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Is 4mg cbd oil safe for a child

CBD Dosage: How Much Should You Take?

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Table of Contents

  • Determining the Best CBD Dosage for You
  • How to Calculate CBD Dosage
  • How to Take CBD

Cannabidiol (CBD) is growing increasingly popular, thanks to its many purported health benefits and non-intoxicating properties (most CBD products contain less than 0.3% tetrahydrocannabinol, or THC). In fact, 60% of U.S. adults have tried CBD at some point and believe it has medicinal benefits, according to a recent Forbes Health survey of 2,000 U.S. adults conducted by OnePoll. As research evolves and sheds light on CBD’s efficacy, especially for pain relief, more and more people are adding it to their daily wellness regimens.

Consumers can choose from a variety of CBD products, from oils to gummies to vapes to capsules. But figuring out the safe and effective CBD dose for an individual is a complex decision.

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Here’s how to find the right CBD dosage for you and how to consume it safely.

Determining the Best CBD Dosage for You

With the exception of one CBD product, a prescription drug used to treat seizures associated with particular syndromes, the Food and Drug Administration (FDA) doesn’t regulate the use of CBD. (In fact, it’s illegal to market CBD as a supplement or add it to food.) Therefore, it’s best to consult a doctor with experience in CBD administration to determine your ideal dosage.

Expressed in milligrams (mg), CBD dosage largely depends on the conditions and symptoms you’re trying to treat and your unique endocannabinoid system, which is associated with motor control, behavior, emotions, the nervous system and homeostasis. CBD dosage remains an area of active research—more large, high-quality studies are needed in different populations to determine appropriate dosing, efficacy and safety guidelines.

“It’s best to start small and gradually increase your dose up to a level that gives you the desired effect,” says Cheryl Bugailiskis, M.D., a cannabis specialist at Heally, a telehealth platform for alternative medicine. Your starting point might look like half a CBD gummy or a drop of oil. Ideally, navigate this process under the guidance of a qualified physician.

If you’re still not sure where to start, offers a questionnaire and CBD calculator to help you based on your specific symptoms and usage goals.

How to Calculate CBD Dosage

When you consume CBD gummies, capsules or softgels, dosage is typically expressed per unit. For example, there may be 50 milligrams of CBD in each individual gummy. These products don’t offer much dosage flexibility since you can’t split up capsules easily. For instance, if one softgel capsule didn’t provide your desired result, you would have to take another full capsule, doubling the total dose.

CBD oil, on the other hand, makes it easier, to begin with a small dose. But calculating CBD oil dosage can be less straightforward. Oils and tinctures tend to come in a dropper bottle and, typically, only the total liquid volume and CBD contents are listed on the label. For example, the label might simply state there’s 1,500 milligrams of CBD in the 30-milliliter bottle.

But what does 1 milliliter look like? Due to the current lack of regulation of CBD, this calculation can be tricky. Start by figuring out the volume of a single drop in your dropper, which is usually 0.05 milliliters, according to Dr. Bugailiskis. If you’re unsure, ask the company.

Here’s where math comes in. Let’s continue with the 30-milliliter bottle with 1,500 milligrams of CBD and 0.05 milliliters in a single drop as our example.

1500mg÷30mL = 50 mg/mL

This bottle contains 50 milligrams of CBD per milliliter. Let’s see how many milligrams are in a drop:

50mg/mL ×0.05mL/drop = 2.5mg/drop

Each drop contains 2.5 milligrams of CBD.

Next, you can calculate how many drops you need to reach your goal dosage. Let’s say you want to consume 25 milligrams each day.

25mg÷2.5mg/drop = 10 drops
10 drops ×2.5mg = 0.5mL

With this CBD oil dosage calculator as your guide, you would find that you needed to consume 10 drops, or 0.5 milliliters, to reach 25 milligrams. And if you intend to consume 25 milligrams daily, you can expect this particular bottle to serve as a 60-day supply.

Some CBD products do some of this math for you and illustrate how many milligrams are in a milliliter, some even marking these points on the dropper so you know exactly what you’re taking.

CBD Dosage for Different Ailments

Without FDA approval, there is little guidance in the U.S. on how much CBD a person should consume for various conditions.

