Herbal Remedies for Childhood Anxiety: Safe and Effective Approaches in Integrative Pediatrics

Anxiety is one of the most common mental health concerns observed in children, affecting up to one in five children (4, 17). Rates of childhood anxiety are increasing over time. According to the 2018 National Health Interview Survey, 10 million parents of children with mental health issues reported using complementary and alternative medicine (CAM) therapies due to a desire for a more natural and holistic healthcare approach. Integrative pediatrics represents a holistic approach that merges conventional medical practices with complementary therapies, such as herbal remedies. 

In the context of managing childhood anxiety, this approach seeks to blend evidence-based conventional treatments with the potential benefits of alternative interventions. By acknowledging the synergies between these approaches, integrative pediatrics strives to create comprehensive and individualized strategies, emphasizing the importance of considering both the physical and emotional aspects of a child's well-being. This integrated paradigm encourages collaboration between healthcare providers, parents, and herbalists, fostering a more holistic and patient-centered approach to pediatric care.

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What Is Childhood Anxiety?

Childhood anxiety refers to excessive worry, fear, or apprehension experienced by children that can interfere with their daily lives. Many children have fears and worries at different times during development; for example, many toddlers often become upset when being away from their parents. These fears are normal reactions to perceived dangers, typically short-lived, and help children solve problems independently. However, when anxiety becomes persistent, overwhelming, and disrupts normal functioning, it may indicate an anxiety disorder. (3, 4) Examples of childhood anxiety disorders include:

• Separation anxiety
• Phobias: extreme fears about objects or situations
• Social anxiety
• Panic disorder

Normal anxiety in children often stems from typical life experiences, such as starting school or meeting new people. It tends to be temporary and proportionate to the situation. In contrast, anxiety disorders involve excessive and irrational fears that persist over time, affecting a child's ability to engage in age-appropriate activities. Anxiety in children can present as fear, worry, irritability, anger, trouble sleeping, fatigue, headaches, and stomachaches. (1, 4) 

The impact of long-term, untreated anxiety in children is significant. Anxiety may hinder social and academic achievement, contribute to the development of other mental health issues, and increase the risk of substance abuse later in life. Additionally, chronic anxiety during childhood has been associated with altered brain development and function. (10, 37) 

The Role of Integrative Pediatrics in Managing Childhood Anxiety

Integrative pediatrics merges conventional Western medicine with CAM therapies for a holistic approach to child health. Emphasizing individualized and evidence-based care, practitioners consider the child's unique factors, addressing root causes rather than just symptoms. Holistic assessment and treatment views the child as a whole, incorporating modalities like nutrition, acupuncture, botanical medicine, and mind-body practices. By combining conventional and complementary medicine, integrative medicine aims to optimize children's well-being, support overall health, and reduce reliance on medications (thereby reducing the burden of unpleasant side effects that often accompany them).

According to the 2012 National Health Interview Survey (NHIS), 11.6% of children use CAM, and the prevalence of CAM among the pediatric population significantly increased compared to previous years. CAM is commonly used in children to address musculoskeletal conditions, colds, anxiety, stress, attention-deficit hyperactivity disorder (ADHD) or attention-deficit disorder (ADD), and insomnia. (11) 

​​Integrative pediatricians approach childhood anxiety with a comprehensive assessment to identify the underlying biological, environmental, and physiological factors that may contribute to anxiety symptoms. Holistic treatment for childhood anxiety involves a personalized strategy that integrates conventional and complementary approaches to support overall well-being and help manage anxiety symptoms to improve quality of life and functioning. Therapeutic interventions may include (but are not limited to) talk therapy, nutrition, botanical medicine, and, when necessary, pharmacotherapy. 

Common Herbal Remedies for Childhood Anxiety

There are many dietary and herbal supplements that may help support anxiety management. In this section, we will explore the research supporting the use and safety of some of the most common herbal remedies for kids' anxiety.

