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The importance of safety when using aromatherapy.

There seems to be an abundance of misinformation about the powers and safety of using essential oils for various effects. In the field for almost 40 years, the authors have seen countless unnecessary injuries to adults, babies, and animals from overuse of undiluted essential oils. Many unfortunately believe that since essential oils are "pure and natural", they are therefore safe. Misuse, especially by overuse, can lead to injury. This is especially true when working with special populations like pregnant women and their children.

What is Aromatherapy?

Aromatherapy is the inhalation and application of essential oils from aromatic plants, flowers, trees and shrubs to restore or enhance health, beauty and well-being. Essential oils have a wide range of biological activity, but they are not universally safe.

Essential oils are not universally safe and misuse can lead to injury.

What Are Essential Oils?

Essential oils are the highly concentrated extract of plant matter. These tiny droplets are present in particular glands, hairs, or specific structures of the plant and contain some of the active principles of the plant. Essential oils are phytochemicals with particular biological properties distinct from herbal preparations. Non-oily in texture, these highly concentrated substances are obtained by steam distillation, peel pressure, and solvent extraction methods. (Sheppard-Hanger, 2008).

How Do Essential Oils Work On the Body?

Essential oils are a great alternative for some traditional medical treatments. Essential oils are less toxic than synthetic antibiotics (Pereira et al., 2014) and can support health working with the body's own natural healing abilities (Miller et al., 2012). Oils can directly or indirectly affect the body's physiological systems. For instance, inhalations of peppermint or eucalyptus oils can relieve respiratory symptoms of congestion because of their mucus thinning properties (Sinclair, 1996), and inhaled peppermint can calm nausea (Sites et al., 2014). Used topically for their antiseptic and soothing qualities, essential oils diluted in carrier oil can successfully treat minor skin conditions and muscle aches (Gbenou et al., 2014).

How Do Essential Oils Work on the Mind?

By sniffing an aroma, a person's whole mind-set can shift. Think about the last time you walked into a place that smelled horrible; or conversely, a place that smelled inviting. The odor of a place will affect our perception of that location. In commercial retail scenting specific areas or products has been shown to encourage sales and create brand recognition by using the abilities of essential oils to affect associative learning and emotional processing (Bradford & Desrochers, 2009).

Because of the effect of relaxation on the brain and the subsequent sedating or stimulating of the nervous system, essential oils can help normalize other body systems, such as blood pressure and the possibly aiding in balancing of hormonal secretion. This relaxation effect, such as with PMS, (Freeman, 2010) has been shown by modulating neurochemicals like dopamine (Yun, 2014). Many healthcare providers are starting to utilize aromatherapy as a tool in their practice.

Olfaction's direct connection to the brain, via the limbic system, allows essential oils to have immediate effects on emotions and mental states. Perception of odors can have a major impact on memory, learning, emotions, thinking, and feeling. Scents can uplift spirits and calm the nervous system. For example, lavender is calming and has a sedative effect (Sayorwan et al., 2012); basil, rosemary and peppermint are uplifting and stimulating (Umezu, 2012); while jasmine and ylang-ylang are exciting or euphoric (Hongratanaworakit, 2010). See Table 1 for more information on general categories of essential oil's mental effects.

How Are Essential Oils Used?

The easiest and most common method essential oils are used is through inhalation. Direct inhalation of the oils can have psychological effects through olfactory links with the limbic system. In addition, physiological effects are possible because inhalation is the fastest route into the bloodstream. Inhalation is most useful for respiratory symptoms and can be done by: sniffing an inhaler, a few drops on a tissue, or sitting near a diffuser. Using essential oils through a spray or a diffuser may help to set the tone or feeling of the room. This method of use may help in preventing colds and flu spread by helping to kill germs in the air.

