The Difference Between Medicine and Poison: Herbal Dosing for Children

There is a reason the old saying goes, “The dose makes the poison.”

One of the biggest misconceptions I see around herbal medicine is that because something comes from a plant, you can use as much as you want and that it is safe.

Ummm....cyanide....I'm looking at you. Would you care to come to center stage and explain for me how just because it's from a plant doesn't mean it's safe? No...damn. Is hemlock in the room? Belladonna? Anyone? How about something a little less threatening? Foxglove... tobacco... licorice root....eucalyptus...

These are all plants that have the ability to kill you in various forms, ranging from deadly in damn near any amount to dose and preparation dependency. The difference between herbal medicine and poisoning isn't whether something is “natural.” It's often how concentrated the preparation is, how often you're taking it, and how your body processes it.

And when we're talking about children, those details become even more important.

Plants Are Medicine

Let's get something straight right from the beginning:

Herbal medicine is chemistry.

Every plant contains dozens, hundreds, and sometimes thousands of chemical constituents. Some of those constituents are responsible for the actions we want from the plant. Others may contribute to unwanted effects. The list of modern pharmaceuticals that are a single constituent derivative of a plant predecessor is crazy. How we prepare that plant determines which constituents we extract and how concentrated they become.

A cup of chamomile tea is not chemically equivalent to a chamomile tincture. A cup of peppermint tea is not chemically equivalent to swallowing peppermint essential oil. And a few drops of a tincture are not chemically equivalent to eating the same amount of the fresh plant.

This is where herbalism and aromatherapy are also VERY, very different.

Herbalism and Aromatherapy Are NOT the Same Thing

When we talk about constituents in herbalism, we focus primarily on terms like saponins or tannins. Sometimes we venture into the realm of vitamins and minerals or lipids. Whether constituents are hydrophobic or hydrophilic really determines what we are consuming in herbalism.

Essential oils, on the other hand, are extremely concentrated preparations of a plant's secondary metabolites. You get a small amount of these when consuming tinctures or infusions, but the amount is far less. The process of creating essential oils is to take a large amount of plant material, extract the very volatile oils in the material being used, and then bottle it. To use peppermint as an example again, it takes approximately 1 pound of dried leaves to make a standard 15 ml bottle of essential oil. 1 pound of dried leaves will give you 115 to 250 cups of tea depending on how stout you like it.

A few drops of an essential oil contain a significant amount of volatile constituents compared to what you are consuming in a single cup of tea. Other essential oils can cause serious toxicity when swallowed (like eucalyptus), and children are particularly vulnerable because of their smaller body size and developing physiology. This is why I will happily talk about herbs and essential oils in the same educational space while still telling you:

They are not interchangeable.

You cannot take the safety information for a cup of herbal tea and apply it to an essential oil. This type of behavior is why injuries happen. You have to understand the difference between the two practices. Enough about essential oils for now. We are talking about herbalism today.

Herbal Infusions and Decoctions

When you make an herbal tea or decoction, you're working with the plant in a much less concentrated form than you typically get with an extract or tincture (and the constituents between an extract and a tincture are also wildly different). You're using a certain amount of plant material, a certain amount of water, and a certain amount of time to pull water-soluble constituents from the plant.

This produces a preparation with a much lower concentration of constituents than a concentrated extract. It also doesn't extract any constituent that is soluble in alcohol. For many commonly used herbs, this makes teas and decoctions relatively forgiving preparations. One textbook I have even says that it is almost impossible for an adult to overdose using herbal teas. The key word there...ADULT.

So I don't want anyone walking away from this article thinking:

“It's a tea, so I can give my kid as much as they want.”

That's not how this works.

Side note: Not all plants are appropriate for kids, so keep that in mind while reading this, too.

Concentration Changes Everything

This is where dosing becomes particularly important.

Think about it this way:

Plant → Tea → Extract → Tincture → Highly concentrated preparation

These aren't interchangeable doses. The further you move toward a concentrated preparation, the more important it becomes to understand exactly what you're giving. An extract can contain considerably more of the plant's constituents in a much smaller volume. A tincture, on the other hand, typically has a different set of constituents because alcohol and water don't extract exactly the same things from a plant. Different constituents have different solubilities, meaning the final chemical profile of the preparation can change depending on how the plant was extracted. Growing conditions can even affect this!

So when someone tells me:

“But it's just one dropperful.”

My response is:

Okay. A dropperful of what?

What plant? Give me the exact species, the part of the plant, your extraction ratio, and how did you extract it? Are we talking tincture? Oxymel? Glycerite? Or a simple tea? Because a dropperful of chamomile or yarrow for a 3-month-old baby who has colic looks a whole hell of a lot different when it's an infusion versus a tincture. One is extremely helpful, and the other can have a negative impact on not just their digestive system, but their liver.

Children aren't simply tiny adults.

