Essential Oils for Kids: Inhalation

If you ask 20 people in the aromatherapy community about pediatric inhalation of essential oils, you’re likely to get 20 different answers. The bottom line is that very little research exists to outline exactly which oils are useful for children and more importantly, how those oils should be used. The lack of an extensive body of research to guide us doesn’t mean we are stuck relying on guesswork. There is a substantial amount of information about inhalation exposures available from the field of environmental health. 

What we know from existing research on childhood inhalation of both toxins and medications is that children are far more susceptible to risks associated with essential oil inhalation. There are several reasons for this.

What happens when children inhale essential oils? 

The first is the sheer quantity of air that children inhale. Compared to adults, children breathe in far more air. For example, a resting infant’s air intake is roughly twice that of an adult (Yeates, 2009). Practically, this means that if you diffuse an essential oil in a room that is occupied by both infants and adults, the infant will receive twice the dose the adult receives, even if they are sitting in the same spot. So if an adult is using their own sense of smell to decide how much essential oil can be diffused, there is a strong chance the infant will receive an overdose. 

This difference in air intake does not change overnight. Pound for pound, the average elementary-aged child inhales about 150% the amount of air an adult inhales. As a result, air quality overall is far more important for children than for adults due to this increased intake (Etzel, 2011). 

To further complicate things, and at risk of stating the obvious, children are smaller than adults. They tend to be shorter overall, which means that if we divide the air in a room into zones based on distance from the ground, they are breathing air from a different zone. Many airborne particles, such as essential oils, tend to concentrate in lower zones of air in the room, so the first few feet above the floor may have larger concentrations of essential oils than the highest few feet near the ceiling. Adults, being taller than children, breathe air that is more pure than children. This air contains less essential oil. Children, however, being closer to the ground are breathing air with a greater concentration of both essential oils and other airborne particles.

For example, a 2016 study found that car exhaust pollution at a child’s breathing level is far higher than pollution at an adult’s level (Kenagy, 2016). So, when an adult is walking a child to school, the child is far more likely to inhale pollution at a dose which would cause adverse health effects even though they are walking side-by-side. The distance from the ground plays a role in overall exposure. Or, as reflected in another study, when pushing a baby in a stroller, they will inhale 60% more air pollution than their parents (Sharma, 2018). This is an important component of pediatric aromatherapy because it means that a child is breathing in a larger concentration of essential oils in the air. 

So practically, when a small child inhales air in a room where essential oils have been diffused, they are inhaling more air per pound than an adult, and they are inhaling air with a greater concentration of essential oil chemicals. This compounds the total dose a child receives through airborne diffusion by as much as 400%.

This doesn’t mean that essential oils cannot be diffused around children; it simply means that the total quantity diffused must be dramatically reduced. Because of that reduction, the total amount diffused may end up being so small that it’s not enough essential oil to provide a therapeutic benefit for an adult in the same room. This is a key reason we don’t typically recommend diffusing essential oils into a room for therapeutic purposes. 

Diffusing essential oils into a room as an alternative to air fresheners in doses low enough to be safe for infants is perfectly acceptable.  Practically speaking, however, diffusing essential oils throughout a room in therapeutic doses means that you are medically treating everyone in the room, whether they need it or not. Personal diffusers are a fantastic alternative. These help to make sure that everyone who wants to smell the oils can do so at a level that is safe for their unique needs. 

How well do children tolerate essential oil inhalation? 

Children not only inhale a larger dose, they also are less able to manage that dose once it is inhaled. This is related to the rate at which respiratory systems develop in children. 

To discuss that, let’s start by looking at the lungs. The lungs are filled with alveoli, tiny structures which facilitate the exchange of oxygen and carbon dioxide to and from the bloodstream. While lung development begins early in gestation (around 4 weeks), alveolarization does not occur until the third trimester. 

At birth, children have around 20-50 million alveoli while an eight-year-old has around 300 million. An adult has around 800 million (Pinkerton and Joad, 2000). Airway branching continues until a child is about 18-20 years old. Absorption of pesticides and other lipid-soluble, low molecular weight chemicals (i.e. essential oils) is dependent on the total amount of alveolar surface area, thickness of these membranes, pulmonary blood flow, and respiratory volume. 

It may be tempting to look at the immaturity of a child’s lungs and assume that less surface area for absorption means lower overall absorption, resolving the increased intake we just discussed. But you know the old saying about assuming things–especially in science. Researchers long ago found that lipid-soluble compounds are absorbed at similar rates by both infants and children (Hemberger, 1978). Essential oils are lipid-soluble compounds. These substances are primarily absorbed by what is known as passive diffusion, rather than active transport, meaning that this happens without requiring any energy from the body. 

In other words, children are still getting a larger exposure of essential oils than adults, even if the same amount was administered. 

These aren’t the only concerns. Children also have smaller airways than those of an adult, increasing the risk of obstruction. These differences leave children more susceptible to lung disease and respiratory concerns. Additionally, at birth, the lung enzyme systems which are responsible for the detoxification of xenobiotics (foreign substances like essential oils) are not fully developed (Castell, 2005). So once they absorb these oils, infants and children are not able to metabolize and eliminate the phytochemicals in the same way as adults. 

Guidelines for Application 

Tools which are suitable for use with medicinal inhalation in children include aromasticks, inhalers, cotton balls, and even facial masks similar to those used in medical centers. A single drop–or less–is typically sufficient to achieve effects with disposable tools, such as cotton balls and face masks. (To achieve a dose of less than a drop, first dilute the essential oil into a carrier oil in a 1:1 ratio. One drop of the diluted oil is equivalent to a half drop of the undiluted oil.) 

Dose: Most oils or blends only require short bursts of direct exposure for 5-10 minutes. These effects often last anywhere from several hours to a day or more.

Risks: The greatest risk is overdose from prolonged exposure. Many adverse effects of essential oils on children are a result of prolonged exposure to essential oils with the belief that more is better. 

Contraindications: Certain oils impact the respiratory system and should be avoided by children under 2. One obvious example is oils rich in menthol and 1,8 cineole. Essential oils should not be used around children without guidance from a qualified expert.  

Dig Deeper

AAP Council on Environmental Health. (2011). Pediatric Environmental Health, 3rd Ed. Etzel, R. A. & Balk, S. J. (Eds.) American Academy of Pediatrics. 

Castell, J. V., Donato, M. T., & Gómez-Lechón, M. J. (2005). Metabolism and bioactivation of toxicants in the lung. The in vitro cellular approach. Experimental and toxicologic pathology : official journal of the Gesellschaft fur Toxikologische Pathologie, 57 Suppl 1, 189–204.

Hemberger, J. A., & Schanker, L. S. (1978). Pulmonary absorption of drugs in the neonatal rat. The American journal of physiology, 234(5), C191–C197.

Pinkerton, K. E., & Joad, J. P. (2000). The mammalian respiratory system and critical windows of exposure for children’s health. Environmental health perspectives, 108 Suppl 3(Suppl 3), 457–462.