Aromatherapy Safety

The number one safety concern with all topical aromatherapy treatments is the risk of sensitization. Sensitization is an irreversible allergic reaction that a person can acquire after repeated undiluted use of an essential oil. Certain oils are known sensitizers (See Table 3) and topical use should be avoided. Even repeated undiluted use of gentle oils, like lavender, has been known to cause a sensitization response. Sensitization typically takes several applications before adverse effects occur. Special populations such as pregnant women or their infants are at particular risk for sensitization.

One of the safety experts in our field, Robert Tisserand, agrees on the importance of diluting essential oils. He says: the importance of diluting is to avoid skin reactions which can take the form of irritation, sensitization and photosensitization. In addition, diluting will help prevent any adverse toxicity effects. In pregnancy this is extremely important because fetal toxicity is possible through the overuse of essential oils since fetus shares blood with mom and is affected by what she is exposed to. Risk of adverse reaction is dose-dependent. Doses in aromatherapy are measured by percentage of concentration of the essential oils within carrier oil (for example coconut or jojoba). With this understanding, undiluted use of essential oils is considered a high risk factor for creating an adverse reaction (Tisserand, 2014). As health care providers, be aware that using essential oils undiluted directly on the skin creates a risk for adverse effects on both the practitioner and the client.

Aromatherapy for Pregnancy

Pregnancy is a time of both excitement and normal discomfort as the woman's body gestates new life and prepares for a major lifestyle transition. A pregnant woman's sense of smell changes during this time. Many scents that were previously pleasant before may not be so in pregnancy, and may change throughout the pregnancy.

During pregnancy, the use of essential oils should be treated the same as medications; if you do not need them do not use them. However, for many of the ailments that can occur during pregnancy, essential oils are a safer alternative to chemical drugs (Tisserand, 2014). There is little debate about which essential oils are appropriate and safe to use on a pregnant woman. See Table 2 for a list of oils commonly considered safe for pregnancy. Avoid oils that are known sensitizers (Table 3) and always do the "mom sniff test." Allow the mom to first sniff any oil that you'd like to apply. Even if the oil is known to help with relaxation, for example, if mom does not like the smell, then it is not going to do her as much therapeutic good than if she found the smell pleasant.

The safest application of aromatherapy for pregnancy would be environmentally (in the air) or on the skin with a carrier oil. The typical safe recommended dilution for a massage blend is 2.5% (15 drops in a 30 ml. of carrier oil). Though we do not promote undiluted use on anyone, this is especially true for pregnancy because of risk of sensitization and the fact that whatever is put on mom will get to the baby through the bloodstream.

Aromatherapy During Childbirth

In practice, the authors have encountered several mothers and midwives that used aromatherapy in the birthing process. Some will use a massage blend to help mom relax in between contractions, or a spray to help set the tone of the room. Though aromatherapy can be very helpful, when used improperly it can create quite the opposite effect. Here are a few ways to use aromatherapy safely and effectively during the birthing process.

First, be aware of the laboring mother's heightened smell sensitivity during her pregnancy. Aromas that she likes at the beginning of labor may be repulsive several hours later. Check with the mother before integrating any scents into the air, since they affect us so deeply and can be hard to remove from the air or her body if she does not like it. It is best to first spray or rub a little of the aromatherapy blend into your hands and let her smell it. Your hands can easily be washed if she does not like the aroma.

Second, once it is known that the mother likes a scent, the next step is to use it safely. All essential oils applied to the skin need to be diluted to 2.5% (15 drops in one ounce of carrier oil) and can be applied during labor for relaxation. It is possible to over-use, which can cause headaches and nausea for mom or others in the room. A good general rule is to have an hour break after each hour of use in the air or on the skin. If the laboring mom finds the aromatherapy helpful, you may not need to break for so long but first check in with the other people in the room, especially if they are a part of the medical or support team.