Chamomile

Records show that chamomile (Matricaria recutita) has been used as a medicinal remedy for anxiety, sleeplessness, and gastrointestinal conditions since ancient times. Its calming effects are attributed to the herb's properties that may support relaxation. Evidence suggests that the herb's flavonoids may affect neurotransmitter transmission and modulate hypothalamic-pituitary-adrenal (HPA) axis function, potentially producing calming effects, which may help manage symptoms associated with generalized anxiety disorder. 

Chamomile is generally considered safe, especially when used as tea. Other administration forms suitable for children include glycerites and essential oil steam inhalations. Caution should be used when administering chamomile to children with allergies to ragweed, chrysanthemums, marigolds, or daisies, as they are at a higher risk of allergic reactions. (9, 21) 

Lavender

Lavender (Lavandula angustifolia) is often used as a dietary supplement for anxiety and mood support. It can be consumed in foods and beverages, extracted as an essential oil for aromatherapy, or administered in tincture or capsule form. (29) 

There is a growing pool of evidence that supports the use of lavender oil, particularly as a standardized form called Silexan, in managing anxiety. Silexan has been shown to be comparable to its pharmaceutical counterparts, such as paroxetine and lorazepam, in reducing anxiety severity based on Hamilton Anxiety Scale (HAM-A) scores. Lavender oil is noted for its potential to deliver calming effects without inducing sedation, dependence, tolerance, or withdrawal symptoms.

While oral capsules are effective in managing anxiety, they may not be a practical option for pediatric patients. Fortunately, lavender is versatile and can be administered as a tea or through aromatherapy to patients who cannot swallow pills, potentially resulting in similar calming effects (26). Research also suggests lavender aromatherapy may support improved sleep quality when combined with proper sleep hygiene practices. 

Lemon Balm

Lemon balm (Melissa officinalis) is known for its antioxidant properties, attributed to its high content of volatile oils and polyphenols. In addition to reducing oxidative stress and inflammation, lemon balm's calming effects may stem from its ability to modulate neurotransmitters. (36) Studies have found that lemon balm may provide various benefits for those experiencing anxiety. Lemon balm has been associated with reduced symptoms of anxiety, mood disturbances, insomnia, and stress. 

Lemon balm can be administered as a tea, capsule, tincture, or essential oil. Caution should be taken when administering lemon balm to patients with preexisting hypothyroidism or allergy to plants belonging to the Lamiaceae family, such as mint. (30) 

Passionflower

The most commonly used plant species within the Passifloraceae family is Passiflora incarnata, which contains many bioactive constituents, such as flavonoids and alkaloids, that may support relaxation and mood balance. These compounds may influence important neurotransmitter systems, like serotonin, dopamine, and GABA, and modulate neuroinflammation, enhance mood, and inhibit activity within the central nervous system – collectively contributing to its calming effects. (20)

Clinical trials have found that passionflower extract may be comparable to the pharmaceuticals oxazepam and midazolam in managing mild-to-moderate anxiety with fewer associated side effects. Evidence also shows that passionflower may be effective for managing more severe cases of anxiety and has been safely coadministered with sertraline, a selective serotonin reuptake inhibitor (SSRI) commonly prescribed for managing anxiety disorders.

Passionflower has been used safely in oral doses of 32-96 mg daily for up to four weeks in children ages 6-12 years. 

Safety Considerations for Herbal Remedies in Children

Using herbal remedies for children necessitates careful attention to safety, proper dosing, and quality control to ensure their well-being. While herbs can offer potential benefits, it's crucial to approach their use with a cautious and informed mindset. Infants and children are more susceptible to side effects of pharmaceutical and natural products due to their small size, immature immune systems, and developing body systems. Natural dietary and herbal supplements can lead to emergency room visits when they are misused. (11, 44) 

Parents should be vigilant about giving their children dietary and herbal supplements. Before giving children any supplements, consulting with a healthcare professional is essential to avoid adverse health effects and negative interactions with other supplements or medications. An integrative pediatrician will be able to determine safe and effective dosing strategies based on the child's health history, height, and weight. 

