Cannabis edibles and children – not a good combination

With recreational marijuana legal in 24 states, including Massachusetts, the national Poison Control center has seen a dramatic rise over the past five years in calls about children consuming edibles containing THC, and the National Institutes of Health also sounded the alarm.

Even though it’s not a common problem at Cape Cod Hospital, pediatric hospitalist Jevon Plunkett-Rondeau, MD, PhD, does see instances.

“We don’t see a lot of cases, but we do see kids with unintended edible cannabis exposure coming through the Emergency Center at Cape Cod Hospital,” she said. “Depending on how severe the symptoms are, children are sometimes admitted overnight on our pediatric unit to monitor their symptoms until they return to normal.”

The most common age for cannabis poisoning is between 2 and 5 years of age. They are curious and can usually figure out how to open containers. They also tend to love candy.

Edible cannabis packaging often looks very similar to popular candy brands' packaging, making it easy for anyone to unintentionally ingest. Children ages 2 to 5 typically cannot read labels yet, making them more easily confused by the similarities in packaging than older children or adults.

Each adult dose is one gummy or piece of chocolate that contains 5 milligrams of THC, according to the Massachusetts Cannabis Control Commission. One candy bar has 20 servings. While no dose is safe for children, the problem is compounded by the fact kids rarely eat just one small bite if they come across a candy bar. That means there is the potential for a serious overdose.

“With severe exposures, sometimes they require intubation,” Dr. Plunkett-Rondeau said. “Children may be so sleepy that they end up needing to get intubated because their brain is so depressed they’re not breathing in an appropriate manner.”

What Parents Should Know

The most common symptom of cannabis poisoning is altered mental status. Children act confused and are overly sleepy. Sometimes they experience balance issues.

“If a child has altered behavior, they should be looked at by a doctor and one of the things we’ll think about is whether there was a medication or a drug exposure that their parents weren’t aware of,” Dr. Plunkett-Rondeau said.

If a parent knows about the exposure, they should call Poison Control and plan to bring their child to the emergency department. But, in most cases, Dr. Plunkett-Rondeau has seen, the parents are unaware of the exposure until their child starts acting differently. Those children should be brought to the ER to be evaluated.

Parents who have recreational marijuana in the house don’t need to be embarrassed or worried about going to the hospital, Dr. Plunkett-Rondeau said. She just reminds parents that they are an adult and marijuana is legal in our state, but they need to be mindful of how it’s stored in the home.

“Ideally it’s stored in a locked box the same way you would with a medication that has high toxicity” she said. “In a perfect world, your child doesn’t even know it exists in the house.”

Parents who do not use recreational marijuana should still be mindful that their child could accidentally be exposed. They might be playing at a friend’s house where there is edible marijuana. Or they could find it in a public place.

When to Call Poison Control

Last October, Dr. Plunkett-Rondeau treated a little girl who was heavily intoxicated with cannabis. She and her parents had spent the afternoon at a Trunk or Treat event and the little girl had been eating candy all day. The family went out for dinner and the little girl found an edible chocolate in the restroom. Thinking it was just another piece of candy, she popped it in her mouth.

After that experience, Dr. Plunkett-Rondeau advises parents the same way she advises her own children. She tells them that if they find candy or get candy from a stranger, they should always show it to a parent or other adult before eating it. That message is important for more than just edible cannabis.

“In general, I think it’s a good rule of thumb to have children double-check whatever candy they want to eat with an adult, especially if they cannot read labels yet,” Dr. Plunkett-Rondeau said.

Anytime a parent is worried their child has eaten something they shouldn’t, they should immediately call Poison Control at 1-800-222-1222. The hospital even coordinates with them for treatment advice because they are the toxicology specialists.

“The Poison Control centers are awesome,” Dr. Plunkett-Rondeau said. “They’re available 24 hours a day and they can really help triage how serious or not serious an ingestion is – if it’s something that families can watch and wait at home or if they need to go to the emergency room right away.”