Finally, if the laboring mother is using a tub or is preparing for a water birth, do not place essential oils in the birthing water. Essential oils do not mix with water and can burn eyes and mucous membranes of anyone in the water including baby. There is also the chance that they may be inhaled by the baby after it is born which could irritate the lungs. Essential oils can be put instead in the air through a spray, diffuser or used as personal inhaler.

Aromatherapy in Parenting and Childcare

Using essential oils on any infant under three months, no matter what dilution percentage, is not recommended. After the first three months, essential oils can be used at a very low dilution, we recommend 1% or less (about 6 drops in a 30 ml bottle). Children over six years can safely use 2.5% or more. We only recommend using documented safe oils, staying away from the oils listed in Table 3.

Children often react to the strength of the odor, rather than the odor itself (Engen, 1974). Children begin learning odors early on. A baby can identify its mother's odor at six hours after one exposure (Porter & Winberg, 1999). A mother can pick out her own newborn's clothes from those of other babies by scent almost as quickly (Engen, 1974) and can be calmed by her scent (Rattaz, Goubet, & Bullinger, 2005). A child can use a mother's garment, which would have her smell or perfume, when having to be away from her as a calming device.

Essential oils should be kept away from children, so they are not mistaken as harmless risking overexposure or ingestion. Or they may copy adults using oils and want to try it. Children may love the smell of some oils and may confuse them with candy. Certain oils, like peppermint and eucalyptus, include components that can trigger a reflex in really young children which slows breathing down significantly. For more info, see Essential Oil Safety: For Health Care Professionals, 2nd Edition, by Robert Tisserand and Rodney Young. These are commonly used oils that can be helpful for respiratory conditions in very small amounts for adults, but you can use pine and conifer oils like spruce and fir instead for children and understand that less is more.

Essential oils can be used on children over two years old the same way they are used with adults with the exception of using only a small fraction of the same amount of oil. A parent may give a child a massage with a relaxing blend for example, but the dilution would be 1% or less. With safe methods, essential oils can enhance the well-being of the whole family.

In conclusion, aromatherapy provides health and body care on a completely natural basis, and the subtle qualities of the oils lend themselves best to a gradual experience. Hopefully, the need for a safe approach to the use of essential oils is evident. As highly-concentrated substances, essential oils can have a powerful effect on physical and mental states. As healthcare providers, we always want to make sure the effects are positive so we can continue to change the lives of our clients and patients in helpful and healthy ways.

In an effort to "do no harm," the following safety guidelines are recommended:

* When using essential oils on the skin, always dilute. For a massage blend on an adult, 2.5% is best, less for pregnancy, and much less for children (1% or less).

* Avoid internal use. Oral use may risk serious injury to GI track, liver, kidneys and other organs: and oral dosing may interfere with medication and aggravate other medical conditions.

* Documented injuries are recorded. (See Atlantic Institute of Aromatherapy First Injury Data Report 2014--ongoing collection site which documents reported injuries from unwise use http://www. atlanticinstitute.com/injury-report-2014)

* Essential oil use on newborns or infants up to three months is not recommended as their organs are still developing and skin is quite permeable. Essential oils may interfere with optimal bonding that occurs with mother's own scent.

* Be wary of using cold-pressed citrus essential oils of bitter orange, lemon, lime, and bergamot, on the skin. These essential oils are phototoxic and can cause pigmentation changes and skin burns up to 12 hours after application when exposed to the sun.

* It is wise to vary oils and blends for safety and variety.

* Do not use the same blend or single oil for extended periods.

Safe and Effective Ways to Use Aromatherapy with Families:

* Have on hand diluted blends for bug bites, first aid, sunburn, and other minor injuries. A starter kit might include German and/or Roman chamomile, Tea tree, Lavender, Rosemary, and Pine.

* Use aromatherapy to clean the air and prevent the spread of germs via diffusion. You can run diffusers with an anti-infectious blend when the family is sick or use citrus or other light oils for a calm and clean atmosphere. Alternately, sprays or drops on a tissue in air vents disperse through air.