Supplements are not regulated in the same way as prescription medications. This allows for variability in the quality and purity of natural supplements. The label "natural" does not always equate to "safe." Healthcare professionals can help ensure safety by recommending quality-controlled, medical-grade supplements.

Lifestyle and Dietary Considerations in Childhood Anxiety

Lifestyle and dietary modifications play a crucial role in managing childhood anxiety, offering holistic and evidence-based approaches to support a child's mental well-being.

Physical Activity

Adapting neurotransmitter systems, regulating brain-derived neurotrophic factors, enhancing the parasympathetic nervous system, and improving self-esteem are possible mechanisms that may explain exercise's calming effects (5). Children should be encouraged to participate in activities they enjoy, such as sports, dancing, and outdoor play. According to the CDC, children ages 3-5 need to be active throughout the day; children and adolescents ages 6-17 should be active for 60 minutes daily.

Balanced Diet

A poor-quality diet lacking nutrient-dense foods (i.e., Standard American Diet) and resulting nutrient deficiencies, such as folate, zinc, magnesium, and omega-3 fatty acids, have been linked to mental health issues in children. Dietary habits can directly impact biological systems related to mental health, including oxidative stress, immune system function, and nervous system development. (39) 

Research has shown that adolescents who adhere to a Mediterranean diet report lower levels of anxiety. The Mediterranean diet encourages avoiding ultra-processed foods and consuming a wide variety of nutrient-dense foods, promoting adequate intake of macro- and micronutrients required for brain development and neurotransmitter synthesis. (41) 

Mindfulness and Relaxation Techniques

Practicing mindfulness and relaxation techniques can empower children with tools to manage anxiety. Techniques such as deep breathing, meditation, and yoga promote self-awareness and emotional regulation. Mindfulness encourages staying present in the moment, reducing worry about the future. These practices have shown positive effects on anxiety reduction in children and adults and can be incorporated into daily routines or taught in structured programs.

When to Seek Professional Help

Recognizing signs that indicate a child's anxiety may require evaluation, and potentially pharmaceutical treatment, is crucial for timely intervention. While herbal remedies and lifestyle changes are valuable, some situations warrant additional professional support. Cognitive behavioral therapy (CBT) is the preferred treatment for mild-to-moderate symptoms of anxiety disorders. Pharmacologic treatment may be required when the child presents with moderate-to-severe symptoms (e.g., panic attacks, inability to attend school), is unable or unwilling to participate in psychotherapy, or has not responded to lower-force interventions. (27) 

Integrating Herbal Remedies With Conventional Treatments

Integrating herbal remedies into a comprehensive anxiety management plan for children requires a collaborative effort between children, their parents, and healthcare providers. Initiating the process involves consulting with the child's healthcare provider, who can assess overall health, existing medications, and potential interactions with herbal remedies, guiding safe and effective integrative approaches. Collaboration with qualified herbalists is valuable, allowing for insights into appropriate dosages, possible interactions, and ongoing monitoring of the child's response to herbal remedies. The creation of an individualized treatment plan tailored to the child's unique needs ensures a personalized approach that addresses specific aspects of anxiety. 

Combining complementary herbal remedies with pharmaceutical medications in the management of childhood anxiety offers a range of potential benefits. This integrative approach can enhance overall treatment efficacy, as certain herbs possess calming properties that may complement the action of medications. This combination can also support long-term management, offering a sustainable and gentle approach that may reduce the need for high doses of pharmaceutical medicines over time, reducing side effects and creating a more tolerable treatment experience for the child.

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Herbal Remedies for Childhood Anxiety: Key Takeaways

An integrative approach to managing childhood anxiety may include the use of specific herbal remedies, which offer potential calming effects without the adverse effects associated with some pharmaceutical medications. When integrated into a comprehensive treatment plan, these natural interventions provide a holistic approach that considers the child's unique needs. Fostering open dialogue between children, parents, and healthcare providers optimizes the effectiveness of herbal remedies and other alternative therapies. This collaborative communication allows for identifying individualized treatment approaches, ensuring that the chosen herbal remedies align with the child's health, preferences, and overall well-being.