but not for psychosis.
A giant study was completed in Denmark:
Antibiotics in Childhood Have Been Linked to an Increased Risk of Mental Illness
Check out CBD and neuro-inflammation for anxiety for interesting studies.
It's not just infection or antibiotics during childhood...it can go back to pregnancy?
Maternal infection during late pregnancy increases anxiety- and depression-like behaviors with increasing age in male offspring.
This all points to immune response and gut bacteria (arbitrators of our immune response).
So...enough with the doom and gloom about things we can't change.
All these systems (brain, immune, stress response, etc) are plastic...they can change all the time!
What does research show for CBD and child anxiety
Just a refresher for how CBD might help with child anxiety:
- Stress response - key to calming further damage and anxiety pathway triggers
- Cortisol - stress hormone which does the damage to the hippocampus
- Hippocampus - brain area under assault from stress, infection, and over-anxious parenting
- CBD and gut, immune balance
- CBD and child anxiety studies
Let's look at each.
We want to look at the specifics to child anxiety we touched on above.
Let's start with doing no MORE harm.
CBD, stress response and child anxiety
Our endocannabinoid system, which CBD works in, is basically our stress response mediator.
For example, Anandamide (2nd most prevalent endocannabinoid in your brain right now) is critical to this process.
It's called the "bliss" molecule and its effects should be obvious from the name.
What's the relationship with Anandamide and stress?:
These data indicate that central anandamide levels predict acute stress-induced anxiety, and that reversal of stress-induced anandamide deficiency is a key mechanism subserving the therapeutic effects of FAAH inhibition
By the way, FAAH is the endocannabinoid that breaks down anandamide.
It's also the lever at play or the woman who can't feel pain or anxiety (details here)!
What does CBD do for anandamide and FAAH?
cannabidiol treatment was accompanied by a significant increase in serum anandamide levels, which was significantly associated with clinical improvement
It did this by blocking FAAH.
Check out CBD, stress, and anxiety for a full run down.
What about the key stress hormone in our body that does all that damage to the hippocampus (and elsewhere) when chronic?
Cortisol - stress hormone which does the damage to the hippocampus
So...can CBD reduce cortisol levels?:
This decrease in cortisol levels was significantly attenuated after CBD (basal measurement = 10.5 +/- 4.9 micrograms/dl; 120 min after 300 mg CBD = 9.9 +/- 6.2 micrograms/dl; 120 min after 600 mg CBD = 11.6 +/- 11.6 micrograms/dl).
This is not surprising given the various effects it has on blood pressure, heart rate, and other physiological signals of cortisol signaling.
Check out CBD and cortisol for anxiety here.
Those are two aspects of child anxiety that deal with not causing more damage to the developing brain.
Again, chronic or acute stress were both shown to negatively impact brain areas above.
Can we actually repair some of this damage (remember the doom and gloom promise!!)?
Let's go to the most vulnerable part of the brain which lies squarely in the anxiety circuit.
Hippocampus - brain area under assault from stress, infection, and over-anxious parenting
We learned how the hippocampus is one of the most plastic (changeable) areas of the brain.
Can CBD help to repair, replenish, and grow it after damage?
This bit of researchers answers our question with all the facets at play:
The anxiolytic effect of cannabidiol on chronically stressed mice depends on hippocampal neurogenesis: involvement of the endocannabinoid system
Anxiolytic just means anti-anxiety.
Read that sentence one more time.
- Anti-anxiety. Check.
- CBD. Check
- Stress. Check
- Hippocampus neurogenesis (making more brain cells!). Check!!!
In fact, researchers are finding that SSRI's (which drive serotonin) have their effect on depression and to a lesser extent, on anxiety by neurogenesis primarily!
CBD does the same thing without the dreaded side effects (more on that below).
Also, check out meditation and exercise's effect here.
Let's go further south to the gut!
CBD and gut, immune balance
Stress is not the only culprit in a child's mind when it comes to anxiety.
Inflammation from an overactive immune system is equally destructive.
In fact, most roads point to the gut for our modern diseases.
This is where CBD had a leg up over medications which can actually damage and alter the microbiome.
With child anxiety, we want to look at neuroinflammation.
The main immune responders in the brain are called microglia.
A very recent study found that they literally can eat our own neurons from lack of sleep.
Another study showed that lack of sleep resembles extreme anxiety in brain scans.
What effect does CBD have specifically there:
These findings suggest that attenuation of the ER stress pathway is involved in the 'oligoprotective' effects of CBD during inflammation.
It's short for oligodendrocyte which is a type of microglia cell in the brain and nervous system.
We have an entire review of CBD and the immune response in the brain here.
Remember how prior infection (you or your mother) can cause an inflammatory response which is tied to anxiety and other mental health issues?
CBD exerts immunosuppressive actions on macrophages and microglial cells as evidenced by decreased TNFα production after treatment with lipopolysaccharide (LPS)
The key word there is lipopolysaccharide.
That's the protein signature for bacteria (infection).
It's what the brain's overactive immune system is looking for and overacting to.
CBD calms the response. Basically, it helps the endocannabinoid system to find balance.
