Abstract
Pediatricians working in an emergency environment are confronted with children admitted to emergency departments for intoxication on a daily basis. We carried out a retrospective cohort study of children admitted to a pediatric emergency department due to unintentional cannabis exposure over a 10-year period from 2004 to 2014. Twenty-nine children under the age of 3 were admitted with a positive cannabis urine test. Eighty-seven percent of intoxications occurred at the family home. Resin was the main form of ingested cannabis (69%). The mean age was 16.5 ± 5.2 months, and mean weight was 11.1 ± 2.1 Kg. Sixty percent of admissions occurred between 2012 and 2014. More severe presentations, based on Poisoning Severity Score, occurred over the past 2 years. Four children experienced seizures before admission. Ten children (34%) had a decreased level of consciousness (GCS <12) and were admitted to a pediatric intensive care unit for 12–24 h. All of them had ingested hashish (resin). The majority (70%) of children suffering from neurological impairment were admitted in the last year, of whom three required assisted ventilation. There were no cases with major outcomes and no deaths. Parents were not assessed regarding their cannabis consumption.
Conclusion: This study supports the impression that accidental child poisonings with cannabis have been more serious than previously thought for 2 years. This observation may be explained by (1) the increased THC concentration in cannabis and (2) the widespread use in young adults, even after they become parents. Introducing an addiction team inside the PED could help to improve the care links with these parents.
What is Known: |
• Cases of unintentional cannabis intoxication in children have been increasing for many years due to an increase of potency. |
What is New: |
• We highlight an increase in more severe presentations in children under the age of 3 occurring over the past 2 years, which will indicate the importance of assessing cannabis abuse in parents by a specialized addiction team. |
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Abbreviations
- ANSM:
-
French National Agency for Medicines and Health Products Safety
- CBD:
-
Cannabidiol
- CBDV:
-
Cannabidivarin
- CBG:
-
Cannabigerol
- CPS:
-
Child Protective Services
- GCS:
-
Glasgow Coma Scale
- ED:
-
Emergency department
- EP:
-
Emergency pediatrician
- PED:
-
Pediatric emergency department
- PSS:
-
Poisoning Severity Score
- SAT:
-
Specialized addiction team
- THC:
-
delta-9-tetrahydrocannabinol
- THCV:
-
Tetrahydrocannabivarin
References
Amirav I, Luder A, Viner Y, Finkel M (2011) Decriminalization of cannabis—potential risks for children? Acta Paediatr 100(4):618–619
Appelboam A, Oades PJ (2006) Coma due to cannabis toxicity in an infant. Eur J Emerg Med 13(3):177–179
Freisthler B, Gruenewald PJ, Wolf JP (2015) Examining the relationship between marijuana use, medical marijuana dispensaries, and abusive and neglectful parenting. Child Abuse Negl 48:170–178
Garrec SL, Dauger S, Sachs P (2014) Cannabis poisoning in children. Intensive Care Med 40(9):1394–1395
Lavi E, Rekhtman D, Berkun Y, Wexler I (2016) Sudden onset unexplained encephalopathy in infants: think of cannabis intoxication. Eur J Pediatr 175(3):417–420
McLaren J, Swift W, Dillon P, Allsop S (2008) Cannabis potency and contamination: a review of the literature. Addiction 103(7):1100–1109
Pélissier F, Claudet I, Pélissier-Alicot A-L, Franchitto N (2014) Parental cannabis abuse and accidental intoxications in children: prevention by detecting neglectful situations and at-risk families. Pediatr Emerg Care 30(12):862–866
Persson HE, Sjöberg GK, Haines JA, Pronczuk de Garbino J (1998) Poisoning severity score. Grading of acute poisoning. J Toxicol Clin Toxicol 36(3):205–213
Spadari M, Glaizal M, Tichadou L, Blanc I, Drouet G, Aymard I, De Haro L, Hayek-Lanthois M, Arditti J (2009) Accidental cannabis poisoning in children: experience of the. Marseille poison center Presse Med 38(11):1563–1567
Spiller HA, Beuhler MC, Ryan ML, Borys DJ, Aleguas A, Bosse GM (2013) Evaluation of changes in poisoning in young children: 2000 to 2010. Pediatr Emerg Care 29(5):635–640
Wang G, Roosevelt G, Heard K (2013) Pediatric marijuana exposures in a medical marijuana state. JAMA Pediatr 167(7):630–633
Wang GS, Roosevelt G, Le Lait MC, Martinez EM, Bucher-Bartelson B, Bronstein AC, Heard K (2014) Association of unintentional pediatric exposures with decriminalization of marijuana in the United States. Ann Emerg Med 63(6):684–689
Wilkinson ST, Yarnell S, Radhakrishnan R, Ball SA, D’Souza DC (2016) Marijuana legalization: impact on physicians and public health. Annu Rev Med 67:453–466
Authors’ contributions
Dr. Isabelle Claudet, Dr. Mathilde Le Breton, and Dr. Camille Bréhin drafted the initial manuscript, reviewed and revised the manuscript, and approved the final manuscript as submitted. Pr Nicolas Franchitto was involved in the conceptual development and preparation of the manuscript. All authors revised and approved the final manuscript as submitted.
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Under French law, no approval is necessary for descriptive case series of poison control centers (public hospital structures), which are not included in a clinical trial.
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Communicated by Patrick Van Reempts
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Claudet, I., Le Breton, M., Bréhin, C. et al. A 10-year review of cannabis exposure in children under 3-years of age: do we need a more global approach?. Eur J Pediatr 176, 553–556 (2017). https://doi.org/10.1007/s00431-017-2872-5
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DOI: https://doi.org/10.1007/s00431-017-2872-5