The Challenging Art of Aromatherapy
By Crystal Fares, CAHP®
There are several parallels between clinical medicine and the practice of aromatherapy. Clinicians are usually not involved directly in theoretical or laboratory studies; however, in order to practise clinical medicine, they must be able to use their fundamental knowledge of the underpinnings of medicine to understand and interpret the scientific data available to them and they must balance this data analysis with their intuitive awareness that every patient is unique in order to responsibly treat their patient.
The practice of aromatherapy is very similar to the practice of clinical medicine with its own unique challenges in bringing balance between knowledge and practice. Science is lacking in aromatherapy, and while there is a wide range of studies on various oils and their chemical constituents, there is a limited number of double-blind, randomized clinical trials, which are gold standard studies to support evidence-based practice.
In addition to the gap in scientific data in the field of aromatherapy, the practice, being somewhat of an art, is further challenged by a variety of practitioners with a range of philosophical practices when it comes to application rates and oil selection. How then does the aromatherapist navigate these challenges in their own practice to ensure they are safeguarding their most vulnerable of patients, while continuing to support their needs?
The National Association for Holistic Aromatherapy (NAHA), a non-profit association that advocates for enhanced academic standards in aromatherapy education and professional practice and offers scientific, empirical, and current information about aromatherapy and essential oils (EOs) (About, 2020), states that the client age is an important factor in EO application safety. They report that “infants, toddlers, and young children are more sensitive to the potency of essential oils” (Safety, 2020) and they recommend using dilutions between 0.5 and 2.5%. They also purport that the condition being treated makes a difference, and some oils should be avoided altogether (Safety, 2020). Robert Tisserand, a tenured aromatherapist who started in the industry over 50 years ago, and Rodney Young, a trained chemist with a PhD in medicinal chemistry, suggest a range of 0.2 to 0.5% maximum dilution for non-premature infants to age 24 months; however, they affirm that the concentrations are not research based and should be taken as suggestions and not absolute rules (Tisserand and Young, 2014, p. 47). Danielle Sade, founder of Healing Fragrances School of Aromatherapy with over 30 years’ experience in teaching, practising, and researching plant-based medicine (Sade, 2020) recommends avoiding the use of essential oils on infants under the age of 6 months and recommends a maximum dose of 0.05% in children (Sade, n.d., A Practitioner’s Guide…, p.17). The variance in these recommended dilutions is large and ranges from 0.3 drops in a 30 mL carrier oil at the lowest range to 3 drops in a 30 mL carrier oil at its highest. Yet another factor in these rates is what calculation is used to determine number of drops. Tisserand uses the 30 drops of EO equals 1 mL calculation making a 0.5% dilution 4.5 drops in a 30 mL Carrier (Tisserand and Young, 2014, p.48), where Sade uses 20 to 30 drops to 1 mL (Sade, n.d., Carrier Oils…) making a 0.05% dilution the equivalent of 0.3 drops in a 30 mL solution, using 20 drops to 1 mL.1
How then is a practitioner to know which guidance to follow, especially when the recommendations are not based on science and are offered by equally experienced and knowledgeable guides?
The clinician we talked about earlier will have a host of science at their disposal, given the money and effort that is put in to studying therapeutics, especially medication; nevertheless, their clinical experience will teach them that, despite what the scientific literature tells them, not every patient will respond favourably to the medication they are prescribed. As a result, through years of experience and trial and error, clinicians learn what works and what doesn’t for most people in real world settings. This too is the way of the aromatherapist. Erring on the side of caution, one should start out with low dilutions and build up a repertoire of knowledge of what works most efficiently, and at what dose. For infants over six months and young children, testing out a small area of skin first and watching for a reaction can help mitigate the extent of any negative response.
In addition to the real-world experience, when using EOs as a therapeutic, it is still important to utilize the ever-growing literature and empirical data that exists. In fact, as more nurses are trained in aromatherapy and as aromatherapists continue to integrate into the world of allopathic medicine, offering complementary support most often in pain and stress relief, the scientific data that supports the efficacy of aromatherapy will be crucial to the ongoing advancement of this integrative effort. The studies are mounting.
In one study found in The Journal of Caring Sciences (2019), scientists found that exposure to lavender oil prior to vaccination reduced pain response in infants. Another study found that preterm infants with apnea—the occurrence of the breath-holding spell for 20 seconds or more or a shorter pause (Ataei et al., 2019, p.9742), who had olfactory stimulation with anise or cinnamon were discharged from hospital 3.4 days earlier than the control group (Ataei et al., 2019, 9741). These are just a couple of the studies that are paramount to aromatherapists positioning themselves to integrate with clinicians treating the ill; the positive outcomes can encourage advancements in scientific study which can ultimately augment the safety and efficacy of use of EOs.
Aligning the field of aromatherapy alongside traditional medicine as a dual approach is a partnership that can serve to both shed light on the importance of the practice and, more importantly, help facilitate enrichment of care for patients, amplify clinical exposure to a range of conditions and people which will further safeguard patients, and provide a rapid cache of case studies that will enhance the practitioner’s navigation of the field and bolster their craft—the art of aromatherapy.
Culminating case study with scientific data is key to navigating the safe and effective use of EOs, hence the educational requirements for certification in aromatherapy involves case study exposure and feedback from the teacher. Monitoring reactions/responses and logging and tracking what works and what doesn’t will help the practitioner build their knowledge of effective EOs and dilutions. Additionally, utilizing existing data to recognize which oils can pose a risk for certain people will further support the minimization of negative reaction.
While data is scarce and philosophical practice is varied, the aromatherapist, honing their craft, should veer toward safe practice to reduce the risk of harm. Engaging with professionals in the field and asking questions to understand their methodology, as well as slowly and safely integrating what they learn from the literature into the field, are cautious measures that will support the safe and supportive care for clients. Like any art, the practitioner’s skills will improve over time and their ability to interpret the science and the client’s needs will too. Like the clinician, the aromatherapist will learn to balance their
fundamental understanding of the underpinnings of aromatherapy with their awareness that every client is unique and, as a result, they will develop a solid foundation for responsible client care.
Ataei Nakgaei A, Javid A, Marefat M, Chichy Z, Alshahrestani A, Nazarpour P. (2019). Is Aromatherapy Effective for Apnea in Preterm Infants? A Systematic Review. International Journal of Pediatrics, 7(7), 9741-47.DOI: 10.22038/ijp.2019.40056.3402
National Association for Holistic Aromatherapy. (2020). About NAHA. NAHA. https://naha.org/about/
National Association for Holistic Aromatherapy. (2020). Safety Information. NAHA. https://naha.org/explore-aromatherapy/safety
Sade, Danielle. (n.d). A Practitioners Guide to Aromatherapy: A Study of Essential Oils and their Therapies. Healing Fragrances. Print.
Sade, Danielle. (n.d). Carrier Oils Lesson V: Finding Dilutions [Class handout]. Ontario, Canada: Healing Fragrances School of Aromatherapy. Print.
Sade, Danielle. (2020). Your Instructor. Healing Fragrances School of Aromatherapy. https://healingfragrances.net/pages/your-instructor-danielle-sade-b-sc-cahp.
Tisserand, Robert and Young, Rodney. (2014). Essential Oil Safety (2nd Ed). Churchill Livingstone Elsevier (original work published 2002).
Vaziri F, khosropoor M, Hidari M, Pourahmad S, Morshed Behbahani B, Saki F. (2019). The effect of aromatherapy by lavender oil on infant vaccination pain: a double blind randomized controlled trial. Journal of Caring Sciences, 8(1), 17-21. doi:10.15171/jcs.2019.003.