Rising child cannabis exposures call for safer storage at home

Unintentional pediatric cannabis ingestion has been rising following medical and recreational legalization. In this study, we aimed to examine the epidemiology of pediatric cannabis ingestion following legalization and to assess the impact of demographic and socioeconomic factors on equity of social management. A retrospective cohort study was conducted at two high-volume children's hospitals with level 1 trauma centers in the United States of America. Emergency department records from June 2016 to September 2024 were reviewed for children aged 0-6 years with a positive urine drug screen for tetrahydrocannabinol. Dates included were inclusive of medical (5/2011, 6/2016) and recreational legalization (4/2023, 11/2023) of cannabis products within both respective sites. Data collected included demographics, home zip code (used to assign a deprivation index), Emergency Severity Index triage level, and disposition. Manual chart review assessed ingestion type, location, suspected source owner, and involvement of social work, child protective services, and safe disposition planning. Descriptive statistics were used to characterize the population, and linear and logistic regression were used to determine the relationship between deprivation index, population characteristics, and social management. Among 266 cases, most children were under age 2 (58.3%), male (52.3%), non-Hispanic White (43.2%), English speaking (98.9%), and publicly insured (71.4%). Ingestions increased over time, with 51.8% occurring in the last two years (2023-2024). Edibles (51.1%) were the most common ingestion type, often belonging to a primary guardian (40.2%). Most cases were triaged as ESI 1or ESI 2 (83.5%), with 41.7% evaluated in a trauma bay. Hospital admission was common (82.0%), with 20.7% of admitted children requiring critical care. Social work (95.5%) and child protective services (80.1%) were involved in most cases. No relationship was found between deprivation index and social work consultation (p = 0.52), child protective service reporting (p = 0.41), discharge to a primary guardian (p = 0.26), or discharge to a primary residence (p = 0.144). The incidence of unintentional cannabis ingestion presenting to the pediatric emergency department is increasing. Findings suggest equitable management across demographic and socioeconomic strata, highlighting high acuity and significant toxicity at presentation.