Keep in mind that our immune response really resides in our gut.
It's all interconnected!
What about there?
CBD targets enteric reactive gliosis, counteracts the inflammatory environment induced by LPS in mice and in human colonic cultures derived from UC patients.
There's that LPS (lipopolysaccharide) signature again.
UC is short for ulcerative colitis...an extreme type of autoimmune inflammation in the gut.
Just remember that many childhood anxieties have a gut component (vomiting, nausea, upset stomach, etc). That's our first clue!!
It's too much for this one article!
Let's now look at actual studies on CBD and child anxiety.
CBD and child anxiety studies
We hope to have many more studies with time on actual child anxiety.
There are lots of studies for general anxiety (adult).
Let's see what we have.
The first one was anecdotal (one girl) but it was powerful and we'll start there.
It's actually a heartbreaking case of a 10 year old girl who suffered tremendous anxiety and sleep disruption due to prior abuse.
The net effect:
A gradual increase in sleep quality and quantity and a decrease in her anxiety were noted. After 5 months, the patient was sleeping in her own room most nights and handling the new school year with no difficulties. No side effects were observed from taking the CBD oil.
Anxiety levels as measured on the SCARED testing dropped from 34 to 18 (above 25 indicating childhood anxiety disorder).
Hers was really in the scope of PTSD (see CBD and PTSD here).
There are many studies on childhood seizures (the first big discovery with CBD) but they're muddied a bit by using cannabis (which also included THC).
Check out THC versus CBD for anxiety. There are negatives to THC which CBD does not possess...especially for the developing brain.
Sadly, the children usually have to go through unsuccessful bouts with anti-seizure medications first.
We can glean some information (especially on the safety front) from the "additional" effects such as with this Stanford study:
In addition, parents reported overall better mood, increased alertness, and better sleep. Parents reported oral CBD dosages of 0.5 mg/kg/day to 28.6 mg/kg/day and THC of 0 to 0.8 mg/kg/day.
That was CBD rich cannabis. We would prefer straight CBD.
Then there's the study on autism anxiety and children.
Self-injury and rage attacks (n = 34) improved in 67.6% and worsened in 8.8%. Hyperactivity symptoms (n = 38) improved in 68.4%, did not change in 28.9% and worsened in 2.6%. Sleep problems (n = 21) improved in 71.4% and worsened in 4.7%. Anxiety (n = 17) improved in 47.1% and worsened in 23.5%.
When we dug deeper, we saw that they actually used CBD with THC again!
Get rid of the THC!
24-36% of the population is allergic to THC and guess what a histamine rush feels like...anxiety!
See CBD, histamine, and anxiety for more detail.
There's a reason that suicides increase in SPRING time when pollen counts are highest (not winter, by the way).
THC can actually increase anxiety (see CBD versus THC for anxiety above).
Very frustrating to us if you're head down in NIH studies every day.
Another Israeli study on CBD and pediatric autism:
In this retrospective study on 60 children, behavioural outbreaks were improved in 61% of patients, communication problems in 47%, anxiety in 39%, stress in 33% and disruptive behaviour in 33% of the patients.
Again, THC involved as well.
Check out CBD and autism anxiety for more detail.
We're only at the advent of studies.
Sadly, they generally test CBD on children who have had no response to other treatments.
Let's look at some of those treatments.
CBD versus anti-anxiety medications for childhood anxiety
There are three common treatments available for childhood anxiety.
First (hopefully) is CBT or cognitive behavior therapy.
This involves "retraining" the brain for stress and anxiety response.
It's a slow process and requires a great deal of effort.
Remember how children learn how to respond to fearful situation from our cues?
This is about retraining those cues.
The brain is plastic! It changes all the time providing it's not under constant stress or inflammation.
Unfortunately, most treatment is given by a general doctor or pediatrician and they're likely to look at benzos or SSRI's.
Check out CBD versus anti-anxiety medications for an overview.
If you read through the studies there, it's hard to fathom using this course of treatment.
Especially in a developing brain!
- Benzos increase GABA (see CBD versus benzos for GABA)
- SSRI's increase Serotonin (see CBD versus SSRI's for serotonin and anxiety)
Obviously, work with your doctor but at least educate yourself on how they work.
The safety profile is SIGNIFICANTLY different.
Plus, a child's brain is incredibly plastic and dynamic.
The last thing we want to do is "marbleize" benzo addiction into a developing brain.
As for SSRI's, that's much more complicated since serotonin is such a workhorse in the brain and gut.
Just educate yourselves so you can make an informed decision.
Speaking of safety…
Safety and developmental concerns with CBD in children
There's always an initial concern from even well-educated people about CBD.
We were the same way.
Especially when it comes to children.
Almost all of this stems from its association with cannabis and THC.
We have lots of resources here:
Let's look at general reviews of safety first.
We'll start with NIH:
In general, the often described favorable safety profile of CBD in humans was confirmed and extended by the reviewed research.
