What herbal supplements are contraindicated in children?

Herbal and Supplemental Treatments Contraindicated in Children

Ephedra (Ma Huang) is absolutely contraindicated in children and should never be used, as it has been linked to serious cardiovascular side effects, seizures, and deaths in young people, leading to an FDA ban. 1

Strongly Contraindicated Herbal Supplements

Ephedra (Ma Huang)

• The FDA banned ephedra-containing supplements after the herb was linked to serious cardiovascular side effects, including 15 deaths among young people in the US. 1
• High-dose ephedrine use causes nervousness, anxiety, tachycardia, hypertension, and seizures. 1
• Multiple states banned botanical ephedra sales prior to the federal FDA ban due to safety concerns. 1

Kava

• Kava should be held for 2 weeks before any surgical procedure and avoided in children due to excessive sedation risk when combined with anesthetics, benzodiazepines, and opiates. 2
• The FDA label for kava-containing products states "Children under 2 years of age: Do not use, consult your doctor." 3

St. John's Wort

• St. John's wort is contraindicated when used with SSRIs or MAOIs due to serotonin syndrome risk, and it significantly reduces effectiveness of multiple critical medications including oral contraceptives, immunosuppressants, and anticoagulants. 4
• Must be discontinued at least 2 weeks before surgical procedures due to multiple drug interactions. 2, 4
• Particularly dangerous in children taking ADHD medications like methylphenidate, with probable NHP-drug interactions documented in adverse event reports. 5

Conditionally Recommended Against

General Herbal and Dietary Supplements for Disease Treatment

The American College of Rheumatology conditionally recommends against using supplemental or herbal interventions specifically to treat juvenile idiopathic arthritis (JIA) due to safety concerns about unregulated supplements and lack of efficacy data in children. 2

• The American Academy of Otolaryngology found significant serious adverse effects of unconventional therapies for children, most associated with inadequately regulated herbal medicines. 2
• Herbal products lack governmental oversight for quality or purity and may alter blood levels of conventional medications, including anticoagulants. 2

Specific Disease-Targeted Supplements

For children with type 2 diabetes, the American Academy of Pediatrics recommends against CAM dietary supplements (including aloe, bitter melon, chromium, cinnamon, fenugreek, ginseng, gymnema, and nopal) due to lack of product standardization, FDA regulation, and potential adverse effects. 2

• Adverse effects from dietary supplements in children include gastrointestinal discomfort, hypoglycemia, favism, insomnia, and increased blood pressure. 2
• Children with diabetes are more likely to use CAM, making provider vigilance essential. 2

Key Safety Concerns Across All Herbal Products in Children

Inadequate Regulation and Quality Control

• Herbal medicines may contain toxic plant material, be contaminated with heavy metals, or be adulterated with synthetic drugs. 6
• Lack of FDA regulation means no standardization of content or potency between products. 4

Documented Serious Adverse Events

• Reported adverse events in children include bradycardia, brain damage, cardiogenic shock, diabetic coma, encephalopathy, heart rupture, intravascular hemolysis, liver failure, respiratory failure, toxic hepatitis, and death. 6
• Infants and children are more susceptible to adverse effects due to differences in physiology, immature metabolic enzyme systems, and dose per body weight. 7

Drug Interactions

• Herbal products may alter blood levels of conventional medications, creating unpredictable and potentially dangerous interactions. 2
• The quality of adverse event reporting is generally poor, making causality assessment difficult. 5

Clinical Approach

Physicians should actively question patients and families about herbal supplement use during every medical history, educate about potential adverse effects, and discourage use of potentially dangerous or ineffective products. 2

• Parents reporting CAM use are more likely to struggle with adherence to conventional medicine. 2
• A risk reduction approach involves closely following supplement use, assisting in therapeutic decisions, and monitoring for adverse effects and interactions. 7
• All herbal supplement use must be disclosed to healthcare providers before starting new medications or undergoing procedures. 4

Common Pitfalls to Avoid

• Never assume herbal products are safe simply because they are "natural" or have traditional use—traditional experience poorly detects reactions that are uncommon, develop gradually, or have prolonged latency periods. 8
• Do not rely on package labeling for safety information, as most herbal products are marketed as dietary supplements without FDA approval of efficacy or safety. 9
• Avoid dismissing parental concerns about supplements without discussion, as this may reduce transparency and adherence to conventional treatment. 2, 7