As more states vote to decriminalize and/or legalize marijuana for recreational use, there has been an increase in pediatric patients—from toddlers to teenagers—presenting to emergency departments with symptoms of acute cannabis exposure.

Researchers from the MassGeneral Hospital for Children recently published a review paper in Current Opinion in Pediatrics that took a detailed look at the types of cannabis-related emergency department (ED) visits by pediatric patients.

The paper also encouraged ED physicians to be aware of the potential for cannabis intoxication to be a contributing factor in a variety of physical or mental health disorders.

 “In a time when more cannabis is more widely available overall, emergency medicine physicians should remain vigilant for acute presentations of cannabis exposure in pediatric patients,” write the authors, Yih-Chieh Chen, MD, and Jean E. Klig, MD.

Effects of Intoxication

Most people may be familiar with the common effects of moderate cannabis intoxication such as increased appetite, red eyes, dry mouth and a loss of coordination.

More concerning are the effects of acute intoxication, which can include gastrointestinal, psychiatric and cardiorespiratory complications, anxiety and paranoia, and traumatic injuries due to falls, motor vehicle accidents, engaging in risky behaviors or attempted suicide or self-harm.

For long term cannabis users, complications can include, depression, psychosis, cognitive impairment and cannabis hyperemesis syndrome – a rare condition that occurs only in long term cannabis users that leads to severe, repeated bouts of vomiting.

Younger children can also be impacted by cannabis use even if they are not using it directly. This can include physical assaults, burns or neglect by cannabis-intoxicated care providers as well as the accidental ingestion of cannabis edibles.

Health Risks of Accidental Ingestion

Accidental ingestion is a growing concern, as Chen and Klig note that edibles often come in the form of colorful candies or baked goods with attractive packaging that can be hard to distinguish from the types of candy and desserts that are popular with children.

For toddlers and young children, the effects of accidental ingestion can occur within 30 minutes to three hours, and symptoms can vary depending on the amount and potency of the product ingested. They can include nausea and vomiting, hyperkinesis (rapid, jerky movement), altered mental status and coma.

In a survey of 3,500+ pediatric patients who presented to EDs for accidental cannabis ingestion, 20 patients required admission into the ICU and seven had to be intubated.

“All cases of accidental cannabis exposure in children should be evaluated by child protection services,” Chen and Klig advise.

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