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A 10-year review of cannabis exposure in children under 3-years of age: do we need a more global approach?

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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Fig. 1

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

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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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Correspondence to Nicolas Franchitto.

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The authors declare that they have no conflict of interest.

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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

Keywords

  • Cannabis
  • Children
  • Emergency department
  • Parental addiction