Elderberry for kids: worth it?

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Every year, pediatricians field a flood of questions about elderberry. When you look online, it seems like a wondrous supplement. But does the data actually live up to the hype? And is it worth giving your child?

Here are my thoughts.

For those who want just the summary…

I’m a no. I think there is some data that is suggestive, but the limitations on safety and efficacy data in children give me pause. I wouldn’t use this in my kids.

What is Elderberry?

Elderberries come from Sambucus trees. Various parts of the plant have been used for centuries in cooking and herbal remedies for a variety of ailments, and it is still used in Europe in cooking.

Interestingly, in their natural form, many parts of the Elderberry plant are toxic - they have to be cooked before being eaten.

The Pediatrician Mom Tip: If prepared incorrectly, Elderberry can cause cyanide poisoning.

Elderberry supplements can be found in a variety of forms: gummies, teas, liquids, pills and more.

Why the hype?

The excitement around Elderberry is based on a few small studies.

• In 2004, Elderberry was found to shorten the duration of influenza by 4 days compared to placebo (PMID: 15080016) when given 4x/day.

• Another study suggests that if taken early in the course, it may compare favorably to medications such as Tamiflu.

• Some meta-analyses have concluded that while Elderberry may not decrease the risk of developing the common cold, it may impact duration and severity compared to placebo (PMID: 30670267, 33827515).

• A study in airline passengers found that those who took the supplement got infected as frequently as those who didn’t, but they also seem to get over their illness faster (PMID: 27023596).

• During the early part of the pandemic, there was a recommendation to avoid Elderberry because of concerns that it might overstimulate the immune system. Although some data does show that taking Elderberry can affect inflammatory markers, it is unclear whether that effect is sustained or whether it has a clinical impact. There also haven’t been studies in patients with underlying inflammatory conditions.

With that said…

• The issue with the studies is that they tend to be small, low-quality and inconsistent. And they often don’t include kids.

• Other studies have found no difference in outcomes. For example, one of the few studies that included children (aged 5y+) showed no substantial difference in the duration or severity of influenza symptoms (PMID: 32929634. It is worth noting—in this study, the elderberry group had slightly longer illnesses).

The truth is…

While there may be some foundation to the claims about Elderberry, its not a slam dunk.

Unfortunately, we don’t have well-designed, large, controlled trials that can answer this question conclusively, especially in kids. These studies are expensive to design and carry out and that remains a huge challenge for those parents who might be interested in the answer to this question.

How might it work?

Elderberry is high in antoxidants. It contains flavonoids (eg anthocyanin), which are known to have immune-modulating effects — these can attach to glycoproteins on the virus surface and block them from entering our cells and replicating.

More generally, antioxidants are important for immune function. With that said, we don’t have a great deal of data that suggests that supplementing with antioxidants improves clinical outcomes.

So should you give it to your kids?

My concerns are primarily around safety and efficacy.

• Supplements are not FDA regulated, and in fact when a number of Elderberry supplements were tested by Consumer Lab, they found that the product concentrations did not always match the label.

• Kids are not small adults—just because something is well-tolerated in adults doesn’t mean the same is true in kids. Aspirin is a good example of this.

• Unfortunately, we dont know the “right” Elderberry dose yet, and we also don’t know the safe dose — especially because there really isn’t research in young kids.

Bottom line:

If you choose to use Elderberry, make sure you choose a reputable company and recognize that even doing that, you may not be giving your child exactly what you expect. Homemade products carry the risk of toxicity.

At the end of the day, even if you do use Elderberry, it should never replace the other known methods of preventing illness and supporting the immune system: immunizations (especially against the flu!), washing hands, variety in the diet and more. If you’re really interested in the best EVIDENCE-BASED ways to support your child’s immune function, I have a free download here.

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When it comes to decisions like this, you want the benefits of anything you give your child to outweigh any risks. If the data around Elderberry’s effectiveness was more robust, the argument for use would be stronger.

So, as a mom and a pediatrician, at this point in time, I am a “nah” on Elderberry. But I remain open-minded.