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Aromatherapy improves nausea, pain, and mood for patients receiving pediatric palliative care symptom-based consults: A pilot design trial

Published online by Cambridge University Press:  19 August 2019

Meaghann S. Weaver*
Division of Pediatric Palliative Care, Department of Pediatrics, Children's Hospital and Medical Center, Omaha, NE, USA
Jacob Robinson
Division of Pediatric Palliative Care, Department of Pediatrics, Children's Hospital and Medical Center, Omaha, NE, USA
Christopher Wichman
Division of Biostatistics, Department of Public Health, University of Nebraska Medical Center, Omaha, NE, USA
Corresponding Author: Meaghann Shaw Weaver, MD, MPH, FAAP Hand in Hand/Division of Palliative Care Children's Hospital and Medical Center Omaha 8200 Dodge Street Omaha, NE68114. E-mail:



The role of aromatherapy in supportive symptom management for pediatric patients receiving palliative care has been underexplored. This pilot study aimed to measure the impact of aromatherapy using validated child-reported nausea, pain, and mood scales 5 minutes and 60 minutes after aromatherapy exposure.


The 3 intervention arms included use of a symptom-specific aromatherapy sachet scent involving deep breathing. The parallel default control arm (for those children with medical exclusion criteria to aromatherapy) included use of a visual imagery picture envelope and deep breathing. Symptom burden was sequentially assessed at 5 and 60 minutes using the Baxter Retching Faces scale for nausea, the Wong-Baker FACES scale for pain, and the Children's Anxiety and Pain Scale (CAPS) for anxious mood. Ninety children or adolescents (mean age 9.4 years) at a free-standing children's hospital in the United States were included in each arm (total n = 180).


At 5 minutes, there was a mean improvement of 3/10 (standard deviation [SD] 2.21) on the nausea scale; 2.6/10 (SD 1.83) on the pain scale; and 1.6/5 (SD 0.93) on the mood scale for the aromatherapy cohort (p < 0.0001). Symptom burden remained improved at 60 minutes post-intervention (<0.0001). Visual imagery with deep breathing improved self-reports of symptoms but was not as consistently sustained at 60 minutes.

Significance of results

Aromatherapy represents an implementable supportive care intervention for pediatric patients receiving palliative care consults for symptom burden. The high number of children disqualified from the aromatherapy arm because of pulmonary or allergy indications warrants further attention to outcomes for additional breathing-based integrative modalities.

