The Continued Rise of Unintentional Ingestion of Edible Cannabis in Toddlers—A Growing Public Health Concern
As use of cannabis continues to be decriminalized and legalized across the US for adults aged 21 years and older, there has been a concurrent increase in unintentional ingestion of cannabis edibles among children, which raises a significant public health concern.
One study found that the mean (SD) age for unintentional ingestion of cannabis edibles in the pediatric population is 25.2 (18.7) months. From2004to 2018, there was a 13-fold increase nationally in encounters involving children younger than 6 years, with the increase in edible cannabis–related exposures being greater than the increase in nonedible cannabis–related exposures.
In addition, a retrospective cohort study of children presenting to a pediatric ED for unintentional ingestion of cannabis edibles found that 87%of intoxications occurred in the home.
Children with THC intoxication can present with neurologic impairment, including lethargy, ataxia, tachycardia, mydriasis, seizures, altered mental status, and hypotonia. However, given the unpredictability of the dose ingested, patient presentation can vary. Altered mental status in children results in broad differential diagnoses ranging from traumatic to infectious causes.
Therefore, acutely altered mental status in children with an undiagnosed cannabis ingestion has led to prolonged hospitalizations with extensive and invasive diagnostic testing, including laboratory studies, lumbar punctures, electroencephalograms, and computed tomographic scans of the head to aid in diagnosis. Although most patients require routine observation in the ED or inpatient hospital unit, some patients require intensive interventions, including airway support and management,in the pediatric intensive care unit.