In many medical studies on CBD, you see administered doses reach hundreds of milligrams a day, which sounds severe compared to our starting dosage example of 25 milligrams. However, Steven Phan, founder of Come Back Daily, a CBD dispensary in New York, points out that patients in these studies are often dealing with serious flare-ups and pain-inducing conditions compared to everyday dispensary customers.

Below are clinically-studied CBD dosages based on different ailments and conditions. Note: Some of the formulations studied contained THC as well—not all available dosage research sticks strictly to CBD.

Condition Dose* Anxiety 300mg–600 milligrams a day [1] Linares, Ila M. et al. Cannabidiol presents an inverted U-shaped dose-response curve in a simulated public speaking test . Brazilian Journal of Psychiatry. 2019;41(1):9-14. [2] Bergamaschi MM, Queiroz RH, Chagas MH, et al. Cannabidiol reduces the anxiety induced by simulated public speaking in treatment-naïve social phobia patients . Neuropsychopharmacology. 2011;36(6):1219-1226. Select forms of epilepsy Starting at 2.5 milligrams per kilogram of the person’s body weight twice daily [3] EPIDIOLEX- cannabidiol solution. DailyMed. Accessed 7/4/2021. Central neuropathic and cancer-related pain A maximum of 30 milligrams a day (or 12 sprays) [4] Sativex Oromucosal Spray – Summary of Product Characteristics (SmPC) – (emc). Datapharm. Accessed 7/4/2021. Opioid addiction 400 or 800 milligrams a day [5] Hurd YL, Spriggs S, Alishayev J, et al. Cannabidiol for the Reduction of Cue-Induced Craving and Anxiety in Drug-Abstinent Individuals With Heroin Use Disorder: A Double-Blind Randomized Placebo-Controlled Trial. American Journal of Psychiatry. 2019;176(11):911-922. Arthritis A maximum of 30 milligrams a day (or 12 sprays), or 250 milligrams applied topically [4] Sativex Oromucosal Spray – Summary of Product Characteristics (SmPC) – (emc). Datapharm. Accessed 7/4/2021.

*Dosages are based solely on small, short-term clinical study results where CBD proved significantly successful over placebo. Much larger studies are needed to further strengthen the evidence.

FDA-approved Epidiolex administers CBD orally as a liquid to treat seizures associated with Lennox-Gastaut syndrome, Dravet syndrome and tuberous sclerosis complex. The dosage of Epidiolex is determined by taking the patient’s weight in kilograms (kg) into account.

Several countries, including Canada and those in the U.K., have approved the use of Sativex, an oral spray with equal amounts of CBD and THC, to treat pain stemming from multiple sclerosis. Canada has also approved it for treatment of cancer pain.

The medical and research community still has a long way to go before figuring out what dose works best for each condition. At an individual level, consumers can experiment with caution until they find what works best for them.

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How to Take CBD

Popular ways to take CBD include:

  • Oils and tinctures (extracts of plant material dissolved in ethanol): A liquid that comes in a bottle with a dropper
  • Gummies: A soft, chewable candy that’s often fruit-flavored
  • Sprays: A liquid that comes in a bottle with a nozzle for spraying into the mouth
  • Capsules: Tablets or softgels that are ingested by mouth
  • Vapes: CBD oil that’s heated without ignition, resulting in an inhalable vapor
  • Flower: Dried hemp plant that’s often ignited and smoked
  • Edibles: Any food that CBD oil has been added to, such as brownies or chips
  • Drinks: Any beverage that’s infused with CBD, often in the form of hemp extract

Your CBD product of choice will largely depend on your personal preferences, as well as your budget since prices vary depending on the potency of ingredients and manufacturing processes. Different mediums also offer varying levels of bioavailability—or how much of what you take is actually absorbed into your bloodstream to have an effect. For example, if you ingest 10 milligrams of CBD via 1 milliliter of liquid, your body might absorb about 60% of it, or about 6 milligrams.

Cannabinoids generally have a low bioavailability compared to other substances, according to Jordan Tishler, M.D., a physician specializing in cannabis treatment in Massachusetts. However, “products that contain emulsifiers like egg yolk (brownies) or lecithin (some gummies) do better,” he says.

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With that said, ingesting CBD via gummies or other edibles may take longer to take effect since the CBD has to travel to your digestive system to be broken down and absorbed.

