Is it safe to give elderberry (Sambucus nigra) supplements or juice to an infant under 12 months for immune support?

Elderberry for Baby's Immunity

Do not give elderberry supplements or juice to infants under 12 months of age. There is no established safety data for elderberry use in this age group, and the theoretical risk of immune overstimulation in an immature immune system outweighs any unproven benefits.

Why Elderberry Should Be Avoided in Infants

Lack of Safety Data

• No clinical trials or safety studies have evaluated elderberry supplementation in infants under 12 months 1, 2
• The existing research on elderberry has been conducted exclusively in older children and adults, making extrapolation to infants inappropriate 1, 3
• Without age-specific safety data, the risk-benefit profile cannot be adequately assessed for this vulnerable population

Immune System Concerns

• Elderberry significantly increases production of inflammatory cytokines (IL-1β, TNF-α, IL-6, IL-8) by 1.3 to 6.2-fold in adult immune cells 3
• The immature immune system of infants under 12 months may respond unpredictably to immune-stimulating substances 3
• While concerns about "cytokine storm" remain theoretical and unproven in older populations, the lack of data in infants makes this a critical safety consideration 4
• Infants' immune systems are fundamentally different from adults, with more immature B-cell and T-cell phenotypes that continue developing through the first year of life 5

Proven Alternatives for Infant Immunity

The evidence-based approach to protecting infants under 12 months focuses on vaccination and cocooning strategies:

• Ensure infants receive their routine vaccination schedule starting at 2 months (DTaP, IPV, Hib, PCV, rotavirus, hepatitis B) 6
• Vaccinate all household contacts and caregivers with Tdap to create a protective "cocoon" around the infant 5
• Mothers should receive Tdap during pregnancy (preferably third trimester) or immediately postpartum to provide passive antibody protection to the infant 5
• Limit infant exposure to persons with respiratory illness until they are determined to be non-infectious 5
• Ensure prompt antimicrobial prophylaxis if pertussis or other serious respiratory pathogen exposure occurs 5

Critical Pitfalls to Avoid

• Never substitute herbal supplements for evidence-based vaccinations - vaccines have extensive safety and efficacy data in infants, while elderberry does not 6
• Avoid the misconception that "natural" equals "safe for infants" - many natural products have not been tested in this age group and may pose unforeseen risks 1, 2
• Do not delay or skip routine infant vaccinations - the risk for severe pertussis, influenza, and other vaccine-preventable diseases is highest in the first months of life before completion of the primary vaccine series 5

When Elderberry Might Be Considered (After 12 Months)

• After 12 months of age, if parents wish to consider elderberry, they should consult their pediatrician first
• Even in older children and adults, elderberry's benefits for viral respiratory illness remain uncertain, with low-quality evidence 1
• The most robust evidence exists for elderberry's potential to reduce duration and severity of influenza symptoms in adults, but this evidence is still uncertain 1

The safest and most effective strategy for supporting infant immunity is adherence to the recommended vaccination schedule and ensuring all caregivers are appropriately vaccinated 5, 6.