Their bodies are still developing, and the systems that absorb, distribute, metabolize, and eliminate substances don't function exactly like an adult's, especially before they hit two. Their microbiome is still developing. Their liver function isn't the same. All of that matters when we are talking about herbal dosing for children. Their smaller body size also means that the same amount of a substance can represent a much larger dose relative to body weight. And the younger the child, the more conservative I want to be.

Infants and very young children are a completely different conversation.

The safety data for many herbal products simply isn't there, and some botanical preparations have caused serious problems in infants and young children. Is there some fearmongering from the medical community? Yep, there is. We have a TON of data on giving herbal remedies to kiddos. It isn't double-blind, peer-reviewed studies, though, so the medical establishment sees it as unsubstantiated. But there is also a HUGE population of people throwing around information willy-nilly with absolutely no respect for physiology or true study that ends up harming people.

Standing in knowledge matters.

This is one of the reasons I don't love blanket statements like:

“Kids can take half the adult dose.”

Half the adult dose of a 200-pound adult isn't appropriate for a 30-pound child.

Weight matters. Age matters. The specific plant matters. The preparation matters. The concentration matters. And the child's individual health circumstances matter. It all matters. So how the hell do you figure out what is safe and what isn't?

First things first....know your plant. That's the big one. If you aren't sure, ask a clinical herbalist, not your neighbor...unless your neighbor happens to be a clinical herbalist...Anyway...don't rely on social media because the amount of bad advice and information I see as someone in this field is scary.

Second, you gotta pull out those handy-dandy math skills you swore up and down you would never need as an adult. There is also a calculator on the website, but these are for The Alchemist Lady products ONLY. It will not help you figure out dosing for anything that I haven't personally formulated. It isn't a universal herbal dosing calculator.

You should not use the number it gives you to dose a completely different product from another manufacturer. Why? Because formulations aren't interchangeable. Two products could contain the same herb but have completely different extraction ratios, concentrations, ingredients, and recommended doses.

Same herb ≠ same dose.

Now for the math.

Under Two

If your child is under two years old, this is where I want you to slow way down. There are simply too many variables and too little safety research for me to recommend approaching herbal extracts and tinctures casually in this age group. This is particularly important with concentrated preparations.

There are herbs I would be comfortable discussing for this age group. They do exist. But I would want to sit down and actually talk to Mom or Dad first.

Protecting the microbiome and developing physiology at this age is imperative. It is also extremely difficult to get an appropriate dose because of how small the numbers are. It is recommended to use the Fried method of calculating doses at this age. He postulates that a dose can be calculated by taking the age in months divided by 150, which gives you the fraction of the adult dose.

A six-month-old baby would then be given 4% of an adult dose. An infusion that is 8 oz is pretty easy to calculate out. That's .32 ounces or 9.5 mL. Try doing that with a tincture that has a dose of 1 mL. It gets a little bit crazy. You have to mix it with something to ensure dosing accuracy, and at that point, much of the medicinal potency has been lost. That's what makes working with these babes such a struggle. It's not impossible, but it is definitely more complicated.

Over 2 but not an adult

What counts as an adult? That depends on who you talk to. For the purpose of this conversation, an adult is someone over the age of 12 or 110 pounds and does not have any metabolic deficiencies or other ailments that may impede their ability to process what is being given to them. The Augsberger and Salisbury methods are typically used to calculate dosing in this age range. The Salisbury Method was designed by anaesthetists at Salisbury Hospital in the UK and is extremely reliable.

Augsberger Method

Augsberger states that the percentage of an adult dose is calculated by utilizing the weight in kilograms multiplied by 1.5 and then adding 10. It looks a little something like this:

1.5 x weight (kg) + 10 = % of adult dose (To convert pounds into kilograms, divide the weight by 2.205)

A kiddo who weighs 32 kg (71 lbs) would receive 58% of an adult dose. A tincture that has an adult dose of 4 mL (often referred to as 4 dropperfulls) would then need 2 1/3 mL. We always reduce the amount, never increase it. So the correct dose would be 2 mL.

Salisbury Method

This is how I calculate doses for kiddos. It looks at not just the weight of a kiddo but also accounts for the body surface area. It goes like this: if a kiddo weighs under 30 kg (66 lbs), you take their weight times two, and that is the percentage of the adult dose. If they are over 30 kg, you take their weight and add 30 to get the percentage. It looks like this:

A kiddo who weighs 25 kg: 25 x 2 = 50% A kiddo who weights 35 kg = 35 + 30 = 65%

There is some variation between the Augsberger and Salisbury Methods, but they are typically extremely close to one another, especially in kiddos who weigh under 32 kg (71 lbs).

(Note: We don't use either of these methods with kiddos under two because the calculations have been shown to result in overdoses, especially with the higher-concentration products such as tinctures.)

Phew....that was a long one. If you have stuck with me thus far, you're a rock star.

With love,