Can You Take Too Much CBD?

Like with any substance, you can take more CBD than your body can handle. Studies show doses up to 1,500 milligrams a day have been well-tolerated, but every person is different [7] Bergamaschi MM, Costa Queiroz RH, Zuardi AW, Crippa JAS. Safety and side effects of cannabidiol, a Cannabis sativa constituent. Current Drug Safety. 2011;6(4):237-49. . Ingesting too much CBD can cause unpleasant side effects, such as dry mouth, nausea, diarrhea, upset stomach, drowsiness, lightheadedness and general disorientation. While rare, liver damage can also occur.

What’s more, CBD can have serious interactions with certain medications. In evaluating available information on five prescription CBD-based medications, researchers found 139 medications could have a potential drug-drug interaction with CBD [8] Kocis PT, Vrana KE. Delta-9-Tetrahydrocannabinol and Cannabidiol Drug-Drug Interactions. Medical Cannabis and Cannabinoids. 2020;3:61–73. . People who take certain blood thinners, heart rhythm medications, thyroid medications and seizure medications need to be particularly careful.

At the end of the day, not all supplements are created equal, which is why it’s important to work alongside a health care provider when adding CBD to your wellness regimen and research reliable brands. And while emerging research and anecdotal evidence is promising, more large, randomized-controlled trials are needed to further understand the benefits of CBD and its dosing.

A pediatric patient with autism spectrum disorder and epilepsy using cannabinoid extracts as complementary therapy: a case report

The pharmacological treatment for autism spectrum disorders is often poorly tolerated and has traditionally targeted associated conditions, with limited benefit for the core social deficits. We describe the novel use of a cannabidiol-based extract that incidentally improved core social deficits and overall functioning in a patient with autism spectrum disorder, at a lower dose than has been previously reported in autism spectrum disorder.

Case presentation

The parents of a 15-year-old boy, of South African descent, with autism spectrum disorder, selective mutism, anxiety, and controlled epilepsy, consulted a medical cannabis physician to trial cannabis extract to replace seizure medications. Incidentally, at a very low cannabidiol-based extract dose, he experienced unanticipated positive effects on behavioral symptoms and core social deficits.


This case report provides evidence that a lower than previously reported dose of a phytocannabinoid in the form of a cannabidiol-based extract may be capable of aiding in autism spectrum disorder-related behavioral symptoms, core social communication abilities, and comorbid anxiety, sleep difficulties, and weight control. Further research is needed to elucidate the clinical role and underlying biological mechanisms of action of cannabidiol-based extract in patients with autism spectrum disorder.


Autism spectrum disorder (ASD) is a neurodevelopmental disorder that is characterized by deficits in two major domains: restrictive, repetitive patterns of behavior, interests, or activities; and deficits in social communication and interaction [1, 2]. ASD is associated with a higher incidence of comorbid conditions including attention deficit hyperactivity disorder, anxiety, gastrointestinal disturbances, motor impairments, and epilepsy. Symptoms appear in early childhood and vary in severity leading to a broad range of clinical manifestations [2].

The pathogenesis of ASD is not completely understood [3]. Given its complexity and diverse clinical manifestations, it is believed that the etiopathogenesis of ASD is a combination of genetic, epigenetic, neurobiological, diet, and other environmental factors [4]. Hundreds of genes (NLGN, SHANK3, ZNF8034A, and UNC13A) [5, 6] have been linked to ASD, most of which are closely related to the development of the nervous system [1].

There is a myriad of theories that attempt to explain the occurrence of ASD [1, 3, 7], although the two most accepted are impaired synaptic transmission and disruption of neural connectivity. The endocannabinoid system (ECS) has attracted considerable attention as a potential contributor to ASD, as the development of the ECS is essential for regulating synaptic function by inhibiting the release of neurotransmitters from presynaptic neurons [1].