Original Article
Copyright © Cambridge University Press 2019

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Adams, D, Dagenais, S, Clifford, T, et al. (2013) Complementary and alternative medicine use by pediatric specialty outpatients. Pediatrics 131(2), 225232.CrossRefGoogle ScholarPubMed
Ali, B, Al-Wabel, NA, Shams, S, et al. (2015) Essential oils used in aromatherapy: A systemic review. Asian Pacific Journal of Tropical Biomedicine 5(8), 601611.CrossRefGoogle Scholar
Ball, TM, Shapiro, DE, Monheim, CJ, et al. (2003) A pilot study of the use of guided imagery for the treatment of recurrent abdominal pain in children. Clinical Pediatrics 42(6), 527532.CrossRefGoogle ScholarPubMed
Bikmoradi, A, Khaleghverdi, M, Seddighi, I, et al. (2017) Effect of inhalation aromatherapy with lavender essence on pain associated with intravenous catheter insertion in preschool children: A quasi-experimental study. Complementary Therapies in Clinical Practice 28, 8591.CrossRefGoogle ScholarPubMed
Brent, M, Lobato, D, and LeLeiko, N (2009) Psychological treatments for pediatric functional gastrointestinal disorders. Journal of Pediatric Gastroenterology and Nutrition 48(1), 1321.CrossRefGoogle ScholarPubMed
Buckle, J (2014). Clinical Aromatherapy (3rd ed.). London: Churchill Livingston.Google Scholar
Busch, V, Magerl, W, Kern, U, et al. (2012) The effect of deep and slow breathing on pain perception, autonomic activity, and mood processing—An experimental study. Pain Medicine 13(2), 215228.CrossRefGoogle ScholarPubMed
Chien, LW, Cheng, SL, and Liu, CF (2012) The effect of lavender aromatherapy on autonomic nervous system in midlife women with insomnia. Evidence-Based Complementary and Alternative Medicine 2012, 740813740818.CrossRefGoogle ScholarPubMed
Cook, N and Lynch, J (2008) Aromatherapy: Reviewing evidence for its mechanisms of action and CNS effects. British Journal of Neuroscience Nursing 4(12), 595601.CrossRefGoogle Scholar
French, GM, Painter, EC, and Coury, DL (1994) Blowing away shot pain: A technique for pain management during immunization. Pediatrics 93(3), 384388.Google ScholarPubMed
Gerik, SM (2005) Pain management in children: Developmental considerations and mind-body therapies. Southern Medical Journal 98(3), 295302.CrossRefGoogle ScholarPubMed
Herz, RS (2009) Aromatherapy facts and fictions: A scientific analysis of olfactory effects on mood, physiology and behavior. The International Journal of Neuroscience 119(2), 263290.CrossRefGoogle Scholar
Hicks, CL, von Baeyer, CL, and McGrath, PJ (2006) Online psychological treatment for pediatric recurrent pain: A randomized evaluation. Journal of Pediatric Psychology 31(7), 724736.CrossRefGoogle ScholarPubMed
Holmes, C and Ballard, C (2004) Aromatherapy in dementia. Advances in Psychiatric Treatment 10(4), 296300.CrossRefGoogle Scholar
Hongratanaworakit, T (2004). Physiological effects in aromatherapy. Songklanakarin Journal of Science and Technology, 26(1), 117125.Google Scholar
Jafarzadeh, M, Arman, S, and Pour, FF (2013) Effect of aromatherapy with orange essential oil on salivary cortisol and pulse rate in children during dental treatment: A randomized controlled clinical trial. Advanced Biomedical Research 2(1), 10.Google ScholarPubMed
Khan, KA and Weisman, SJ (2007) Nonpharmacologic Pain Management Strategies in the Pediatric Emergency Department. Clinical Pediatric Emergency Medicine 8(4), 240247.CrossRefGoogle Scholar
Lahlou, M (2004) Essential oils and fragrance compounds: Bioactivity and mechanisms of action. Flavour and Fragrance Journal 19(2), 159165.CrossRefGoogle Scholar
Louis, M and Kowalski, SD (2002) Use of aromatherapy with hospice patients to decrease pain, anxiety, and depression and to promote an increased sense of well-being. The American Journal of Hospice & Palliative Care 19(6), 381386.CrossRefGoogle ScholarPubMed
Ma, X, Yue, ZQ, Gong, ZQ, et al. (2017) The effect of diaphragmatic breathing on attention, negative affect and stress in healthy adults. Frontiers in Psychology 8, 874.CrossRefGoogle ScholarPubMed
Maddocks-Jennings, W and Wilkinson, JM (2004) Aromatherapy practice in nursing: Literature review. Journal of Advanced Nursing 48(1), 93103.CrossRefGoogle ScholarPubMed
Marofi, M, Sirousfard, M, Moeini, M, et al. (2015) Evaluation of the effect of aromatherapy with Rosa damascena Mill. on postoperative pain intensity in hospitalized children in selected hospitals affiliated to Isfahan University of Medical Sciences in 2013: A randomized clinical trial. Iranian Journal of Nursing and Midwifery Research 20(2), 247254.Google ScholarPubMed
Ndao, DH, Ladas, EJ, Cheng, B, et al. (2012) Inhalation aromatherapy in children and adolescents undergoing stem cell infusion: Results of a placebo-controlled double-blind trial. Psycho-Oncology 21(3), 247254.CrossRefGoogle ScholarPubMed
Nord, D and Belew, J (2009) Effectiveness of the essential oils lavender and ginger in promoting children's comfort in a perianesthesia setting. Journal of Perianesthesia Nursing 24(5), 307312.CrossRefGoogle Scholar
Peretz, B and Gluck, GM (1999) Assessing an active distracting technique for local anesthetic injection in pediatric dental patients: Repeated deep breathing and blowing out air. The Journal of Clinical Pediatric Dentistry 24(1), 58.Google ScholarPubMed
Post-White, J and Hawks, RG (2005) Complementary and alternative medicine in pediatric oncology. Seminars in Oncology Nursing 21(2), 107114.CrossRefGoogle ScholarPubMed
Raghuraj, P and Telles, S (2003) Effect of yoga-based and forced uninostril breathing on the autonomic nervous system. Perceptual and Motor Skills 96(1), 7980.CrossRefGoogle ScholarPubMed
Robins, JLW (1999) The science and art of aromatherapy. Journal of Holistic Nursing 17(1), 517.CrossRefGoogle ScholarPubMed
Rusy, LM and Weisman, SJ (2000) Complementary therapies for acute pediatric pain management. Pediatric Clinics of North America 47(3), 589599.CrossRefGoogle ScholarPubMed
Shakeel, M, Little, SA, Bruce, J, et al. (2007) Use of complementary and alternative medicine in pediatric otolaryngology patients attending a tertiary hospital in the UK. International Journal of Pediatric Otorhinolaryngology 71(11), 17251730.CrossRefGoogle ScholarPubMed
Soltani, R, Soheilipour, S, Hajhashemi, V, et al. (2013) Evaluation of the effect of aromatherapy with lavender essential oil on post-tonsillectomy pain in pediatric patients: A randomized controlled trial. International Journal of Pediatric Otorhinolaryngology 77(9), 15791581.CrossRefGoogle ScholarPubMed
Vempati, RP and Telles, S (2002) Yoga-based guided relaxation reduces sympathetic activity judged from baseline levels. Psychological Reports 90(2), 487494.CrossRefGoogle ScholarPubMed
Yang, MH, Lin, LC, Wu, SC, et al. (2015) Comparison of the efficacy of aroma-acupressure and aromatherapy for the treatment of dementia-associated agitation. BMC Complementary and Alternative Medicine 15(1), 93.CrossRefGoogle ScholarPubMed