358 - Presentations and management of young children who test positive for cannabis at a large free standing children’s hospital

The prevalence of marijuana use in the United States is rising with an estimated 20% of Americans who use cannabis. Unintentional ingestion of cannabis products among young children is mirroring this trend. While previous studies have discussed symptoms and management of children who ingest cannabis products, these studies are limited to small case series or case reports and do not include Emergency Department management or disposition. To fill this gap we studied a large cohort of young children testing positive for cannabis. 

Objective: Describe symptoms and emergency room management in a cohort of young children who test positive for cannabis.

Design/Methods:

We performed a retrospective cross-sectional study including children under the age of 10 years who presented to a free-standing children’s hospital and had a urine drug screen positive for cannabis. We excluded children who were born positive, prescribed cannabis and false positives. Descriptive statistics were used to analyze our cohort. Chi-squared and non-paired T-test were used to look at differences in ingestion rates related to demographics, legalization, packaging laws, and COVID-19.

Results:

Total number of charts reviewed was 180. Fifty one percent were male, the average age was 3.6 years, 50% identified as white-Hispanic and 28% as White non-Hispanic. After June of 2020 there was a significant and sustained increase in cannabis positive children (p-value < 0.001). Stricter packaging laws did not impact ingestion rates.  Nearly 70% of the cohort had ingested cannabis in the form of an edible. There was a wide range of chief complaints upon presentation to the Emergency Department with the top 5 being sleepy/fatigued, altered mental status, vomiting or non-febrile seizure. Seventy percent of children had normal vital signs. Excluding patients whose chief complaint was ingestion, 52% of children received a head CT prior to an order for urine drug screen. There was no significant difference in age or race/ethnicity between those who had a CT and those who did not. Fifty eight percent were admitted to the hospital, 10% requiring PICU admission. Eighty six percent of children positive for cannabis were reported to child welfare services.

Conclusion(s):

There has been a substantial increase in young children presenting to the Emergency Department who are positive for cannabis. The range of symptoms makes it difficult for clinicians to identify an ingestion has occurred leading to unnecessary testing such as head CTs. In previously healthy children with new onset altered mental status cannabis ingestion should be considered.