The management of ASD requires individualized, comprehensive treatment. Non-psychopharmacologic interventions (for example, cognitive behavioral therapy) modify disruptive behaviors and improve social communication skills with varying degrees of success. Traditional psychopharmacologic medications target specific ASD core behaviors (for example, repetitive behaviors) and associated behaviors (for example, hyperactivity, aggression, anxiety, and sleep disturbances), but do not treat core social communication deficits [8, 9]. These medications are well known for their substantial side effects. For example, aripiprazole and risperidone, the only two medications approved by the US Food and Drug Administration (FDA) to treat irritability and agitation in ASD, frequently cause somnolence, increased appetite, and weight gain [10]. No other medication has been approved for management of behavioral and/or core ASD symptoms. Challenges with these traditional treatment approaches include barriers to access (economical, geographic), lack of efficacy, and undesirable side effects, which have led many families to seek complementary and alternative medicine (CAM) to augment or replace standard therapy [8]. One of the newest CAM options now being explored in ASD (and, in fact, the wider medical community) is cannabinoids: for example, cannabidiol-based extract (CBE), which is an extract from the cannabis plant, rich in cannabidiol (CBD) [11].

Follow-up of these patients must also be individualized as presentation of the disorder is highly variable. There are no validated questionnaires to accurately assess clinical progress, therefore, conducting an objective clinical assessment of related behavioral and core symptoms is challenging. Despite this, there are tools available for characterizing the overall functionality of patients with ASD, for example, Autism Spectrum Quotient (AQ) adults version [3].

The World Health Organization stated that CBD should not be scheduled with the International Drug Control Conventions because of growing evidence of its medicinal applications [12, 13]. It is imperative for health care providers to understand the minutiae of how cannabinoids interact with the human body and the different forms of cannabinoids that are available for medical use (for example, synthetocannabinoids, phytocannabinoids) [1]. Delta-9-tetrahydrocannabinol (THC) and CBD are the most well-known and studied phytocannabinoids. THC is associated with the impairing psychoactive effects of cannabis, resulting in potentially undesirable side effects (dizziness, anxiety, paranoia, dependency, cognitive impairment, and so on). In contrast, CBD is only minimally psychoactive and not impairing or intoxicating at typically used doses (for example, ≥ 20 mg/kg of CBD referred in the majority of intractable seizures studies) [1, 8, 10, 11].

A multitude of studies have analyzed the use of high-dose CBD extract (~ 20 mg/kg of weight per dose) in the context of intractable seizure treatment [14, 15]. It has been reported that CBD effects are dose-dependent (for example, > 160 mg/day elicits a sedating effect and lower doses have been associated with increased wakefulness) [16]. A few case reports and observational studies have suggested the safety and efficacy of lower dose CBD, for treating behavioral symptoms in ASD [11, 17, 18]. In a prospective study, 188 patients with ASD were treated with lower to medium doses of phytocannabinoids (from 15 mg of CBD three times a day to 300 mg of CBD three times a day), the majority taking 1:20 CBE: 30% CBD to 1.5% THC [19]. This study found that cannabis was well tolerated, safe, and effective in relieving certain ASD symptoms. More research is needed to assess the long-term effects of CBD, as well as optimal dosing, formulation, delivery method, and so on to maximize both safety and efficacy.

This case report describes the clinical presentation of a pediatric, overweight patient with ASD, epilepsy, anxiety, insomnia, and social deficits who benefited clinically with even lower doses of CBE (4 mg of CBD and 0.2 mg of THC twice a day) compared to the ones already studied [19].

Case presentation

A 15-year-old boy, of South African descent, is presented with a long-standing history of social and communicative challenges dating back to early childhood, including difficulties in appropriate use of facial expressions, eye contact, and gestures to regulate social interaction (see Fig. 1 for patient’s timeline). He has a history of difficulty in establishing and maintaining relationships, although he has been able to establish some friendships. His mother notes a history of selective mutism dating back to age 3. He has areas of fixated interests and some ritualized behaviors that on assessment were below the threshold for a diagnosis of obsessive-compulsive disorder. In 2016, he was formally diagnosed as having ASD by a specialized organization in British Columbia (BC), the Interior Health Children’s Assessment Network (IHCAN), with supporting evidence from Autism Diagnostic Interview – Revised (ADI-R) and the Autism Diagnostic Observation Schedule 2 (ADOS-2). He does well academically and there are no cognitive concerns. Sometimes he shows aggressive behaviors towards his mother and other relatives.

