Dose–Response • Pediatrics
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Toxic THC dose threshold in < 6-year-olds with edibles
Ingested ≥1.7 mg/kg Δ9-THC strongly predicts severe and prolonged toxicity—clinically useful for triage/observation.
Summary
Retrospective multi-center review linking known edible THC dose to outcomes; dose, not age/sex, best predicted severity and time to baseline.
Pepin LC, Simon MW, Banerji S, Leonard J, Hoyte CO, Wang GS. Toxic Tetrahydrocannabinol (THC) Dose in Pediatric Cannabis Edible Ingestions. Pediatrics. 2023;152(3):e2023061374. PubMed
Epidemiology • Edibles & < 6 yrs
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National trends in pediatric edible exposures (2017–2021)
Sharp rise in edible ingestions among children under 6 with substantial health-care utilization.
Summary
NPDS analysis quantifies trends, clinical effects, and dispositions; helpful for prevention messaging and packaging policy discussions.
Tweet MS, Gulbranson S, Nicks B, et al. Pediatric Edible Cannabis Exposures and Acute Toxicity: 2017–2021. Pediatrics. 2023;151(2):e2022057761. PubMed • PDF
Surveillance • CDC MMWR
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Youth cannabis-involved ED visits (U.S., 2019–2022)
539,106 cannabis-involved ED visits in persons <25; largest proportional increases among ≤10 and 11–14 during the pandemic.
Summary
National syndromic surveillance analysis; includes age-stratified rates and pandemic-period spikes—useful for local coalition briefings.
Roehler DR, Hoots B, Vivolo-Kantor A, et al. Cannabis-Involved Emergency Department Visits Among Persons Aged <25 Years — United States, 2019–2022. MMWR. 2023;72:749-755. CDC • PDF
Δ8-THC • Case Series
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Δ8-THC unintentional ingestions requiring PICU care
Two toddlers with severe Δ8 exposures required intensive care—alerts to “hemp” products sold as non-Δ9 THC.
Summary
Describes presentations, tox confirmation, and supportive management; reinforces counseling that Δ8 products can cause classic THC toxicity.
Bradley EK, Etzel RA, et al. Unintentional ingestion of putative delta-8 tetrahydrocannabinol by two pediatric patients. J Med Toxicol. 2023;19(2):158-162. PubMed
Systematic Review • Pediatrics
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Unintentional cannabis ingestion in children: systematic review
Common findings: lethargy, ataxia, hypotonia, mydriasis, hypoventilation—maintain high suspicion in altered children.
Summary
Aggregates dozens of pediatric cases; provides symptom frequencies, time course, and outcomes to guide ED observation and discharge advice.
Richards JR, Smith NE, Moulin AK. Unintentional cannabis ingestion in children: a systematic review. J Pediatr. 2017;190:142-152.e1. PubMed
Clinical Review • Pediatric Emergencies
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Comprehensive review of pediatric cannabis emergencies
Clear orientation to pharmacology, presentations, epidemiology, and ED management points for children/adolescents.
Summary
Summarizes common findings (somnolence, ataxia, hypotonia, vomiting) and red flags (respiratory depression, apnea). Offers pragmatic workup and disposition advice to limit low-yield testing.
Stoner MJ, Borawski K, Wang GS, et al. Marijuana use in children: an update focusing on pediatric emergencies. Clin Pediatr Emerg Med. 2022;23(2):100170.
PubMed •
PMC
Syndrome • CHS in Pediatrics
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Cannabinoid hyperemesis syndrome (CHS): pediatric update
CHS presents with recurrent vomiting and dehydration; standard antiemetics often fail—consider capsaicin or dopamine antagonists.
Summary
Reviews diagnostic criteria (chronic use + cyclic vomiting + relief with hot bathing), differentials, and treatment pathways for teens; emphasizes counseling on abstinence to prevent recurrence.