Since CBD uses the same pathways as seizure medications, there was some interaction there albeit positive:
The CBD interaction with isozymes CYP3A4 and CYP2C19 caused increased clobazam bioavailability, making it possible to reduce the dose of the antiepileptic drug, which in turn reduced its side effects.62
A teenager was treated with up to 1500 mg of CBD for bi-polar with no reactions:
gamaschi et al. describe a chronic study, where a teenager with severe side effects of traditional antipsychotics was treated with up to 1500 mg/day of CBD for 4 weeks. No adverse effects were observed and her symptoms improved.
There's also the original trials for Epeliodex (synthetic CBD):
The reported side effects were 21% experienced tiredness, 17% diarrhea, and 16% reduced appetite
Look...every study we've looked at with CBD isolate compared to synthetic shows a completely different safety profile for the synthetic (always worse). This true for hormones as well (See progesterone versus progestin).
This is not surprising.
Haven't we learned from synthetic fat (hydrogenated oil) or synthetic sugar (Splenda, etc)?
That being said, some other studies found various side effects but the dosage were extremely high AND for the synthetic version.
For a 100 pound person, 800+ mg in children.
Those effects versus placebo:
Adverse events that occurred more frequently in the cannabidiol group than in the placebo group included diarrhoea (31% vs 10%), loss of appetite (28% vs 5%) and somnolence (36% vs 10%).
With anxiety, it doesn't make sense to go higher than 300 mg since that's the optimum level for neurogenesis and even then, it's a very high dose.
We'll discuss that further below.
Those were specific to children.
The WHO's overall assessment:
Across a number of controlled and open label trials CBD of the potential therapeutic effects of CBD it is generally well 39th ECDD (2017) Agenda item 5.2 Cannabidiol (CBD) Page 14 of 27 tolerated, with a good safety profile.
We clearly need more studies on children specifically.
If it's a comparison of CBD versus benzos or SSRI's, that's a no brainer to us personally.
What does the NIH say?
Controlled trials do not support the use of benzodiazepines in children
As for SSRI's (the main medication offered for child or pediatric anxiety:
select SSRIs are approved by the US Food and Drug Administration (FDA) to treat obsessive-compulsive disorder (OCD), SSRIs are not approved for pediatric non-OCD anxiety.
The OCD connection is important.
There's an increase in suicidal and homicidal "ideation" for younger patients on SSRI's if they have OCD symptoms.
That's why there's a black box warning on them since 2004.
More concerning is the effectiveness of them.
The authors estimated that compared to a placebo, an antidepressant would be helpful for 1 out of every 3 young patients treated for anxiety disorders, 1 of every 6 young patients treated for obsessive-compulsive disorder, and 1 of every 10 young patients treated for major depression.
Keep in mind that SSRI's eventually lose their effective (when they do work) and appear to have any positive effect via the neurogenesis effect of serotonin (see CBD versus SSRI for serotonin and anxiety).
Like we said...get informed.
The more information you have, the better.
One note...always take CBD at least 2 hours away from medications and work with your doctor.
Check out CBD and medication here.
Also, we unfortunately have entire write ups on how to use CBD for benzo withdrawals and CBD to wean off SSRI's.
Let's look at dosage next.
How much mg of CBD for anxiety
There's no established dosage for anxiety specifically.
The max limit is around 300 mg for neurogenesis but that's a high amount.
You still have neurogenesis effects at lower amounts so it's a slower process which is what we wanted.
A good test amount is generally around 20-25 mg (about half a dropper at the 1000 mg bottle).
From there, it depends on response obviously.
We usually give as needed or at night (for sleep) and in the morning.
To be clear...there are set dosage levels for children!
We just don't have that research yet.
Next, some very important tips.
What's the best CBD for anxiety
Of course, there are the baseline requirements:
- Organically grown in the US (Can't buy from Amazon, etc)
- CO2 processed (cleanest option)
- Absolutely NO THC (see THC versus CBD for anxiety to see powerful effects of THC on developing brain)
- 3rd party tested for:
- No solvents
- No pesticides
- No mold
- No bacteria
- No heavy metals
Those are minimum requirements that we full abide by at IndigoNaturals.
We actually test our CBD twice. After all, our entire family uses it.
Now to some of the important tips that research supports.
We want CBD Isolate instead of full spectrum.
We know we know...everyone's selling full spectrum and its many benefits.
It's not in the research. It's also at such infinitesimal levels that it wouldn't matter.
All the studies above and on NIH are on CBD by itself.
Everything else is just a sales job and we don't feel comfortable giving our children substances that are not vetted.
More importantly, a good percentage of child (or any for that matter) anxiety may be due to histamine issues.
Histamines are what drives allergies.
There's an interesting tie between Histamines and anxiety.
Remember GABA, our natural "brake" which benzos spike?
Histamine is antagonistic to GABA!
They actually work against each other so we don't want to eat up more GABA.
All that plant material full spectrum is the wrong direction.
90% of the market is either full spectrum, too expensive, or bogus product.
That partially why we created Indigo Naturals.
We wanted clean CBD crafted based on research if we're going to give it our kids.
We don't mess around with guesswork.
Let us know what works for you and be well. Welcome to a new way to deal with childhood anxiety.
We wish you all the luck we had.