Patient’s timeline depicting important dates and events. ACH Alberta Children’s Hospital, ADI-R Autism Diagnostic Interview – Revised, ADOS-2 Autism Diagnostic Observation Schedule 2, ASD autism spectrum disorder, AQ Autism Spectrum Quotient (Adult), BC British Columbia, BMI body mass index (calculated by Du Bois method), CBD cannabidiol, CBE cannabidiol-based extract, CSHQ Children’s Sleep Habits Questionnaire (Abbreviated), CYMH Child and Youth Mental Health, IHCAN Interior Health Children’s Assessment Network, OCD obsessive-compulsive disorder, THC delta-9-tetrahydrocannabinol, upset stomach gastrointestinal side effects, VAS visual analog scale, VPA valproic acid. VAS severity for overall anxiety, social anxiety, aggressiveness and irritability, 0 = least severe, 10 = most severe. VAS for talkativeness, 0 = quiet, 10 = very talkative. VAS for focus, 0 = unfocused, 10 = focused

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He was diagnosed as having epilepsy characterized by focal seizures at age 7 at an emergency department service in BC and was subsequently treated by his pediatrician and a pediatric neurologist at the Alberta Children’s Hospital (ACH). He was initially prescribed carbamazepine for seizures which was stopped in 2015 due to side effects (upset stomach), followed by clobazam (stopped in 2016 due to suicidal ideation) and valproic acid (VPA) (stopped in 2017 due to alopecia, tremor, and reflux). The latter also caused a significant weight gain of approximately 13 kg in 1 year, resulting in a calculated body mass index (BMI) with the Du Bois method of 25.5 kg/m 2 . He is currently on lamotrigine for seizures, lorazepam for breakthrough seizures, melatonin for insomnia, riboflavin, ranitidine, magnesium, and orally administered CBE 0.2 mL (4 mg of CBD and 0.1 mg twice a day). No therapy had been tried for behavioral symptoms, although his mother mentioned that VPA and lamotrigine were also prescribed for their effect on mood.

He is currently in psychotherapy at the Child and Youth Mental Health (CYMH) clinic in BC for his selective mutism and anxiety disorder diagnosed by psychiatrists in the same province. He has also had sleep difficulties since 2016. His perinatal history is unremarkable. His birth followed a full-term pregnancy and was uncomplicated except for a required caesarean section due to macrosomia (> 4000 g) and macrocephaly (his mother does not remember the measurement), and subsequent hospitalization for neonatal jaundice. No genetic syndrome was suspected; no genetic testing was ever done. He met expected neurodevelopmental milestones for his age. His mother and grandmother have a history of depression and anxiety. There is other familial history of eating disorders and alcoholism, but no history of genetic syndromes.

In mid-2017, his parents consulted a medical cannabis physician from Caleo Health to assess the suitability of cannabis-based medicines as adjunctive or replacement therapy for seizures. At the time, a physical examination and laboratory findings were normal. A neurologic examination was unremarkable; mental status – awake, alert, cooperative; cranial nerves – normal; motor – normal tone, bulk, strength, and reflexes in upper and lower extremities, proximal and distal, deep tendon reflexes 2+ symmetric. A skin examination was unremarkable, there were no hypopigmented macules, café-au-lait macules, neurofibromas, or axillae ephelides. A long-term (48-hour) electroencephalogram done in 2016 did not record any epileptogenic potentials; magnetic resonance imaging (MRI) showed no intracranial abnormalities and a computed tomography (CT) scan of his head was normal (2015). Laboratory results done mid-2017 were normal: complete blood count and differential, vitamin B12, creatinine, sodium, potassium, calcium, magnesium, total bilirubin, albumin, alkaline phosphatase, aspartate aminotransferase, gamma-glutamyl transferase, alanine aminotransferase, and triacylglycerol lipase. He had low ferritin (11 μg/L) but normal hemoglobin (159 g/L), due to starting a vegetarian diet, which was followed up by the family physician.