* To help kids go to sleep, use lavender and marjoram in the bath (equal parts, 2-3 drops), or in a carrier oil for relaxing back massage before bed.

* To help with focus and homework, use oils that are stimulating like rosemary, lemon, or peppermint. Scents will also help with memorization; children learning a word list with a scent can recall the words later with same scent. For example, a child could study with orange, then take orange on a tissue to class when they go for the test.

* To help kids to calm themselves (along with punching bag to burn off anger and excess energy), use relaxing scents to help soothe emotions when upset. Make a special aromatherapy spray to ward off 'monsters' or nightmares.

* Make craft projects using essential oils (make aromatic clays, jewelry, perfume, bath salts).

References

Bradford, K. D., & Desrochers, D. M. (2009). The Use of Scents to Influence Consumers: The Sense of Using Scents to Make Cents. Journal of Business Ethics, 90(2), 141-153.

Engen, T. (1974). Method and Theory in the Study of Odor Preference In Amos Turk, James W. Johnston, David G. Moulton (Eds.), Human Responses to Environmental Odors (122-140) New York: Academic Press, Inc.

Freeman, E. W. (2010). Therapeutic management of premenstrual syndrome. Expert Opinion on Pharmacotherapy, 11(17), 2879-2889.

Gbenou, J. D., Ahounou, J. F., Akakpo, H. B., Laleye, A., Yayi, E., Gbaguidi, F, ... Kotchoni, S. O. (2012). Phytochemical composition of Cymbopogon citratus and Eucalyptus citriodora essential oils and their anti-inflammatory and analgesic properties on Wistar rats. Molecular Biology Reports, 40(2), 1127-1134.

Guba, R. (2001). Toxicity Myths. International Journal of Aromatherapy, 11(2), 76-83.

Hongratanaworakit, T. (2010). Stimulating effect of aromatherapy massage with jasmine oil. Natural Product Communications, 5(1), 157-62.

Miller, J. A., Thompson, P. A., Hakim, I. A., Lopez, A. M, Thomson, C. A., Chew, W., Chow, H. S. (2012). Safety and Feasibility of Topical Application of Limonene as a Massage Oil to the Breast. Journal of Cancer Therapy, 3(5A).

Pereira, T. S., de Sant'anna, J. R., Silva, E. L., Pinheiro, A. L., & de Castro-Prado, M. A. (2014). In vitro genotoxicity of Melaleuca alternifolia essential oil in human lymphocytes. Journal Ethnopharmachology, 3(2), 852-857.

Porter, R., & Winberg, J. (1999). Unique salience of maternal breast odors for newborn infants. Neuroscience & Biobehavioral Reviews. Retrieved from http://www.sciencedirect.com/science/article/pii/S01497634980044X

Rattaz, C., Goubet, N., & Bullinger, A., (2005) The calming effect of a familiar odor on full-term newborns. Journal of Developmental & Behavioral Pediatrics. Retrieved from http://www.ncbi.nlm.nih.gov/pubmed/15827459

Sayorwan, W., Siripornpanich, V., Piriyapunyaporn, T., Hongratanaworakit, T., Kotchabhakdi, N., & Ruangrungsi, N. (2012). The effects of lavender oil inhalation on emotional states, autonomic nervous system, and brain electrical activity. Journal of the Medical Association Thailand, 95(4), 598-606.

Sheppard-Hanger, S. (2008). The Aromatic Mind Book. Tampa, FL: The Atlantic Institute of Aromatherapy.

Sinclair, A. (1996). Remedies for common family ailments: 10 nasal decongestants. Professional Care of Mother and Child, 6(1), 9-11.

Sites, D. S., Johnson, N. T., Miller, J. A., Torbush, P. H., Hardin, J. S., Knowles, S. S., Tart, R. C. (2014). Controlled breathing with or without peppermint aromatherapy for postoperative nausea and/or vomiting symptom relief: a randomized controlled trial, Journal of PeriAnesthesia Nursing, 29(1), 12-9.

