How much alcohol in a tincture is safe for your baby or child?

*If you want to download my dosing charts for free, go here*

Note that the sources I used for this page are all linked. Any text with an underline is the link to the source I used for that particular sentence. Where there are multiple sources, I included the links in () at the end of the sentence.

I have gone over different ways to get around the alcohol issue in another post (ie. How to give a liquid dose to a baby, without giving them alcohol).  But the question remained: how much alcohol is safe to give a small human??

To find the answer, I turned to herbalism.  Herbal tinctures usually have alcohol, and have been given to infants for millennia.   Looking at research on herbal remedies, I was able to find some concrete data on how much is safe for our little ones.  There are some pharmacological medicines for infants that contain alcohol as well, and so there is also a little information on dosing from those sources.  

I will say, however, that all of the sources I looked at used 1-6 year-olds as their study population.  In other words, I couldn’t find sources that looked specifically at newborns and infants.  I have extrapolated the data, but note that you may want to be extra careful with your infant/newborn, because they may metabolize even slower than a toddler does.

Given that caveat, what I found was an absolute toxic limit of 300mg of alcohol per kilogram for children (in other words, this is the dose that will result in unconsciousness, an ER visit and potentially death, and again, this is the limit for children, so infants and neonates may become poisoned at lower doses) (1; 2).  For context, this is the equivalent of a 150lb adult drinking 14 drinks at once.  Obviously, we want to make sure we are nowhere near this level in infants or children. Or anyone really.

A proposed upper limit for medicinal dosing (by the European Medicines Agency) is 75mg of alcohol per kilogram (this is the dose they believe could be safe if it is absolutely necessary to give a medicine with this amount of alcohol).  At this dose of 75mg/kg, the European Medicines Agency notes that there could be symptoms of alcohol intoxication – drowsiness, altered behavior, etc. 

The dose considered to be safe enough that the European Medicines Agency says the alcohol will “not have any effect” is 6 mg of alcohol per kilogram.  This is so low, that we in fact get more alcohol than that just by drinking fruit juices, having a ripe banana or eating bread, as I will show below.

For context: How much alcohol we get in our daily lives

Believe it or not, tiny amounts of alcohol are common in everyday foods and beverages.  It’s a product of fermentation, so all foods that undergo fermentation (think the fruit getting riper on your counter, or the juice slowly turning into vinegar in your fridge!) or has already undergone fermentation (bread, yogurt, kefir, kombucha, vinegar, etc) has a little bit of alcohol in it.  This means that all children, from the time they start having solids at just a few months old, are getting tiny bits of alcohol through food.  It’s obviously safe to eat these small amounts of it – no one (as far as I am aware) has ever had to go to the ER because they got alcohol poisoning from a very ripe banana. 

In one research article (by Gorgus et al), the authors tried to quantify this daily intake of alcohol in food.  They estimated (after studying dietary intake of six-year-olds) an average intake of 10mg of alcohol per kg for six year olds, with the high end of estimated intake from food at 23.3g/kg.  To put it in perspective, most places in Europe mandate that any herbal or pharmacological product that contains more than 6mg/kg should have a warning label on it (1, 2, 3).  Therefore, its possible children are getting more alcohol from food than they would be if they took herbal products as directed. 

How much is in a drop of herbal tincture or homeopathic remedy?

This will depend on the manufacturing process of course, but I will walk you through the liquid remedies I make, and the calculations for most herbal tinctures.  This way, you can calculate how much your kid is getting, no matter the product you are looking at.

Let’s start with herbal tinctures because the math is a bit easier.

Here are the 3 doses (6mg/kg, 23.3mg/kg, and 75mg/kg) with a 50% alcohol solution.

Many herbal tinctures are made with 50% water, 50% grain alcohol.  If you have 100ml of tincture, you have 50ml of pure alcohol or ethanol and 50ml of water.  One drop is 0.05ml, so one drop contains 0.025ml of ethanol.  To figure out dosing, we need to convert this to grams.  1 ml contain 0.79g of ethanol at room temperature.  Therefore, half of one drop (0.025ml) contains 0.01975g, or 19.75mg of ethanol (0.79*0.025 = 0.01975). 

Now remember the dosing is by kilogram of bodyweight for the patient.  If we want to go the most conservative route, 6mg/kg, then the green columns in the picture to the left show how many drops by bodyweight can be given.

This chart means that if you want to give a very low and safe dose, a 4lb preemie could only get 1 drop a day, and a 27lb one-year-old could get 4 drops a day.  This is quite a bit lower than what I hear of herbalists using; most herbs are dispensed multiple times a day in teaspoons (which is 100 drops!). 

If you are a little more daring, the Gorgus et al paper estimated high intake of alcohol in a child’s diet to be 23.3 mg/kg.  In other words, this is the level we can get from a diet high in ripe fruits and fermented products, so this is still a relatively low dose.  You can see these doses in the yellow columns to the left.

Taking the examples above, a 4lb preemie could potentially get 2 drops a day, and a 27lb one-year-old could get 14 drops a day.  This is still a level we can get from food (and since one-year-olds tend to love sweet fruits, they may in fact get this level from their diet), so it’s likely safe.  However, again, this data is extrapolated from work on older children, and infants may metabolize alcohol differently.

These are the 3 levels of dosing with a solution that is 20% alcohol, or 50% vodka, 50% water.

Let’s calculate if you used vodka, not grain alcohol, to stabilize your solution.

When I make up a liquid dose of a remedy, I make a bottle of 50% water, 50% vodka.  Vodka is not 100% alcohol; it’s usually 40% alcohol.  So one drop of my mixture has 40% of half a drop of alcohol, or 0.01ml (0.025*0.40).  1ml contains 790mg, so 0.01ml contains 7.9mg of alcohol.  So to compare, one drop of this vodka mixture has 7.9ml of alcohol, one drop of a mixture with 100% alcohol has 19.75mg. 

To the left are the same charts as above, but for a mixture with vodka:

The long and short of it:

This is a scary area, I know.  You need to give your bundle of joy some medicine, but don’t know how much is safe.  Unfortunately, I can’t tell you exactly what dose is, or is not, safe; we don’t know the exact toxic dose in infants, and all the data here is extrapolated from research done on children, not on infants.  However, if you are giving an herbal or homeopathic product with alcohol to an infant and you are dosing by drops, you are unlikely to give a highly toxic dose.  However, if you want to dose by teaspoons, you need to pay careful attention to how much alcohol you are giving them.  I recommend staying on the cautious side of dosing, around 6mg/kg of alcohol.  This dose corresponds to the green columns above, which is a dose we get by eating fermented foods or ripe fruits, and should not pose a problem.  As stated at the beginning of this post, I made an excel sheet for you to download so you can easily calculate the different doses. All you have to know is the percent alcohol in your particular medicine and the bodyweight of your patient.