He had not had a clinical seizure in 6 months (last seizure in March 2017). Medications at the time of initiation of CBE were: lamotrigine 200 mg twice a day for seizures, lorazepam 1 mg sublingual (SL)/buccal as necessary, infrequently used for seizures, melatonin 6 mg for sleep initiation, riboflavin 400 mg administered orally once daily, magnesium 1 tablet administered orally once daily, and ranitidine 150 mg twice a day. When asked for symptom severity on a visual analog scale (VAS) (0 = least severe, 10 = most severe), his mother reported overall anxiety, social anxiety, aggressiveness, and irritability severity, at 10/10, 10/10, 6/10, and 9/10, respectively. On VAS to assess for talkativeness (0 = quiet, 10 = very talkative) in social situations, the mother reported 0/10. On VAS for concentration (0 = unfocused, 10 = very focused), 4/10 was reported. In regards to sleep, the mother stated he was sleeping approximately 5 to 6 hours, and was having trouble falling asleep. After the initial assessment, his parents gave consent to start therapy and CBE was prescribed (60 mL bottle of 1:20 CBE – 0.001% THC and 0.02% CBD), from CanniMed, with an olive oil carrier. His parents were instructed to administer 0.1 mL twice a day (2 mg CBD and 0.1 mg THC) and increase by 0.1 mL (2 mg CBD and 0.1 mg THC) per dose if no effects were shown to a maximum of 0.5 mL (10 mg CBD and 0.5 mg THC) per dose.

In December 2017, after 3 months of the CBE prescription, his mother increased the dose to 0.2 mL twice a day (4 mg CBD and 0.2 mg THC) as the family noted only mild improvements in anxiety symptoms. In August 2018, a medical cannabis follow-up was conducted. At 0.2 mL twice a day for almost 9 months, our patient’s family reported an improvement of 7 points for overall and social anxiety and irritability, and 6 points on aggressiveness on their respective VAS. Talkativeness improved by 4 points and focus by 2 points. In February 2020, another medical cannabis follow-up was conducted and positive effects were still evident at the same dose. When the mother was asked to complete the Children’s Sleep Habits Questionnaire (CSHQ) Abbreviated, she stated that he slept 7 hours and only had trouble falling asleep in his own bed as he resists going to bed. No side effects were reported (nausea/vomiting, diarrhea, headaches, euphoria, feeling high, anxiety, panic attacks, palpitations, somnolence during the day or drowsiness). Laboratory results remained normal and low ferritin was corrected. He began to initiate and reciprocate conversations with acquaintances he had previously been unable to speak to (for example, doctors, community members). He became more motivated and energetic, starting his own vegetarian diet and exercise programs, ultimately losing 6.4 kg after starting CBE for a calculated BMI of 21.33 kg/m 2 . He was able to start his first part-time job helping customers and interacting with them. He was instructed to fill out the self-administered Adult AQ which resulted in a normal score of 10 as shown in Table 1. His mother stated he now also has a girlfriend. Recently, his mother started weaning him off CBE to go on a trip and noted an immediate change. He became more irritable and aggressive.

In discussion with their neurologist, the family decided to wean lamotrigine while remaining on CBE (0.2 mL twice a day – 4 mg CBD and 0.2 mg THC). Unfortunately, there was a recurrence of seizures and lamotrigine was titrated back to the full 200 mg twice a day dose.

Currently, our patient remains on the same medication as mentioned above, as well as low dose of CBE. He has maintained the positive effect on his behavioral symptoms, anxiety, sleep, and social deficits on CBE 1:20 ratio, 0.2 mL twice a day (4 mg CBD and 0.2 mg THC) and no side effects have been reported.


This case demonstrates the benefit of a lower than previously studied CBE dose for core social communicative and behavioral ASD symptoms, as well as improvements in co-occurring anxiety, sleep dysregulation, and weight, which led to substantial improvements in both our patient’s and his family’s quality of life and daily functioning. There was partial response at the initial dose of 0.1 mL twice a day (2 mg CBD and 0.1 mg THC) and a dramatic response at 0.2 mL twice a day (4 mg CBD and 0.2 mg THC). Seizures recurred when conventional anti-epileptic medication (lamotrigine) was weaned while on the CBE at the 0.1 mL twice a day dose (low doses), reiterating CBE at this dose did not have any significant anti-epileptic effect; lamotrigine has not been weaned while on the 0.2 mL twice a day (4 mg CBD and 0.2 mg THC) dose of CBE. Typically, significant higher CBD doses are needed for seizure control (> 20 mg/kg per day) [14, 15].

