The current breast gel on the market provides per application 1/4,000 of a teaspoonful of peppermint oil (1/8,000 of a teaspoonful of menthol) per application, if the baby even ingested the whole amount placed on the breast. That would be equal to 0.5 mg of peppermint oil. The lethal dose of the menthol in peppermint oil is 50 mg - 100 mg per Kg of body weight or for a 3 Kg baby (over 6 pounds) would be 150 - 300 mg of menthol, 300 to 600 times the amount of menthol per application.
To date, over 10,000 babies have been exposed to the gel with no ill effects at all, let alone toxicity or morbidity.
Please see the following documentation:
C<https://www.sciencedirect.com/science/article/pii/B9781437707748100077>https://www.sciencedirect.com/topics/medicine-and-dentistry/peppermint-oilhronic Abdominal Pain of Childhood and Adolescence
Peppermint Oil - an overview | ScienceDirect Topics<https://www.sciencedirect.com/topics/medicine-and-dentistry/peppermint-oil>
www.sciencedirect.com
Comments. Peppermint oil is a low-risk skin allergen, and no use restriction for skin reactivity is needed. It is clear from both acute and subchronic data that peppermint oil is neurotoxic in high doses.
Lori A. Mahajan, Barbara Kaplan, in Pediatric Gastrointestinal and Liver Disease (Fourth Edition)<https://www.sciencedirect.com/science/book/9781437707748>, 2011
Peppermint Oil
Peppermint oil has been used to soothe the gastrointestinal tract for hundreds of years. It relaxes intestinal smooth muscle by decreasing calcium influx into the smooth muscle cells. A meta-analysis of five randomized, double-blinded, placebo-controlled trials performed in adult patients supported the efficacy of peppermint oil in the treatment of irritable bowel syndrome.91 One randomized, double-blind, controlled trial in pediatric patients with IBS demonstrated the efficacy of enteric-coated peppermint oil capsules (Colpermin, Pfizer Consumer Healthcare) in the reduction of pain during the acute phase of IBS.92 Children weighing 30 to 45 kg received one capsule (187 mg peppermint oil) and those over 45 kg received two capsules, three times daily. Use of enteric-coated products reduces side effects such as nausea and heartburn. Unfortunately, this product is usually not covered by insurance companies in the United States and is relatively expensive.
Read full chapter<https://www.sciencedirect.com/science/article/pii/B9781437707748100077>
Recurring Abdominal Pain in Pediatrics<https://www.sciencedirect.com/science/article/pii/B9780323358682000451>
Joy A. Weydert MD, in Integrative Medicine (Fourth Edition)<https://www.sciencedirect.com/science/book/9780323358682>, 2018
Peppermint (Mentha piperita)
Analysis of peppermint oil typically shows more than 40 different compounds; however, the principal components are menthol, methone, and methyl acetate. Pharmacological studies on peppermint have focused almost entirely on menthol, which has carminative effects (elimination of intestinal gas), antispasmodic effects, and choleretic effects (bile flow stimulant). The mechanism of action of peppermint is thought to be inhibition of smooth muscle contraction by blocking calcium channels.36 Many studies have been conducted using peppermint oil as a treatment for IBS, including one study in children.37 Although peppermint did not alter symptoms associated with IBS, such as urgency of stool, stool patterns, or belching, peppermint was found to reduce associated pain. Peppermint is most widely used as a tea. Due to its calcium channel blockage effects, peppermint may cause relaxation of the lower esophageal sphincter and lead to an increase in heartburn symptoms in some patients. An enteric-coated capsule is available for use in the treatment of IBS. With its delayed release in the small intestine, peppermint has little effect on the lower esophageal sphincter; therefore, it is less likely to cause heartburn.
Dosage
•
Tea: one to two teaspoons of dried leaves steeped in 8 oz of hot water as needed
•
Enteric-coated capsules (200 mg or 0.2 mL):
•
Two capsules three times a day for children weighing more than 100 lb
•
One capsule three times a day for children weighing 60 to 100 lb
Precautions
Peppermint is generally regarded as safe; however, hypersensitivity reactions have been reported.
Due to its smooth muscle-relaxing properties, peppermint has the greatest effect on pain related to abdominal spasm.
Workplace Environmental Exposure Level OARS WEEL: Menthol (2014)
https://www.tera.org/OARS/Menthol%20WEEL%20FINAL.pdf
WORKPLACE ENVIRONMENTAL EXPOSURE LEVEL<https://www.tera.org/OARS/Menthol%20WEEL%20FINAL.pdf>
www.tera.org
Menthol is widely used in consumer products as well as other uses. Product types were listed as antipruritics, dermatologic agents.
The WHO estimates the human oral lethal dose to be approximately 50 - 100 mg/Kg
JECFA. Menthol. In evaluation of certain food additives and contaminants: forty second report of the
Joint FAO/WHO Expert Committee of Food Additives
; World Health Organization: Geneva, 1999; p. 57–76.
Frank J. Nice, RPh, DPA, CPHP
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