Administering Herbs to Children
The Mayway Herbal Consultants are available every day by phone and email to answer your questions and address your concerns about our herbs and products. In the Consultants’ Corner we will share in-depth information about the most frequently asked questions.
One series of questions that the Mayway Herbal Consultants consistently receive relates to administering Chinese herbs to children. Many practitioners in the field know that Chinese medicine can be helpful for addressing imbalances in young people, but often have received little training, or clinical exposure in the realm of pediatrics. As a result, many of the practitioners we speak to do not feel as confident when prescribing herbs to kids. We would like to share with you some of the most frequently asked questions we have received over the years about how to safely and effectively use Chinese medicine when working with children. We hope that this information will offer you some useful tools that will help you implement your unique knowledge of herbalism with the old and young alike.
Pediatric Administration Methods
Extract powders— These are extremely easy to use for infants and children of all ages. As they dissolve easily in a small amount of hot water, extract powders can easily be prepared anywhere. To increase palatability they may be mixed with milk, formula, grape or apple juice. For infants, dissolve extract powder in a small amount of hot water, cool, and then administer 1/2 to 1 tsp. at a time to the back of throat with a dropper or oral dispensing syringe. This technique also works well for administering bitter or bad tasting formulas to older children.
Teapills and tablets— Teapills and tablets may be similarly dissolved and administered for infants and small children, whereas older children can easily swallow them. To dissolve for infants and young children, combine a couple of days’ doses with half a cup of boiling water and steep for 5-10 minutes, then mush into thick liquid with a spoon. Strain through a fine mesh strainer to remove any large undissolved pieces. Divide the liquid into the same number of doses that were added to make the resulting mixture. This may be mixed with juice, milk or formula to increase palatability, or may be mixed with honey for children over 1 year old. Store liquid in the refrigerator for up to one week and reheat as needed. Alternately, a few days’ dosage of teapills and tablets can also be ground into a fine powder with a coffee grinder or mortar and pestle and administered in a manner similar to the extract powders above.
Infusions— Our infusions are extremely easy to use. Since they already contain sugar, they are easy to prepare and quite palatable. Just mix with hot water and administer as a tea, or squirt to the back of throat as above.
Syrups— These are even easier to use as they are in liquid extract form and pre-sweetened. They can be used alone or as a medium for administering other dissolved formulas.
We have included both an Age-to-Dose guideline and a Weight-to-Dose guideline for pediatric dosages. The Age-to-Dose guideline is most useful to gauge the approximate maturity of a child’s internal organs and is therefore an estimate of their ability to absorb, utilize and eliminate Chinese herbs. The chart below appears in John Chen’s “Chinese Medical Herbology and Pharmacology,” which he sourced from “Zhong Cao Yao” (Chinese Herbal Medicine), published by the Nanjing College of Traditional Chinese Medicine.
The Weight-to-Dose guideline is most useful to gauge the amount of Chinese herbs the body would contain on a per pound basis, and as such, it is a better estimation of dosage for infants and children who fall outside the normal weight parameters of their age group. The chart below appears in John Chen’s Chinese Medical Herbology and Pharmacology, which he created from calculations based on Clark’s Rule in Pharmaceutical Calculations, written by Michell Stoklosa and Howard Ansel.
Other Dosage Considerations
When determining a pediatric dosage, practitioners should also keep in mind the character of the patient’s condition and their overall health, well-being etc. With more acute conditions it may often be appropriate to use a larger dose, whereas with chronic conditions a smaller dose may be more appropriate. Also, in patients with healthy constitutions a stronger dose may be used while patients who are weak or deficient may require a smaller dose. Overall it is important to remember that guidelines are just that, helpful guides and not hard and fast rules. Each patient is unique and careful evaluation is required to determine the appropriate dose in each case.
Pediatric Cautions & Contraindications
Due to infants and children having a relatively weak Spleen and Stomach function, we recommend using caution when administering cold herbs. Herbs that purge accumulations, or other irritant laxatives, such as Da huang/Rheum palmatum root, Fan xie ye/Cassia angustifolia leaf, or Mang xiao/Mirabilite mineral, are generally contraindicated. We do not strongly caution formulas with herbs such as Shi gao/Gypsum fibrosum mineral, Huang lian/Coptis chinensis rhizome, even though they are cold natured and potentially hard on the Spleen and Stomach, because traditionally they are not specifically cautioned in children. In addition, these herbs tend to be within formulas that are actually indicated for infants and children to clear heat and expel toxic heat on a short-term basis. We also recommend using caution with formulas containing herbs that are considered by traditional Chinese medicine to be toxic or slightly toxic.
Administration of Herbs to Lactating Mothers
Please see our pediatric cautions & contraindications above for herbs to avoid for nursing mothers. In particular, very cold herbs or herbs that purge accumulation may go through the breast milk, disrupting the digestion and causing problems such as diarrhea or colic for the baby. Toxic or slightly toxic herbs may also go through the breast milk and should be used with appropriate caution.
The only herb used in our formulas that is specifically “cautioned” for nursing mothers in the Chinese materia medica is Mai Ya/Hordeum vulgare sprout, which when taken in large dosages can sometimes inhibit lactation. That being said, it does not seem to be the case with all women, and the amount of Mai Ya present within our formulas is not considered potent enough to have this action, so caution should be taken primarily with women who already have difficulty letting down or producing enough milk.
When administering Chinese herbal formulas to a nursing mother it is important to observe the baby for a few days while the mother is taking the herbs to see if signs of digestive upset, such as colic or diarrhea, or difficulty sleeping occur. If the baby’s digestion or sleep is disturbed the mother should discontinue the herbs to see if the symptoms disappear. If the baby doesn’t experience any digestive upset or sleeping problems, then the formula can continue to be administered as needed.
According to Chinese medical theory, the pregnant mother creates an abundant supply of Blood, part of which is then transformed into milk to nourish her baby. If the mother is sick or out of balance, the illness may affect the composition of her Blood or reduce her production of Blood, and thus affect the quality and quantity of her milk. Therefore, when herbs are needed, appropriate formulas to address the mother’s syndrome-pattern will not only bring her back into balance, but should improve the quality and production of her milk.
The special focus needed when working with children may at first seem daunting, yet the rewards of working with this special population can be great. Results can be achieved relatively quickly and you can extend your practice and services to a new population. Most importantly your work can contribute to healthy youth and can help create healthy lifestyles that your young patients will carry with them into adulthood.
Alisa Wrinkle, L.Ac., is a TCM practitioner practicing in Oakland CA. since 1997. She has been an herbal consultant for Mayway for 14 years. In the course of her tenure at Mayway where she has contributed to a wide range of projects including the research and development of new products, consulting, teaching and writing. She assists practitioners from around the country with herbal concerns and advises on product selection for their patients.
Laura Stropes, L.Ac. is a licensed acupuncturist and herbalist specializing in Chinese medicine gynecology and fertility, who has been practicing in Berkeley, California since 1998. She has been an herbal consultant for Mayway for over 10 years. In her consulting capacity for Mayway, she assists other acupuncturists, chiropractors, veterinarians, and medical doctors in choosing suitable TCM herbal treatments for their patients.
Teo Potts, L.Ac. has worked for Mayway Corporation as an Herbal Consultant since 2006. In this capacity he regularly assists acupuncturists, physicians, chiropractors and veterinarians from around the country with the selection of herbal formulas for their patients. Teo has a private practice in Emeryville, California, where he combines Chinese herbal medicine, acupuncture and massage. He specializes in pediatrics, pain, and dermatological conditions.