The symptom improvement occurred within a 6-month period following the initiation of CBE treatment, during which time there were no new additions or significant alterations of/to any concurrent medications or therapies that could otherwise explain the improvements in symptomatology. It remains unclear whether the CBE directly modified the core ASD symptoms in some way, or whether the impact of CBE was secondary to its positive effects on comorbid conditions, namely anxiety and/or sleep dysregulation, which were producing or exacerbating underlying ASD behaviors. We must also consider there are limitations inherent in the method used to assess his clinical improvement, as the VAS and the AQ are not yet validated. These measures were chosen by default, as no scale is currently validated to assess clinical progress [3]. Seizures recurred at the initial 0.1 mL twice a day (2 mg CBD and 0.1 mg THC) dose of CBE. In addition to the fact that seizures were well controlled prior to starting CBE, the recurrence of seizures on the initial 0.1 mL twice a day dose of CBE, a dose at which symptoms were already starting to improve, suggests that improvements in ASD symptoms were not related to improvements in epilepsy control; the anti-seizure properties of CBD alone are unlikely to be the predominant mechanism responsible for the improvements in this patient’s ASD symptoms.

The ECS is a unique biological system that is present in the majority of body tissues. It plays an important role in cellular processes at the early stages of development [21]. The ECS is an essential regulatory system of the central nervous system that modulates both neurotransmission and synaptic plasticity. It is also involved in emotional and social functioning, and cognition [1, 21]. There is evidence that the ECS is underdeveloped in ASD [1, 22]. CBD may be treating core symptoms in ASD by interacting with the ECS to boost function in one way. CBD may increase the availability of the endogenous cannabinoids, anandamide (AEA), by directly inhibiting one of its degrading enzymes, that is, fatty amide acid hydrolase (FAAH) [1, 23, 24]. Wei et al. demonstrated that selective inhibition of FAAH in BTBR animals, increased AEA activity [25]. Further to this, a case–control study by Karhson et al. assessed AEA concentrations in ASD (n = 59) versus controls, and found lower AEA concentrations associated with ASD [26].

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High-dose CBD has been studied for seizures and has been approved by the FDA (Epidiolex) for the treatment of intractable epilepsy [14, 15, 27, 28], but there remains a lack of evidence for the use of phytocannabinoids in ASD [11]. Only a few low-powered studies address the clinical efficacy of cannabinoids for such symptoms, and there are no established recommendations for its use in ASD treatment [5, 6]. The majority of published studies for ASD either involve synthetic cannabinoids [11, 17, 18] or synthetic enzyme-inhibitors [25, 29]. Only a few studies offer evidence for the use of phytocannabinoids in ASD. An observational study by Bar-Lev Schleider et al. provided valuable information on safety and efficacy, but the study design was insufficient to draw strong conclusions on standard clinical care [19]. lists an ongoing randomized trial comparing different phytocannabinoid extracts in the setting of behavioral symptoms, but results are not yet available [30]. Therefore, this case report is rare as it documents observed effects of CBE in ASD-related symptoms as opposed to other forms of cannabinoids (for example, nabilone, dronabinol, and nabiximols).

From a clinical perspective, the use of CBD-based products to treat neuropsychiatric symptoms must be done only after appropriate education and informed discussion with families, including consideration of risks and benefits of CBD compared to other available treatment options, and with vigilant monitoring.

Research into the role of cannabinoids in treating ASD symptoms and associated behaviors is in its infancy. Although there is an increasing amount of evidence providing biological plausibility for the use of CBD in treating ASD [1, 5, 25, 26, 31], further research is essential to better understand the effects of phytocannabinoids on neurobiological pathways and their impact on behavior and brain function. Rigorous, controlled clinical trials are needed to further establish safety, especially long-term safety, optimal dosing, and efficacy, including further delineation of the effect of CBE on core versus associated ASD symptoms. Until sufficient, supportive evidence is found, CBE remains an unproven alternative treatment and should not replace conventional evidence-based treatments for children with autism. However, the unexpected and significant benefits of CBE in this case report highlight the urgent need and potential benefits of continuing to pursue research in this area.


While there is a lack of strong evidence to support the use of CBE in ASD, this case report provides the first insight about lower than previously reported doses of phytocannabinoids in the form of CBE, which may benefit ASD-related behavioral and core social symptoms, as well as anxiety, sleep disturbances, and weight. We encourage scientists and clinicians to pioneer placebo-controlled studies to validate the clinical efficacy of very low doses of CBE in a larger cohort.

