Integrative & Functional Medicine in San Antonio TX and Quincy IL: Pediatric Dosing of LDN

By Yoon Hang Kim MD

Optimizing You Child's Health with LDN

Low-dose naltrexone (LDN) refers to administering naltrexone, an opioid antagonist, at doses much lower than those approved by the FDA for opioid and alcohol use disorder in adults (typically 50 mg daily). Within pediatric populations, LDN is used off-label for conditions such as autism spectrum disorder (ASD), self-injurious behaviors, Crohn's disease, complex regional pain syndrome (CRPS), PANS/PANDAS, and other inflammatory or autoimmune-related disorders. These uses stem from LDN's proposed mechanisms, including modulation of the immune system through transient opioid receptor blockade and reduction of microglial activation, which may alleviate inflammation and pain. However, evidence for efficacy and safety in children is limited, with most data coming from small studies, case reports, and retrospective reviews. At this time, there is no formal FDA approval for pediatric indications.

Developmental pharmacokinetics play a critical role in naltrexone dosing for children. The drug undergoes significant first-pass metabolism, resulting in low bioavailability (5–40%), and is mostly metabolized by aldo-keto reductase enzymes in the liver, with renal excretion of metabolites. Ontogenic changes—such as immature enzyme activity in infants and changes in body composition—affect drug disposition, making individualized dosing essential. Genetic differences and disease states (like eating disorders that impact gastric emptying) can further contribute to variability. Because pediatric formulations are not sold commercially, compounding LDN into liquid or cream is common to achieve precise low-dose delivery, though data on the stability and efficacy of creams are limited.

Dosing Guidelines in Pediatric Populations

Recommendations for pediatric LDN are weight-based and condition-specific, with a strong emphasis on starting low and titrating slowly to minimize side effects such as transient sedation or GI upset. General guidelines include:

• Children under 40 kg: Start at 0.1 mg daily, increasing incrementally over four weeks to a target of 0.1 mg/kg/day. This applies broadly to autoimmune and chronic pain conditions.

• Children over 40 kg: Follow adult LDN protocols—start at 1 mg daily, increase by 0.5–1 mg every two weeks, and titrate up to a maximum of 4.5 mg or the highest tolerated dose (typically 3 mg or above).

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Condition-Specific Dosing (drawn from research and clinical practice):

• Autism Spectrum Disorder and Self-Injurious Behaviors: 0.5–2 mg/kg/day has shown effectiveness in reducing hyperactivity, irritability, and stereotyped behaviors. A double-blind study in children aged 3–7 administered a mean dose of 1 mg/kg/day for four weeks.

• Crohn’s Disease: Studies have used 0.1 mg/kg/day (not to exceed 4.5 mg), with open-label trials demonstrating potential safety and efficacy in children with active disease.

• Complex Regional Pain Syndrome (CRPS): Case reports describe starting at 2 mg/day and titrating to 4 mg/day, with improvements in pain and function within a month.

• Other Indications (e.g., Impulsivity, Eating Disorders): Doses up to 2 mg/kg/day or set amounts (e.g., 100 mg/day) appear in the literature, though supporting data is limited.

Dosing is usually once daily at bedtime to maximize possible immunomodulatory effects overnight. Providers monitor for vivid dreams, insomnia, or other side effects and adjust as needed.

Safety and Efficacy Considerations

Most pediatric studies report a favorable safety profile for LDN, with transient sedation as the most common side effect and no serious harms observed in short-term studies. Long-term data remain sparse. Potential drug interactions—especially with opioids—should be considered. Efficacy varies by condition: in ASD, the most consistent benefit is for self-injurious behaviors, but published studies often include small cohorts and varied methodologies. The off-label status of LDN should be clearly discussed with families, and informed consent is crucial.

Functional Medicine LDN Pediatric Dose San Antonio: Clinical Experience and Holistic Approach

Dr. Yoon Hang Kim, MD, is a leader in functional medicine with extensive experience in pediatric LDN dosing for families in San Antonio and across multiple states. He currently serves patients in Illinois, Missouri, Texas, Georgia, and Florida through telemedicine consultations. Blending advanced pharmacological expertise with a patient-centered, integrative philosophy, Dr. Kim supports families facing complex pediatric conditions with care that bridges traditional and holistic therapies.

Families working with Dr. Kim benefit from:

• Individualized pediatric LDN titration protocols based on the child’s specific needs and current research

• Comprehensive assessment and monitoring for optimal safety and efficacy

• Clear, supportive communication that empowers parents to make informed decisions

• Integration of nutrition, lifestyle, and holistic treatments alongside evidence-based LDN protocols

To learn more or schedule a virtual consultation, visit www.directintegrativecare.com.

Dr. Kim’s compassionate, evidence-based approach is helping to shape the future of pediatric LDN therapy and functional medicine for children and families throughout these states.

References

1. Developmental Considerations for the Use of Naltrexone in Children and Adolescents. PMC.

2. Potential Indications and Administration in Children and Adolescents. Psychopharmacology Institute.

3. SAFETY AND TOLERABILITY OF LOW DOSE NALTREXONE THERAPY IN CHILDREN WITH MODERATE TO SEVERE CROHN'S DISEASE: A PILOT STUDY. PMC.

4. LDN 2020 Dosing Information for prescribers. LDN Research Trust.

5. The effects of chronic naltrexone treatment in young autistic children. Biological Psychiatry.

6. MANAGEMENT OF PEDIATRIC COMPLEX REGIONAL PAIN SYNDROME WITH LOW-DOSE NALTREXONE: A CASE REPORT. Pain Medicine Case Reports.

7. Retrospective chart review of children on Low-Dose Naltrexone. UNTHSC-IR.

8. The Efficacy of Low Dose Naltrexone Therapy in Children With Crohn's Disease. ClinicalTrials.gov.

9. Naltrexone (oral route) - Side effects & dosage. Mayo Clinic.

10. Pediatrics Efficacy and Safety of Naltrexone Use in Pediatric Patients with Autistic Disorder. Sage Journals.

11. LDN Dosage Guidelines: A Comprehensive Guide to Navigating Low-Dose Naltrexone. Welltopia RX.

12. Low-Dose Naltrexone (LDN) for PANS/PANDAS. New Drug Loft.

13. Deanna Windham, DO - Pediatric and Geriatric Dosing for LDN. LDN Research Trust.

14. LDN 2022 Dosing Information For Prescribers. LDN Research Trust.

15. Safety and tolerability of low-dose naltrexone therapy in children with moderate to severe Crohn's disease: a pilot study. Penn State.

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