Cannabinoid exposure in infants and children in the pediatric emergency department—the child protection perspective

TL;DR

This study examines cannabis exposure in young children and highlights the importance of child protection involvement due to non-specific symptoms and frequent emergency visits.

Contribution

The study reveals universal child protection team activation and links frequent emergency visits to potential neglect, even without prior abuse reports.

Findings

All cases of cannabis-exposed children triggered child protection team involvement.

Most caregivers denied cannabis exposure despite positive drug tests.

Frequent emergency department visits were linked to neglect risk in over a third of cases.

Abstract

Cannabinoid exposure in pediatric populations has become an increasing concern with the growing legalization and availability of cannabis products. While studies have addressed the clinical presentation of intoxication, limited data exist on child protection team (CPT) activation and child safety concerns in these cases. A 10-year retrospective study (2010–2021) was conducted at Hadassah Medical Center who operates two campuses within the Jerusalem metropolitan area. Cases of children aged 0–48 months with positive urine toxicology for cannabis were analyzed. Data collected included demographics, clinical presentation, and involvement of CPT, child protection services, and police. Out of 36 cases, 29 met the inclusion criteria. The majority (65.5%) were male, with a median age of 14 months. Neurological symptoms were universal, and CPT was activated in all cases (100%). Police reports were filed in 93.1%, while child protection services were contacted in 62.1%. Despite positive drug screens, only one caregiver admitted to cannabis exposure, and more than 60% denied any knowledge of exposure. Most children had no prior reports with social services; however, 11 (37.9%) had multiple pediatric emergency department (PED) visits, suggesting a heightened risk of neglect. Conclusions: Cannabis intoxication in young children presents diagnostic challenges due to non-specific symptoms and low caregiver disclosure rates, often leading to unnecessary investigations. Although prior reports of abuse or neglect are uncommon, frequent PED visits may signal neglect. Early CPT involvement is essential in managing these cases and ensuring child safety.
What is known:• Pediatric cannabis intoxication presents primarily with non-specific neurological symptoms, making early diagnosis challenging.• Most existing studies focus on the clinical aspects of intoxication, with limited data on child protection team involvement and reporting practices.What is new:• Universal involvement of the Child Protection Team (CPT) led to high reporting rates to authorities, with nearly all cases being reported either to the police or to Child Protection Services.• Multiple pediatric emergency department visits, especially for injuries, may indicate neglect even when prior CPS reports are absent.

What is known:

• Pediatric cannabis intoxication presents primarily with non-specific neurological symptoms, making early diagnosis challenging.

• Most existing studies focus on the clinical aspects of intoxication, with limited data on child protection team involvement and reporting practices.

What is new:

• Universal involvement of the Child Protection Team (CPT) led to high reporting rates to authorities, with nearly all cases being reported either to the police or to Child Protection Services.

• Multiple pediatric emergency department visits, especially for injuries, may indicate neglect even when prior CPS reports are absent.

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