Availability of data and materials

The dataset generated and analyzed during this case report are available in Netcare (Alberta’s public Electronic Health Record used to store patient information).

Is CBD Safe For Children To Use?

Could children safely use CBD? Many adults use it, for headaches, stress or trouble sleeping. If you have a child and would like to give CBD, you might ask yourself if it is safe. There hasn’t been done much research into CBD for children, but already, there is a CBD-based medicine. Developments certainly are ongoing. Read all about CBD for children below.

What Exactly is CBD?

CBD is a cannabinoid and it’s extracted from the hemp plant. After you take CBD, it can influence the endocannabinoid system. This system controls a great deal of processes in our body, like feeling pain, dealing with stress, regulating blood pressure, sleep and emotions. Spread out through the body and the brain, there are endocannabinoid receptors. CBD, which is a cannabinoid, has the ability to bind to these receptors. From there, it can create a new balance in the endocannabinoid system. In short, CBD can help you feel good.

Furthermore, it’s important to make the distinction between CBD and THC. THC is also extracted from the hemp plant, it’s the psychoactive compound of weed. THC also has an effect on the endocannabinoid system, but the influence it has is completely different. It gets you high. With CBD, that certainly is not the case. CBD has an entirely different effect. In the Netherlands, CBD contains very little or no THC, which is the reason you will not get high.

What Are The Benefits Of CBD F or Children?

More and more people are using CBD. Adults notice the many benefits it can have. But for children, it can also have positive effects. We can’t make any hard medical claims, as we still need more clinical evidence to do so. Still, CBD is already used to treat the following symptoms and disorders:


Researchers have done experiments on animals, which show that CBD can affect autistic behaviour. Of course, we need more research to see what it can signify for people with autism. They scheduled more studies, and research will focus on the influence of CBD on behaviours that occur with autism. Like auto-mutilation, aggressive and repetitive behaviour. CBD could be used instead of or next to regular medication.


In America, the FDA approved the first CBD-based medicine in june 2018. The medicine, called Epidiolex, is used to treat epilepsy. This is an important step in spreading knowledge about CBD.

The most famous story about using CBD for epilepsy, is that of Charlotte Figi, a little girl who had up to 20 seizures every day, all of her life. After her parents consequently administered CBD, the attacks were brought back to only 1 a month. And she’s not the only one who was helped by CBD. It really is a very good reason to do more research into the possible benefits of CBD.

The benefits of CBD when treating ADHD have not been studied extensively. The cannabinoid surely has a lot of potential and could give hyperactive children, w ho have trouble focusing and are very restless, some much needed tranquility. Children with ADHD often have trouble regulating their emotions, and CBD could also offer some support in that area.

Restlessness And Anxiety

Many children feel pressured nowadays. Expectations are really high, but they also have to process an excess of stimuli. Unfortunately, many children experience difficulty handling this pressure. They feel anxious and/or restless. This also influences how well they sleep, because t heir sleep gets disrupted easily. Your child may sleep lightly or have nightmares. You could give your child CBD, to help it cope better with stress and anxiety.

As it happens, CBD could create more peace and quiet in a child’s mind. Endless thoughts decrease, promoting a sense of calm and optimism. Physically, CBD makes it possible for your child to relax. Both during the day as at night, he or she will be better able to wind down.

How Do You Administer CBD To Children?

We recommend to give CBD to children aged 4 years and older.

Children aged 4 years and older:

2 to 3 drops per day, 4% CBD oil

Or try the tasty CBD Gummies, who contain 4 mg per Gummy, ideal for kids.

Tips for administering CBD to children

  • Start with a low dose and build up, until you see the desired results.
  • When you administer CBD to your child, the best way to give it, is to put the drops under the tongue. The oil is very quickly absorbed by the body through the mucus membrane. Try to convince your child to hold the oil in the mouth for 30 seconds.
  • CBD oil has a strong taste that’s not very appetizing to children. In case your child has trouble taking it, try putting the drop(s) on a piece of bread or mix it with some water.

If you would like to give CBD to your child, you should consider buying good quality CBD. SupMedi’s CBD oil is always strictly monitored. This way we guarantee that we supply you with high quality CBD oil, rich in active compounds.

  • Quality Genetics
  • Secure Packaging
  • Fast Delivery

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