Dosani K, Koletic C, Alhosh R. Cannabinoid Hyperemesis Syndrome in Pediatrics: An Emerging Problem. Pediatrics in Review. 2021;42(9):500–506.
PubMed
ED Series • Single Center
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Pediatric ED edible ingestions—presentation & outcomes
<10 years associated with bradypnea, hypertension, and admission; respiratory depression not rare.
Summary
Retrospective series of pediatric ED visits for cannabis products; details vitals, symptom clusters, imaging/lab utilization, and disposition—useful for local protocol design.
Kaczor EE, Zielinski MJ, Teter CJ, et al. Cannabis Product Ingestions in Pediatric Patients. West J Emerg Med. 2021;22(5):1114–1122.
PubMed •
PMC
Policy Impact • Pre/Post Legalization
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Unintentional exposures before vs after legalization
Post-legalization period showed more pediatric cases with altered consciousness and vomiting—supports prevention/packaging policies.
Summary
Retrospective pediatric center analysis comparing presentations, tox screens, and admission rates across policy eras; highlights need for child-resistant packaging and public education.
Coret A, To T, Friedman JN, et al. Unintentional cannabis exposures in children pre/post legalization: a retrospective study. Paediatr Child Health. 2022;27(5):269–275.
PubMed •
PMC
Guidance • ED/CPS Considerations
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Presentation, management, and CPS considerations
Targeted history can limit unnecessary tests; includes documentation tips and when CPS reporting is indicated.
Summary
Practical guidance covering triage, observation windows, differential diagnosis, family counseling, and mandated reporting nuances for pediatric cannabis exposures.
Dubinin A, Sills MR, Wang GS. Presentation, Management, and Child Protective Services Considerations for Pediatric Cannabis Exposures. Pediatr Emerg Care. 2024;40(6):301–307.
PubMed
Clinical • Narrative
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Accidental cannabis ingestion in young children
Common symptoms include somnolence, vomiting, and ataxia; underscores need for awareness of 1.7 mg/kg Δ9-THC threshold.
Summary
Canadian narrative review highlighting symptom patterns, ED length of stay, and community prevention recommendations.
Zwiebel H, et al. Accidental cannabis ingestion in young children. CMAJ. 2025;197(32):E1045–E1050.
PubMed •
PMC
Cardiorespiratory • Severe Toxicity
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Asystole and apnea after pediatric THC overdose
Life-threatening cardiac arrest can occur after large edible ingestion—supports extended observation for severe cases.
Summary
Case of a 3-year-old with delayed asystole; reviews mechanisms and resuscitation pearls for ED and PICU teams.
Masilamani MSJ, et al. Asystole in a young child with tetrahydrocannabinol overdose. Front Toxicol. 2024;6:1371651.
PubMed •
PMC
Outbreak • Restaurant Exposure
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Community-wide THC intoxication from restaurant food
Cross-contamination from THC-infused oil caused a multi-age outbreak including pediatric cases; highlights need for labeling oversight.
Kita-Yarbro A, et al. Tetrahydrocannabinol Intoxication from Food at a Restaurant — Wisconsin, October 2024. MMWR. 2025;74:845–848.
CDC •
PDF
Syndrome • CHS in Adolescents
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Cannabinoid Hyperemesis Syndrome in Adolescents
Describes diagnostic challenges and limited efficacy of standard antiemetics; emphasizes need for use-history screening.
Pietrantoni C, et al. Cannabinoid Hyperemesis Syndrome in Adolescents. Children (Basel). 2025;12(4):75.
PubMed •
PMC
Clinical • Urine Tox & Screening
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Urine toxicology screening for altered mental status in youth
AAP guidance supports targeted THC screening as edible exposures rise; avoids unnecessary broad panels.
Van Oyen A, Doron O, et al. Urine Toxicology Test for Children With Altered Mental Status After THC Exposure. Pediatrics. 2023;152(5):e2022060861.
PubMed
Informational only — not medical advice. For any pediatric THC ingestion, seek emergency care and contact poison control (1-800-222-1222).