Tisserand, R., & Young, R. (2014). Essential Oil Safety, A guide for Health Care Professionals, 2nd Ed. New York: Elsevier.

Tisserand, R., (2014). Why is dilution important? Retrieved from http:// roberttisserand.com/2014/05/essential-oil-dilution-important/

Umezu, T. (2012). Evaluation of the effects of plant-derived essential oils on central nervous system function using discrete shuttle-type conditioned avoidance response in mice. Phytotherapy Research, 26(6), 884-91.

Watt, M. (2013). Essential Oils during pregnancy: Myths Exposed and Some Facts. Retrieved November 27, 2014, from http://aromamedical.org/PDF/ oils-in-pregnancy.pdf

Yun, J. (2014). Limonene inhibits methamphetamine-induced locomotor activity via regulation of 5-HT neuronal function and dopamine release. Phytomedicine, 2/(6). 883-887. Retrieved from http://www.phytomedicine-journal.com/article /S0944-7113(13)00479-0/abstract

by Sylla Sheppard-Hanger, LMT & Nyssa Hanger, MA LMT

Sylla Sheppard-Hanger has forty years of experience with essential oils and is the Founder and Director of The Atlantic Institute of Aromatherapy (Tampa, Florida) and most notably, author of The Aromatherapy Practitioner Correspondence Course, and The Aromatherapy Practitioner Reference Manual (1995), and others.

Nyssa Hanger is the Assistant Director and Instructor for The Atlantic Institute of Aromatherapy and Founder of Upward Spiral Therapy, Inc. Both Sylla and Nyssa maintain private massage and aromatherapy practices in Tampa, FL and teach aromatherapy classes across Florida.

Table 1. General Categories of Mental Effects of
Essential Oils. (Sheppard-Hanger 2008)

Essential Oil    Action

Jasmine          Euphoric: uplifting to emotions, enhances
Rose             sensuality, lifts mild depression, possible
Sandalwood       light narcotic and euphoric effect
Ylang-Ylang
Clary sage

Lavender         Sedative: calms emotions, relieves anxiety,
Sweet marjoram   reduces nervous tension, sedates
Neroli
Mandarin

Geranium         Balancing: regulating, uplifting to
Bergamot         emotions
Rosewood
Clary Sage
Grapefruit

Rosemary         Stimulant: awakening, mental stimulant
Basil
Peppermint
Lemon

Table 2. Essential Oils Considered Safe for
Pregnancy (Guba, 2001)

Essential Oil     Botanical Name

Cardamom          Elettaria cardamomum
German and        Matricaria recutita, Anthemis noblis
Roman chamomile
Frankincense      Boswellia carterii
Geranium          Pelargonium graveolens
Ginger            Zingiber officinale
Neroli or
Orange Blossom    Citrus aurantium bigaradia
Patchouli         Pogostemon cablin
Petitgrain        Citrus aurantium
Rose              Rosa damascene
Sandalwood        Santalum album

Table 3. Essential Oils Known to Cause Adverse
Effects (Sensitization) on Skin

Essential Oil      Botanical Name

Cassia             Cinnamomum cassia
Cinnamon bark      Cinnamomum zeylanicum
Peru balsam        Myroxylon pereirae
Verbena absolute   Lippia citriodora
Tea absolute       Camellia sinensis
Lemon Myrtle       Backhousia citriodora
Turpentine oil     Pinus spp.
Inula              Inula graveolens

Watt (2013). Used with permission from: Essential Oils during
pregnancy: Myths Exposed and Some Facts. Retrieved from
http://aromamedical.org/PDF/oils-in-pregnancy.pdf
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Author:Sheppard-Hanger, Sylla; Hanger, Nyssa
Publication:International Journal of Childbirth Education
Article Type:Report
Date:Jan 1, 2015
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