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

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. (Table presented.)